Health misinformation, defined as false or misleading claims lacking scientific evidence, poses a significant threat to public health. This paper investigates factors associated with the failure to discern misinformation, including health consciousness, information processing strategies, and inaccurate self-assessments of health literacy. Through an online experiment involving 707 English-speaking U.S. participants (mean age = 43 years, 56.2% female), we found that misinformation beliefs about nutrition, vaccination, vaping, and cancer were significantly correlated, implying susceptibility across health topics. Greater susceptibility was associated with higher health consciousness, lower objective health literacy, more elaboration, and more selective scanning. Results provided evidence for the Dunning-Kruger effect and metacognitive monitoring errors, whereby confident individuals were unaware of inadequate health literacy and showed poor misinformation identification. Findings suggest that promoting both health literacy education and cognitive reflection skills among the general adult population could empower them to more critically evaluate online health information.
AhadzadehASSharifSPOngFS, et al. (2015) Integrating health belief model and technology acceptance model: An investigation of health-related internet use. Journal of Medical Internet Research17(2): e45.
2.
AhmedS (2021) Fooled by the fakes: Cognitive differences in perceived claim accuracy and sharing intention of non-political deepfakes. Personality and Individual Differences182, 111074.
3.
Alvarez-GalvezJSuarez-LledoVRojas-GarciaA (2021) Determinants of infodemics during disease outbreaks: A systematic review. Frontiers in Public Health9: 236.
4.
BatterhamRWHawkinsMCollinsPA, et al. (2016) Health literacy: Applying current concepts to improve health services and reduce health inequalities. Public Health132: 3–12.
5.
BerkmanNDDavisTCMcCormackL (2010) Health literacy: What is it?Journal of Health Communication 15 Suppl 2(S2): 9–19.
6.
BrainardJHunterPR (2020) Misinformation making a disease outbreak worse: Outcomes compared for influenza, monkeypox, and norovirus. Simulation96(4): 365–374.
7.
BucchiM (2008) Of deficits, deviations and dialogues: Theories of public communication of science. In: BucchiMTrenchB (eds) Handbook of Public Communication of Science and Technology. London: Routledge, pp.20–76.
8.
Cabellos-GarcíaACMartínez-SabaterACastro-SánchezE, et al. (2018) Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: A narrative systematic review. BMC Public Health18(1): 1157–1212.
9.
CanadyBELarzoM (2023) Overconfidence in managing health concerns: The Dunning-Kruger effect and health literacy. Journal of Clinical Psychology in Medical Settings30(2): 460–468.
10.
ČavojováVŠrolJBallová MikuškováE (2022) How scientific reasoning correlates with health-related beliefs and behaviors during the COVID-19 pandemic?Journal of Health Psychology27(3): 534–547.
11.
ChangC (2020) Self-control-centered empowerment model: Health consciousness and health knowledge as drivers of empowerment-seeking through health communication. Health Communication35(12): 1497–1508.
12.
ChenXHayJLWatersEA, et al. (2018) Health literacy and use and trust in health information. Journal ofHealth Communication23(8): 724–734.
13.
DunningDJohnsonKEhrlingerJ, et al. (2003) Why people fail to recognize their own incompetence. Current Directions in Psychological Science12(3): 83–87.
14.
EvelandWPJr (2004) The effect of political discussion in producing informed citizens: The roles of information, motivation, and elaboration. Political Communication21(2): 177–193.
15.
EvelandWP (2001) The cognitive mediation model of learning from the news: Evidence from nonelection, off-year election, and presidential election contexts. Communication Research28(5): 571–601.
16.
EvelandWPCorteseJ (2004) How web site organization influences free recall, factual knowledge, and knowledge structure density. Human Communication Research30(2): 208–233.
17.
FlavellJH (1979) Metacognition and cognitive monitoring: A new area of cognitive-developmental inquiry. American Psychologist34(10): 906–911.
18.
FreemanDWaiteFRosebrockL, et al. (2022) Coronavirus conspiracy beliefs, mistrust, and compliance with government guidelines in England. Psychological Medicine52(2): 251–263.
19.
FriisKLasgaardMRowlandsG, et al. (2016) Health literacy mediates the relationship between educational attainment and health behavior: A Danish population-based study. Journal of Health Communication21(sup2): 54–60.
20.
HaunJNValerioMAMcCormackLA, et al. (2014) Health literacy measurement: An inventory and descriptive summary of 51 instruments. Journal of Health Communication 19 Suppl 2: 302–333.
21.
HongH (2009) Scale development for measuring health consciousness: Re-conceptualization. that matters to the practice. In: Proceedings of the 12th annual international public relations research conference. Available at: https://www.instituteforpr.org/wp-content/uploads/IPRRC_12_Proceedings.pdf#page=212 (accessed 22 February 2023).
22.
HongH (2011) An extension of the extended parallel process model (EPPM) in television health news: The influence of health consciousness on individual message processing and acceptance. Health Communication26(4): 343–353.
23.
HoSSPehXSohVW (2013) The cognitive mediation model: Factors influencing public knowledge of the H1N1 pandemic and intention to take precautionary behaviors. Journal of Health Communication18(7): 773–794.
24.
HowardMCDavisMM (2023) The mediating role of vaccine hesitancy in the relations of COVID-19 conspiracy beliefs and vaccination outcomes: Which dimensions matter?Journal of Health Psychology28(3): 241–250.
25.
JensenJD (2011) Knowledge acquisition following exposure to cancer news articles: A test of the cognitive mediation model. Journal of Communication61(3): 514–534.
26.
KhullarD (2022) Social media and medical misinformation: Confronting new variants of an old problem. JAMA: the Journal of the American Medical Association328(14): 1393–1394.
27.
KiechleESBaileySCHedlundLA, et al. (2015) Different measures, different outcomes? A systematic review of performance-based versus self-reported measures of health literacy and numeracy. Journal of General Internal Medicine30(10): 1538–1546.
28.
KimKShinSKimS, et al. (2023) The relation between eHealth literacy and health-related behaviors: Systematic review and meta-analysis. Journal of Medical Internet Research25, e40778.
29.
KosickiGMMcLeodJM (1990) Learning from political news: Effects of media images and information processing strategies. In: KrausS (ed.) Mass Communication and Political Information Processing. Hillsdale, NJ: Erlbaum, pp.69–83.
30.
KrugerJDunningD (1999) Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology77(6): 1121–1134.
31.
KuKYLKongQSongY, et al. (2019) What predicts adolescents’ critical thinking about real-life news? The roles of social media news consumption and news media literacy. Thinking Skills and Creativity33: 100570.
32.
MetzgerMJFlanaginAJMarkovA, et al. (2015) Believing the unbelievable: Understanding young people’s information literacy beliefs and practices in the United States. Journal of Children and Media9(3): 325–348
33.
MonteiroSSherbinoJSibbaldM, et al. (2020) Critical thinking, biases and dual processing: The enduring myth of generalisable skills. Medical Education54(1): 66–73.
34.
NelsonTONarensL (1994) Why investigate metacognition? In: MetcalfeJShimamuraAP (eds) Metacognition: Knowing About Knowing. Cambridge: The MIT Press, pp.1–25.
35.
NguyenTHPaasche-OrlowMKMcCormackLA (2017) The state of the science of health literacy measurement. Information Services & Use37(2): 189–203.
36.
NutbeamD (2009) Defining and measuring health literacy: What can we learn from literacy studies?International Journal of Public Health54(5): 303–305.
37.
Oude OphuisPAM (1989) Measuring health orientation and health consciousness as determinants of food choice behavior: Development and implementation of various attitudinal scales. In: AvlonitisGJPapavasiliouNKKouremenosAG (eds) Marketing Academy: Marketing Thought and Practice in the 1990’s. Athens: Athens School of Economics and Business, pp.1723–1725.
PennycookGMcPhetresJZhangY, et al. (2020) Fighting COVID-19 misinformation on social media: Experimental evidence for a scalable accuracy-nudge intervention. Psychological Science31(7): 770–780.
40.
PennycookGRandDG (2019) Lazy, not biased: Susceptibility to partisan fake news is better explained by lack of reasoning than by motivated reasoning. Cognition188: 39–50.
41.
PennycookGRandDG (2020) Who falls for fake news? The roles of bullshit receptivity, overclaiming, familiarity, and analytic thinking. Journal ofPersonality88(2): 185–200.
42.
PennycookGRossRMKoehlerDJ, et al. (2017) Dunning–Kruger effects in reasoning: Theoretical implications of the failure to recognize incompetence. Psychonomic Bulletin & Review24(6): 1774–1784.
43.
PettyRECacioppoJT (1986) The Elaboration Likelihood Model of Persuasion. In: PettyRECacioppoJT (eds) Communication and Persuasion: Central and Peripheral Routes to Attitude Change. New York: Springer, pp. 1–24.
44.
PlohlNMusilB (2021) Modeling compliance with COVID-19 prevention guidelines: The critical role of trust in science. Psychology Health & Medicine26(1): 1–12.
45.
RanaJPaulJ (2017) Consumer behavior and purchase intention for organic food: A review and research agenda. Journal of Retailing and Consumer Services38: 157–165.
46.
RoozenbeekJCullotyESuiterJ (2023) Countering misinformation. European Psychologist28(3): 189–205.
47.
SchererLDMcPhetresJPennycookG, et al. (2021) Who is susceptible to online health misinformation? A test of four psychosocial hypotheses. Health Psychology40(4): 274–284.
48.
ScheufeleDAKrauseNM (2019) Science audiences, misinformation, and fake news. Proceedings of the National Academy of Sciences116(16): 7662–7669.
49.
ScheufeleDAKrauseNMFreilingI (2021) Misinformed about the “infodemic?” Science’s ongoing struggle with misinformation. Journal of Applied Research in Memory and Cognition10(4): 522–526.
50.
SchiffersteinHNJOude OphuisPAM (1998) Health-related determinants of organic food consumption in the Netherlands. Food Quality and Preference9(3): 119–133.
51.
SchulzPJPessinaAHartungU, et al. (2021) Effects of objective and subjective health literacy on patients’ accurate judgment of health information and decision-making ability: survey study. Journal of Medical Internet Research23(1): e20457.
52.
SouthwellBGOtero MachucaJCherryST, et al. (2023) Health misinformation exposure and health disparities: Observations and opportunities. Annual Review of Public Health44: 113–130.
53.
SuldovskyB (2016) In science communication, why does the idea of the public deficit always return? Exploring key influences. Public Understanding of Science25(4): 415–426.
54.
Swire-ThompsonBDeGutisJLazerD (2020) Searching for the backfire effect: Measurement and design considerations. Journal of Applied Research in Memory and Cognition9(3): 286–299.
55.
TandonAJabeenFTalwarS, et al. (2021) Facilitators and inhibitors of organic food buying behavior. Food Quality and Preference88: 104077.
56.
van der LindenSPanagopoulosCAzevedoF, et al. (2021) The paranoid style in American politics revisited: An ideological asymmetry in conspiratorial thinking. Political Psychology42(1): 23–51.
57.
van der LindenSPanagopoulosCRoozenbeekJ (2020) You are fake news: Political bias in perceptions of fake news. Media Culture & Society42(3): 460–470.
58.
WangYMcKeeMTorbicaA, et al. (2019) Systematic literature review on the spread of health-related misinformation on social media. Social Science & Medicine240: 112552.
59.
WarnerELBasen-EngquistKMBadgerTA, et al. (2022) The online cancer nutrition misinformation: A framework of behavior change based on exposure to cancer nutrition misinformation. Cancer128(13): 2540–2548.
60.
WeirHAndersonRNKingSMC, et al. (2016) Peer reviewed: heart disease and cancer deaths - trends and projections in the United States, 1969–2020. Preventing Chronic Disease13: e157.
61.
WeissBDMaysMZMartzW, et al. (2005) Quick assessment of literacy in primary care: The newest vital sign. Annals of Family Medicine3(6): 514–522.
62.
XueHTaylorL (2023) When do people believe, check, and share health rumors on social media? Effects of evidence type, health literacy, and health knowledge. Journal of Health Psychology28(7): 607–619.
63.
YangCZhaoWYuanB, et al. (2023) Mind the gap between comprehension and metacomprehension: Meta-analysis of metacomprehension accuracy and intervention effectiveness. Review of Educational Research93(2): 143–194.
64.
ZaidmanEAScottKMHahnD, et al. (2023) Impact of parental health literacy on the health outcomes of children with chronic disease globally: A systematic review. Journal of Paediatrics and Child Health59(1): 12–31.
65.
ZhaXYangHYanY, et al. (2018) Exploring the effect of social media information quallity, source credibiliy and reputation on informational fit-to-task: Moderating role of focused immersion. Computers in Human Behavior79: 227–237.
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