Health misinformation discernment: health literacy or cognitive-attitudinal determinants?

Background

Health misinformation, understood as false or misleading health-related claims lacking scientific evidence, is a growing challenge. Health literacy (HL) should support accurate appraisal of such claims, but discernment may also depend on broader cognitive-attitudinal factors (CAF) related to cognitive reflection (CR), open-minded thinking (OMT), and views on science (VSC). The main aim of the study was to compare the relative explanatory value of HL and CAF for health misinformation discernment (HMD).

Methods

The study was based on an online survey conducted among Polish adults aged 18–75 years (N = 2,701), with quotas for gender, age, educational level, place of residence, and NUTS1 region. HMD was assessed using a balanced 24-item instrument comprising 12 true and 12 false health-related statements; the score reflected the difference between ratings of true and false statements. Hierarchical linear regression was used with HMD as the dependent variable. Sociodemographic variables were entered in block 1, HL categories in block 2, and CR, OMT, and VSC in block 3. The study was funded by the National Science Centre, Poland (Grant No. UMO-2021/41/B/HS6/02131).

Results

Sociodemographic variables explained 9.0% of the variance in HMD. HL added 6.5% (ΔR²=0.065, p < 0.001), and CAF a further 11.1% (ΔR²=0.111, p < 0.001), yielding a final R² of 0.266. In the final model, higher HMD was associated with older age (B = 0.01, 95%CI 0.006 to 0.012), higher CR (B = 0.063, 95%CI 0.030 to 0.097), greater OMT (B = 0.427, 95%CI 0.376 to 0.478), and more positive VSC (B = 0.019, 95%CI 0.015 to 0.022). Compared with sufficient HL, all remaining HL categories were associated with lower HMD, for example, inadequate HL (B=−0.499, 95%CI -0.601 to -0.397).

Conclusions

CAF explained more additional variance in HMD than HL, but both contributed independently. Interventions should therefore address not only HL but also the reflective, evidence-oriented evaluation of health information.

Key messages

• Cognitive-attitudinal factors explained more variance in health misinformation discernment than health literacy, although both contributed independently.

• Public health responses to misinformation should strengthen not only health literacy but also reflective, open-minded, evidence-oriented evaluation of health claims.