1932

Abstract

The concepts of health misinformation and health disparities have been prominent in public health literature in recent years, in part because of the threat that each notion poses to public health. How exactly are misinformation proliferation and health disparities related, however? What roles might misinformation play in explaining the health disparities that we have documented in the United States and elsewhere? How might we mitigate the effects of misinformation exposure among people facing relatively poor health outcomes? In this review, we address such questions by first defining health disparities and misinformation as concepts and then considering how misinformation exposure might theoretically affect health decision-making and account for disparate health behavior and health outcomes. We alsoassess the potential for misinformation-focused interventions to address health disparities based on available literature and call for future research to address gaps in our current evidence base.

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2023-04-03
2024-04-19
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Literature Cited

  1. 1.
    Acevedo N. 2021. Latinos more likely to get, consume and share online misinformation, fake news. NBC News Oct. 6. https://www.nbcnews.com/news/latino/latinos-likely-get-consume-share-online-misinformation-fake-news-rcna2622
    [Google Scholar]
  2. 2.
    Aikin KJ, Betts KR, O'Donoghue AC, Rupert DJ, Lee PK et al. 2015. Correction of overstatement and omission in direct-to-consumer prescription drug advertising. J. Commun. 65:4596–618
    [Google Scholar]
  3. 3.
    Aikin KJ, Southwell BG, Paquin RS, Rupert DJ, O'Donoghue AC et al. 2017. Correction of misleading information in prescription drug television advertising: the roles of advertisement similarity and time delay. Res. Soc. Adm. Pharm. 13:378–88
    [Google Scholar]
  4. 4.
    Asp E, Manzel K, Koestner B, Cole CA, Denburg NL, Tranel D. 2012. A neuropsychological test of belief and doubt: damage to ventromedial prefrontal cortex increases credulity for misleading advertising. Front. Neurosci. 6:100
    [Google Scholar]
  5. 5.
    Austin EW, Borah P, Domgaard S. 2021. COVID-19 disinformation and political engagement among communities of color: the role of media literacy. Harvard Kennedy School Misinformation Rev. 1:7 https://doi.org/10.37016/mr-2020-58
    [Crossref] [Google Scholar]
  6. 6.
    Baker DW. 2006. The meaning and measure of health literacy. J. Gen. Intern. Med. 21:878–83
    [Google Scholar]
  7. 7.
    Barber SJ, Rajaram S, Marsh EJ. 2008. Fact learning: how information accuracy, delay, and repeated testing change retention and retrieval experience. Memory 16:8934–46
    [Google Scholar]
  8. 8.
    Barrett NJ, Hasan M, Bethea K, Johnson KS. 2020. The fierce urgency of now: addressing racial and ethnic disparities in serious illness care. N. C. Med. J. 81:4254–56
    [Google Scholar]
  9. 9.
    Barrett NJ, Ingraham KL, Bethea K, Hwa-Lin P, Chirinos M et al. 2020. Project PLACE: enhancing community and academic partnerships to describe and address health disparities. Adv. Cancer Res. 146:167–88
    [Google Scholar]
  10. 10.
    Bass PF III, Wilson JF, Griffith CH 2003. A shortened instrument for literacy screening. J. Gen. Intern. Med. 18:1036–38
    [Google Scholar]
  11. 11.
    Berkman ND, Davis TC, McCormack L. 2010. Health literacy: What is it?. J. Health Commun. 15:29–19
    [Google Scholar]
  12. 12.
    Blake KD, Willis G, Kaufman A. 2020. Population prevalence and predictors of self-reported exposure to court-ordered, tobacco-related corrective statements. Tob. Control 29:516–21
    [Google Scholar]
  13. 13.
    Bode L, Vraga EK. 2015. In related news, that was wrong: the correction of misinformation through related stories functionality in social media. J. Commun. 65:4619–38
    [Google Scholar]
  14. 14.
    Bogart LM, Wagner G, Galvan FH, Banks D. 2010. Conspiracy beliefs about HIV are related to antiretroviral treatment nonadherence among African American men with HIV. J. Acquir. Immune Defic. Syndr. 53:5648–55
    [Google Scholar]
  15. 15.
    Boudewyns V, Southwell BG, Betts KR, Gupta CS, Paquin RS et al. 2018. Awareness of misinformation in health-related advertising: a narrative review of the literature. See Ref. 89 35–50
    [Google Scholar]
  16. 16.
    Boulware LE, Mohottige D. 2021. The seen and the unseen: race and social inequities affecting kidney care. Clin. J. Am. Soc. Nephrol. 16:5815–17
    [Google Scholar]
  17. 17.
    Brandon DT, Isaac LA, LaVeist TA. 2005. The legacy of Tuskegee and trust in medical care: Is Tuskegee responsible for race differences in mistrust of medical care?. J. Natl. Med. 97:7951–56
    [Google Scholar]
  18. 18.
    Braveman P. 2006. Health disparities and health equity: concepts and measurement. Annu. Rev. Public Health 27:167–94
    [Google Scholar]
  19. 19.
    Braveman P, Gruskin S. 2003. Defining equity in health. J. Epidemiol. Commun. Health 57:254–58
    [Google Scholar]
  20. 20.
    Calac AJ, Bardier C, Cai M, Mackey TK. 2021. Examining Facebook community reaction to a COVID-19 vaccine trial on the Navajo Nation. Am. J. Public Health 111:81428–30
    [Google Scholar]
  21. 21.
    Cappella JN, Ophir Y, Sutton J. 2018. The importance of measuring knowledge in the age of misinformation and challenges in the tobacco domain. See Ref. 89 51–70
    [Google Scholar]
  22. 22.
    Carson SL, Casillas A, Castellon-Lopez Y, Mansfield LN, Morris D et al. 2021. COVID-19 vaccine decision-making factors in racial and ethnic minority communities in Los Angeles, California. JAMA Netw. Open 4:9e2127582
    [Google Scholar]
  23. 23.
    Cha M, Cha C, Singh K, Lima G, Ahn Y-Y et al. 2021. Prevalence of misinformation and factchecks on the COVID-19 pandemic in 35 countries: observational infodemiology study. JMIR Hum. Factors 8:1e23279
    [Google Scholar]
  24. 24.
    Champion VL, Skinner CS 2008. The health belief model. Health Behavior and Health Education: Theory, Research, and Practice K Glanz, BK Rimer, K Visanath 45–66 Hoboken, NJ: Jossey-Bass. , 4th ed..
    [Google Scholar]
  25. 25.
    Chen X, Hay JL, Waters EA, Kiviniemi MT, Biddle C et al. 2018. Health literacy and use and trust in health information. J. Health Commun. 23:8724–34
    [Google Scholar]
  26. 26.
    Chou W-YS, Gaysynsky A, Vanderpool RC. 2021. The COVID-19 misinfodemic: moving beyond fact-checking. Health Educ. Behav. 48:19–13
    [Google Scholar]
  27. 27.
    Christy SM, Gwede CK, Sutton SK, Chavarria E, Davis SN et al. 2017. Health literacy among medically underserved: the role of demographic factors, social influence, and religious beliefs. J. Health. Commun. 22:11923–31
    [Google Scholar]
  28. 28.
    Coughlin SS, Stewart JL, Young L, Heboyan V, De Leo G. 2018. Health literacy and patient web portals. Int. J. Med. Inform. 113:43–48
    [Google Scholar]
  29. 29.
    Dale SK, Bogart LM, Wagner GJ, Galvan FH, Klein DJ. 2016. Medical mistrust is related to lower longitudinal medication adherence among African-American males with HIV. J. Health Psychol. 21:71311–21
    [Google Scholar]
  30. 30.
    Davis JL, Gandy OH Jr. 1999. Racial identity and media orientation: exploring the nature of constraint. J. Black Stud. 29:3367–97
    [Google Scholar]
  31. 31.
    Davis SN, Wischhusen JW, Sutton SK, Christy SM, Chavarria EA et al. 2020. Demographic and psychosocial factors associated with limited health literacy in a community-based sample of older Black Americans. Patient Educ. Couns. 103:2385–91
    [Google Scholar]
  32. 32.
    Davis TC, Long SW, Jackson RH, Mayeaux EJ, George RB et al. 1993. Rapid estimate of adult literacy in medicine: a shortened screening instrument. Fam. Med. 25:391–95
    [Google Scholar]
  33. 33.
    Diez Roux AV. 2012. Conceptual approaches to the study of health disparities. Annu. Rev. Public Health 33:41–58
    [Google Scholar]
  34. 34.
    Duerksen SC, Mikail A, Tom L, Patton A, Lopez J et al. 2005. Health disparities and advertising content of women's magazines: a cross-sectional study. BMC Public Health 5:85
    [Google Scholar]
  35. 35.
    Ecker UK, Lewandowsky S, Fenton O, Martin K. 2014. Do people keep believing because they want to? Preexisting attitudes and the continued influence of misinformation. Mem. Cognit. 42:2292–304
    [Google Scholar]
  36. 36.
    Fishbein M, Ajzen I. 2010. Predicting and Changing Behavior: The Reasoned Action Approach New York: Psychology Press
  37. 37.
    Fishbein M, Yzer MC. 2003. Using theory to design effective health behavior interventions. Commun. Theory 13:164–83
    [Google Scholar]
  38. 38.
    Gilbert DT, Krull DS, Malone PS. 1990. Unbelieving the unbelievable: some problems in the rejection of false information. J. Pers. Soc. Psychol. 59:601–13
    [Google Scholar]
  39. 39.
    Glasgow LM. 2020. Beyond lip service: taking a genuine approach to tackling COVID-19 (and all) Black-White health disparities in the United States. Health Affairs Forefront June 9. https://www.healthaffairs.org/do/10.1377/forefront.20200604.585088/full/
    [Google Scholar]
  40. 40.
    Greene CM, Murphy G. 2021. Quantifying the effects of fake news on behavior: evidence from a study of COVID-19 misinformation. J. Exp. Psychol. Appl. 27:4773–84
    [Google Scholar]
  41. 41.
    Hamilton JT. 2004. All the News That's Fit to Sell: How the Market Transforms Information into News Princeton, NJ: Princeton Univ. Press
  42. 42.
    Hammonds EM, Reverby SM. 2019. Toward a historically informed analysis of racial health disparities since 1619. Am. J. Public Health 109:101348–49
    [Google Scholar]
  43. 43.
    Harris K, Jacobs G, Reeder J. 2019. Health systems and adult basic education: a critical partnership in supporting digital health literacy. Health Lit. Res. Pract. 3:3 Suppl.S33–36
    [Google Scholar]
  44. 44.
    Hill L, Artiga S, Haldar S. 2022. Key facts on health and health care by race and ethnicity. KFF Jan. 26. https://www.kff.org/racial-equity-and-health-policy/report/key-facts-on-health-and-health-care-by-race-and-ethnicity/
    [Google Scholar]
  45. 45.
    Horrigan JB. 2017. How people approach facts and information. Pew Research Center Sept. 11. http://www.pewinternet.org/2017/09/11/how-people-approach-facts-and-information/
    [Google Scholar]
  46. 46.
    Inst. Med. Roundtable Health Lit 2011. Health literacy and health disparities: opportunities for trans-disciplinary collaboration. Innovations in Health Literacy Workshop Summary: 3 rapp. C Vancheri 7–11 Washington, DC: Natl. Acad. Press
    [Google Scholar]
  47. 47.
    Ioannidis J, Stuart ME, Brownlee S, Strite SA. 2017. How to survive the medical misinformation mess. Eur. J. Clin. Invest. 47:11795–802
    [Google Scholar]
  48. 48.
    Israel BA, Schulz AJ, Parker EA, Becker AB. 1998. Review of community-based research: assessing partnership approaches to improve public health. Annu. Rev. Public Health 19:173–202
    [Google Scholar]
  49. 49.
    Jaiswal J, LoSchiavo C, Perlman DC. 2020. Disinformation, misinformation and inequality-driven mistrust in the time of COVID-19: lessons unlearned from AIDS denialism. AIDS Behav 24:2776–80
    [Google Scholar]
  50. 50.
    Kemp E, Trigg J, Beatty L, Christensen C, Dhillon HM. 2021. Health literacy, digital health literacy and the implementation of digital health technologies in cancer care: the need for a strategic approach. Health Promot. J. Austr. 32:S1104–14
    [Google Scholar]
  51. 51.
    Kim Y-C, Matsaganis MD, Wilkin HA, Jung J-Y, eds. 2018. The Communication Ecology of 21st Century Urban Communities New York: Peter Lang
  52. 52.
    King AJ, Lazard AJ. 2020. Advancing visual health communication research to improve infodemic response. Health Commun. 35:141723–28
    [Google Scholar]
  53. 53.
    Kontos E, Blake KD, Chou W-Y, Prestin A. 2014. Predictors of eHealth usage: insights on the digital divide from the Health Information National Trends Survey. J. Med. Internet Res. 16:e172
    [Google Scholar]
  54. 54.
    Larson HJ. 2018. The biggest pandemic risk? Viral misinformation. Nature 562:7727309
    [Google Scholar]
  55. 55.
    Laurencin CT, Valantine H, Yancy C, Jones CP, Bright C 2021. The COVID-19 vaccine and the Black community: addressing the justified questions. J. Racial Ethn. Health 8:4809–20
    [Google Scholar]
  56. 56.
    Lee S-YD, Arozullah AM, Cho YI. 2004. Health literacy, social support, and health: a research agenda. Soc. Sci. Med. 58:1309–21
    [Google Scholar]
  57. 57.
    Mantwill S, Monestel-Umaña S, Schulz PJ. 2015. The relationship between health literacy and health disparities: a systematic review. PLOS ONE 10:12e0145455
    [Google Scholar]
  58. 58.
    Marsh EJ, Yang BW. 2018. Believing things that are not true: a cognitive science perspective on misinformation. See Ref. 89 15–34
  59. 59.
    McCormack L, Haun J, Sørensen K, Valerio M. 2013. Recommendations for advancing health literacy measurement. J. Health Commun. 18:Supp. 19–14
    [Google Scholar]
  60. 60.
    McKee M. 2017. The tobacco industry: the pioneer of fake news. J. Public Health Res. 6:1878
    [Google Scholar]
  61. 61.
    Mena P. 2020. Cleaning up social media: the effect of warning labels on likelihood of sharing false news on Facebook. Policy Internet 12:2165–83
    [Google Scholar]
  62. 62.
    Mheidly N, Fares J. 2020. Leveraging media and health communication strategies to overcome the COVID-19 infodemic. J. Public Health Policy 41:4410–20
    [Google Scholar]
  63. 63.
    Morley J, Cowls J, Taddeo M, Floridi L 2020. Public health in the Information Age: recognizing the infosphere as a social determinant of health. J. Med. Internet Res. 22:8e19311
    [Google Scholar]
  64. 64.
    Muñoz-Antonia T, Ung D, Montiel-Ishino FA, Nelson A, Canales J, Quinn GP. 2015. African Americans’ and Hispanics’ information needs about cancer care. J. Cancer Educ. 30:2327–32
    [Google Scholar]
  65. 65.
    Murthy VH. 2021. Confronting health misinformation: the US Surgeon General's advisory on building a healthy information environment Rep. Off. Surg. Gen. Washington, DC: https://www.hhs.gov/sites/default/files/surgeon-general-misinformation-advisory.pdf
  66. 66.
    Nana-Sinkam P, Kraschnewski J, Sacco R, Chavez J, Fouad M et al. 2021. Health disparities and equity in the era of COVID-19. J. Clin. Transl. Sci. 5:1e99
    [Google Scholar]
  67. 67.
    Napoli PM. 2019. Social Media and the Public Interest: Media Regulation in the Disinformation Age New York: Columbia Univ. Press
  68. 68.
    Nartey S-R, Temte J, Petty E. 2021. Combatting anti-vaccination misinformation: improving immunization rates of Black/African American children at UW Health. Wisc. Med. J. 120:Suppl. 1S31–38
    [Google Scholar]
  69. 69.
    Natl. Acad. Med 2022. Lemon juice does not cure COVID-19. National Academies of Sciences, Engineering, and Medicine https://www.nationalacademies.org/based-on-science/lemon-juice-does-not-cure-covid-19
    [Google Scholar]
  70. 70.
    Neter E, Brainin E. 2012. eHealth literacy: extending the digital divide to the realm of health information. J. Med. Internet Res. 14:e19
    [Google Scholar]
  71. 71.
    Nutbeam D. 2008. The evolving concept of health literacy. Soc. Sci. Med. 67:2072–78
    [Google Scholar]
  72. 72.
    Nutbeam D, Lloyd JE. 2021. Understanding and responding to health literacy as a social determinant of health. Annu. Rev. Public Health 42:159–73
    [Google Scholar]
  73. 73.
    Oeldorf-Hirsch A, Schmierbach M, Appelman A, Boyle MP. 2020. The ineffectiveness of fact-checking labels on news memes and articles. Mass Commun. Soc. 23:5682–704
    [Google Scholar]
  74. 74.
    Pelikan JM, Ganahl K, Roethlin F. 2018. Health literacy as a determinant, mediator and/or moderator of health: empirical models using the European Health Literacy Survey dataset. Glob. Health Promot. 25:457–66
    [Google Scholar]
  75. 75.
    Pérez-Stable EJ, El-Toukhy S. 2018. Communicating with diverse patients: how patient and clinician factors affect disparities. Patient Educ. Couns. 101:122186–94
    [Google Scholar]
  76. 76.
    Rosenstock IM, Strecher VJ, Becker MH. 1988. Social learning theory and the health belief model. Health Educ. Q. 15:2175–83
    [Google Scholar]
  77. 77.
    Ross MW, Essien EJ, Torres I. 2006. Conspiracy beliefs about the origin of HIV/AIDS in four racial/ethnic groups. J. Acquir. Immune Defic. Syndr. 41:3342–44
    [Google Scholar]
  78. 78.
    Saltz E, Barari S, Leibowicz CR, Wardle C. 2021. Misinformation interventions are common, divisive, and poorly understood. Harvard Kennedy School Misinformation Rev. 2:5 https://doi.org/10.37016/mr-2020-81
    [Crossref] [Google Scholar]
  79. 79.
    Seo H, Blomberg M, Altschwager D, Vu HT. 2021. Vulnerable populations and misinformation: a mixed-methods approach to underserved older adults’ online information assessment. New Media Soc 23:72012–33
    [Google Scholar]
  80. 80.
    Sirlin N, Epstein Z, Arechar AA, Rand DG. 2021. Digital literacy is associated with more discerning accuracy judgments but not sharing intentions. Harvard Kennedy School Misinformation Rev. 2:6 https://doi.org/10.37016/mr-2020-83
    [Crossref] [Google Scholar]
  81. 81.
    Skurnik I, Yoon C, Park DC, Schwarz N. 2005. How warnings about false claims become recommendations. J. Consum. Res. 31:4713–24
    [Google Scholar]
  82. 82.
    Smith B, Magnani JW. 2019. New technologies, new disparities: the intersection of electronic health and digital health literacy. Int. J. Cardiol. 292:280–82
    [Google Scholar]
  83. 83.
    Southwell B, Corin D, Eck M, Hessenius A, Li L et al. 2021. Dimensions of trust and information seeking on natural disasters, hazards, and extreme weather in North Carolina (USA). EMS Annu. Meet. Abstr. 18:EMS2021–25
    [Google Scholar]
  84. 84.
    Southwell BG. 2005. Between messages and people: a multilevel model of memory for television content. Commun. Res. 32:1112–40
    [Google Scholar]
  85. 85.
    Southwell BG. 2013. Social Networks and Popular Understanding of Science and Health: Sharing Disparities Baltimore, MD: Johns Hopkins Univ. Press
  86. 86.
    Southwell BG, Anghelcev G, Himelboim I, Jones J. 2007. Translating user control availability into perception: the moderating role of prior experience. Comp. Hum. Behav. 23:1554–63
    [Google Scholar]
  87. 87.
    Southwell BG, Brennen JSB, Paquin R, Boudewyns V, Zeng J. 2022. Defining and measuring scientific misinformation. Ann. Am. Acad. Political Soc. Sci. 700:98–111
    [Google Scholar]
  88. 88.
    Southwell BG, Hamilton JT, Slater JS. 2011. Why addressing the poor and underinsured is vexing. Health Commun 26:6583–85
    [Google Scholar]
  89. 89.
    Southwell BG, Thorson EA, Sheble L, eds. 2018. Misinformation and Mass Audiences Austin: Univ. Tex. Press
  90. 90.
    Southwell BG, Wood JL, Navar AM. 2020. Roles for health care professionals in addressing patient-held misinformation beyond fact correction. Am. J. Public Health 110:S3S288–89
    [Google Scholar]
  91. 91.
    Southwell BG, Wood JL, Navar AM. 2021. Función de los profesionales de la salud de rectificar la información errónea que tienen los pacientes más allá de corregir los hechos. Rev. Panam. Salud Publica 45:e60
    [Google Scholar]
  92. 92.
    Squiers L, Peinado S, Berkman N, Boudewyns V, McCormack L. 2012. The health literacy skills framework. J. Health Commun. 17:Suppl. 330–54
    [Google Scholar]
  93. 93.
    Swire-Thompson B, Lazer D. 2020. Public health and online misinformation: challenges and recommendations. Annu. Rev. Public Health 41:433–51
    [Google Scholar]
  94. 94.
    Tan ASL, Bigman CA. 2020. Misinformation about commercial tobacco products on social media—implications and research opportunities for reducing tobacco-related health disparities. Am. J. Public Health 110:S281–83
    [Google Scholar]
  95. 95.
    US Census Bur 2022. About the Hispanic population and its origin. Census.gov https://www.census.gov/topics/population/hispanic-origin/about.html
    [Google Scholar]
  96. 96.
    Vinck P, Pham PN, Bindu KK, Bedford J, Nilles EJ. 2019. Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey. Lancet Infect. Dis. 19:529–36
    [Google Scholar]
  97. 97.
    Wallace M, Crear-Perry J, Richardson L, Tarver M, Theall K. 2017. Separate and unequal: structural racism and infant mortality in the US. Health Place 45:140–44
    [Google Scholar]
  98. 98.
    Webb Hooper M, Nápoles AM, Pérez-Stable EJ 2021. No populations left behind: vaccine hesitancy and equitable diffusion of effective COVID-19 vaccines. J. Gen. Intern. Med. 36:72130–33
    [Google Scholar]
  99. 99.
    Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA et al. 2005. Quick assessment of literacy in primary care: the newest vital sign. Ann. Fam. Med. 3:6514–22
    [Google Scholar]
  100. 100.
    White RM. 2005. Misinformation and misbeliefs in the Tuskegee Study of Untreated Syphilis fuel mistrust in the healthcare system. J. Natl. Med. Assoc. 97:111566–73
    [Google Scholar]
  101. 101.
    Williams DR, Lawrence JA, Davis BA. 2019. Racism and health: evidence and needed research. Annu. Rev. Public Health 40:105–25
    [Google Scholar]
  102. 102.
    Wilson SL, Wiysonge C. 2020. Social media and vaccine hesitancy. BMJ Glob. Health 5:10e004206
    [Google Scholar]
  103. 103.
    Vosoughi S, Roy D, Aral S. 2018. The spread of true and false news online. Science 359:63801146–51
    [Google Scholar]
  104. 104.
    Xiang D, Lehmann LS. 2021. Confronting the misinformation pandemic. Health Policy Technol 10:3100520
    [Google Scholar]
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