{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T20:27:30Z","timestamp":1777753650253,"version":"3.51.4"},"reference-count":54,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2023,5,1]],"date-time":"2023-05-01T00:00:00Z","timestamp":1682899200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Information Services and Use"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:p>The COVID-19 pandemic presented a teachable moment to empower citizens to assess and apply information to protect their health by promoting critical health literacy. Most Americans took preventive measures, suggesting some overall increase in critical health literacy around infectious disease. Simultaneously, however, a torrent of misinformation, disinformation and malinformation intentionally buried facts, sewed doubt and confusion, promoted lies and conspiracies, and undermined health authorities and institutions. The authors discuss how this \u2018infodemic\u2019 rose from previously localized, unconnected anti-vaccination, anti-government, and anti-science groups galvanized by the pandemic. Prominent politicians seeking political gain lent the power of their offices to the movement, layering a \u2018polidemic\u2019 onto the infodemic and overwhelming inconsistent public health messaging. Even those with strong health literacy skills were challenged. Millions were misled to over-confidently self-manage their risk, revealing the possibility and perils of empowerment in the absence of critical health literacy skills \u2013 negative empowerment. The roots of resistance to the government response to COVID-19, and conditions that fostered its influence are examined, followed by recommendations to position health literacy scholars and practitioners to better meet communication challenges and opportunities in future crises.<\/jats:p>","DOI":"10.3233\/isu-230186","type":"journal-article","created":{"date-parts":[[2023,6,2]],"date-time":"2023-06-02T13:17:16Z","timestamp":1685711836000},"page":"89-100","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Health literacy and empowerment in the COVID-19 era"],"prefix":"10.1177","volume":"43","author":[{"given":"Sandra A.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena T.","family":"Carbone","sequence":"additional","affiliation":[{"name":"Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA"},{"name":"Commonwealth Honors College, University of Massachusetts, Amherst, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2023,5,1]]},"reference":[{"key":"bibr1-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/daab197"},{"key":"bibr2-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/dah609"},{"key":"bibr3-ISU-230186","first-page":"369","volume-title":"Health Literacy in Clinical Practice and Public Health: New Initiatives and Lessons Learned at the Intersection with other Disciplines","author":"Smith S.A.","year":"2020"},{"key":"bibr4-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1093\/heapro\/15.3.259"},{"key":"bibr5-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2012.09.006"},{"key":"bibr6-ISU-230186","unstructured":"CDC Data Tracker. [Internet]. 2023. Available from: https:\/\/covid.cdc.gov\/covid-data-tracker\/#vaccinations_vacc-people-booster-percent-pop5. Retrieved May 3, 2023."},{"key":"bibr7-ISU-230186","unstructured":"Smith-SchoenwalderC., Three years of death - and finger-pointing. US News [Internet]. 2023 March 10. Available from: https:\/\/www.usnews.com\/news\/the-report\/articles\/2023-03-10\/three-years-into-the-pandemic-who-is-dying-from-covid-19-now. Retrieved May 4, 2023."},{"key":"bibr8-ISU-230186","unstructured":"LaFreniereS. and WeilandN., U.S. plans to end public health emergency for Covid in May. The New York Times [Internet]. 2023 February 3. Available from: https:\/\/www.nytimes.com\/2023\/01\/30\/us\/politics\/biden-covid-public-health-emergency.html. Retrieved May 3, 2023."},{"key":"bibr9-ISU-230186","unstructured":"H. J. Res. 7 - 118th Congress (2023\u20132024): Relating to a national emergency declared by the President on March 13, 2020. [Internet]. 2023 April 10. Available from: https:\/\/www.congress.gov\/bill\/118th-congress\/house-joint-resolution\/7. Retrieved May 3, 2023."},{"key":"bibr10-ISU-230186","unstructured":"CubanskiJ.KatesJ.TolbertJ.GuthM.PollitzK. and FreedM., What happens when COVID-19 emergency declarations end? Implications for coverage, costs, and access. Kaiser Family Foundation [Internet]. 2023 January 31. Available from: https:\/\/www.kff.org\/coronavirus-covid-19\/issue-brief\/what-happens-when-covid-19-emergency-declarations-end-implications-for-coverage-costs-and-access\/. Retrieved May 3, 2023."},{"key":"bibr11-ISU-230186","unstructured":"LapowskyI. \u2018This could actually be catastrophic:\u2019 What the end of the public health emergency means for telehealth. [Internet]. 2023 March 21. Available from: https:\/\/www.fastcompany.com\/90867065\/future-of-telehealth-public-health-emergency-ending. Retrieved May 3, 2023."},{"key":"bibr12-ISU-230186","doi-asserted-by":"publisher","DOI":"10.31478\/202003a"},{"key":"bibr13-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00136-8"},{"key":"bibr14-ISU-230186","doi-asserted-by":"publisher","DOI":"10.2196\/30979"},{"key":"bibr15-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1007\/s41649-021-00164-4"},{"key":"bibr16-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1172\/JCI149072"},{"key":"bibr17-ISU-230186","unstructured":"CancrynA., Biden\u2019s top Covid advisor wishes he had tangled with Tucker Carlson.\n                      Politico Magazine\n                      [Internet] 2023 February 6. Available from: https:\/\/www.politico.com\/news\/magazine\/2023\/02\/06\/biden-covid-adviser-david-kessler-00081091. 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Retrieved May 3, 2023.","DOI":"10.2196\/preprints.25143"},{"key":"bibr22-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0261648"},{"key":"bibr23-ISU-230186","unstructured":"MontiniE.J., Rep Andy Biggs believes mandatory face masks are tyranny. Yeah, he said that, tyranny.\n                      Ariz Repub\n                      [Internet]. 2020 June 19. Available from: https:\/\/www.azcentral.com\/story\/opinion\/op-ed\/ej-montini\/2020\/06\/19\/rep-andy-biggs-believes-mandatory-face-masks-lead-tyranny-meh\/3226097001\/. Retrieved May 3, 2023."},{"key":"bibr24-ISU-230186","unstructured":"TorinusJ., Anti-vaxxers are fake patriots.\n                      Urban Milwaukee\n                      [Internet]. 2021 May 6. Available from: https:\/\/urbanmilwaukee.com\/2021\/05\/06\/op-ed-anti-vaxxers-are-fake-patriots\/. Retrieved May 4, 2023."},{"key":"bibr25-ISU-230186","unstructured":"KekatosM., Masks are effective but here\u2019s how a study from a respected group was misinterpreted to say they weren\u2019t.\n                      AbcNews\n                      [Internet]. 2023 March 14. Available from: https:\/\/abcnews.go.com\/Health\/masks-effective-study-respected-group-misinterpreted\/story?id=97846561. Retrieved May 3, 2023."},{"key":"bibr26-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-021-00534-z"},{"key":"bibr27-ISU-230186","volume-title":"Empowerment in Practice: From Analysis to Implementation. 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Available from: https:\/\/www.yalemedicine.org\/news\/covid-19-variants-of-concern-omicron. Retrieved May 4, 2023."},{"key":"bibr32-ISU-230186","unstructured":"HoffmanJ., Opposition to school vaccine mandates has grown significantly, study finds. The New York Times [Internet]. 2022 December 16. Available from: https:\/\/www.nytimes.com\/2022\/12\/16\/health\/vaccines-public-opinion.html. Retrieved May 4, 2023."},{"key":"bibr33-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.23241"},{"key":"bibr34-ISU-230186","unstructured":"Secretary of Defense, Memorandum for senior Pentagon leadership commanders of the combatant commands defense agency and DOD field activity directors: memo [Internet]. 2023 January 10. Available from: https:\/\/media.defense.gov\/2023\/Jan\/10\/2003143118\/-1\/-1\/1\/secretary-of-defense-memo-on-rescission-of-coronavirus-disease-2019-vaccination-requirements-for-members-of-the-armed-forces.pdf. Retrieved May 4, 2023."},{"key":"bibr35-ISU-230186","doi-asserted-by":"publisher","DOI":"10.2196\/20044"},{"key":"bibr36-ISU-230186","unstructured":"BraseT., COVID-19 quick reference guide: Immediate steps to reduce your risk of COVID-19 and \u201cLong Covid\u201d disease: document [Internet]. 2023 January. Available from: https:\/\/www.cchfreedom.org\/files\/files\/\u2013COVID-19_Quick_Ref_Guide\u2013(3).pdf. Retrieved May 4, 2023."},{"key":"bibr37-ISU-230186","unstructured":"Select Subcommittee on the Coronavirus Pandemic. Investigating the origins of COVID-19: hearing [Internet]. 2023 March 8. Available from: https:\/\/oversight.house.gov\/hearing\/investigating-the-origins-of-covid-19\/. Retrieved May 4, 2023."},{"key":"bibr38-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1038\/d41586-020-01452-z"},{"key":"bibr39-ISU-230186","unstructured":"City & County of San Francisco. COVID-19 Vaccine FAQs: report [Internet]. 2023 April 5. Available from: https:\/\/sf.gov\/information\/health-order-faqs. Retrieved May 4, 2023."},{"key":"bibr40-ISU-230186","unstructured":"National Academy for State Health Policy. State efforts to ban or enforce COVID-19 vaccine mandates and passports: document [Internet]. 2023 April 5. Available from: https:\/\/nashp.org\/state-efforts-to-ban-or-enforce-covid-19-vaccine-mandates-and-passports\/. Retrieved May 4, 2023."},{"key":"bibr41-ISU-230186","unstructured":"YangM., Ron DeSantis moves to permanently ban Covid mandates in Florida. The Guardian. [Internet]. 2023 January 21. Available from: https:\/\/www.theguardian.com\/us-news\/2023\/jan\/21\/ron-desantis-covid-mandates-florida. Retrieved May 4, 2023."},{"key":"bibr42-ISU-230186","unstructured":"LeeB.Y., New Idaho bill would criminalize anyone administering Covid-19 mRNA vaccines. Forbes. [Internet]. 2023 February 18. Available from: https:\/\/www.forbes.com\/sites\/brucelee\/2023\/02\/18\/new-idaho-bill-would-criminalize-anyone-administering-covid-19-mrna-vaccines\/?sh=761e6e1f3ba8. Retrieved May 4, 2023."},{"key":"bibr43-ISU-230186","unstructured":"Only in America,\n                      The Week\n                      23\n                      (1121) 2023, 6. https:\/\/vk.com\/s\/v1\/doc\/e0qkDNnkTaTWEvUDr4Un5uSWa8MHoPbybQbGaH3pL-jMmhCPR1k."},{"key":"bibr44-ISU-230186","unstructured":"Congresswoman Tenney reintroduces legislation prohibiting COVID mandates: press release [Internet]. 2023 January 26. Available from: https:\/\/tenney.house.gov\/media\/press-releases\/congresswoman-tenney-reintroduces-legislation-prohibiting-covid-mandates. Retrieved May 4, 2023."},{"key":"bibr45-ISU-230186","unstructured":"Science News Staff. Nobel laureates and science groups demand NIH review decision to kill coronavirus grant. Science Insider [Internet]. 2020 May 21. Available from: https:\/\/www.science.org\/content\/article\/preposterous-77-nobel-laureates-blast-nih-decision-cancel-coronavirus-grant-demand. Retrieved May 4, 2023."},{"key":"bibr46-ISU-230186","doi-asserted-by":"publisher","DOI":"10.1126\/science.adg7356"},{"key":"bibr47-ISU-230186","unstructured":"RifkinJ., FAUCI Act would ban US from funding in China the medical research technique some suspect caused Covid-19 pandemic. GovTrackerUs [Internet]. 2022 September 8. Available from: https:\/\/govtrackinsider.com\/fauci-act-would-ban-us-from-funding-in-china-the-medical-research-technique-some-suspect-caused-46985bd9692. Retrieved May 4, 2023."},{"key":"bibr48-ISU-230186","doi-asserted-by":"crossref","unstructured":"KaiserJ., Draft bill would ban CDC, NIH from funding lab research in China. Science Insider [Internet]. 2022 July 12. Available from: https:\/\/www.science.org\/content\/article\/draft-bill-would-ban-cdc-nih-funding-lab-research-china. 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We\u2019re in this together: Disinformation stops with you: document [Internet]. n.d. Available from: https:\/\/www.cisa.gov\/sites\/default\/files\/publications\/SLTTCOVIDToolkit_FINAL_508.pdf. Retrieved May 4, 2023."}],"container-title":["Information Services and Use"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3233\/ISU-230186","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.3233\/ISU-230186","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3233\/ISU-230186","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:03:24Z","timestamp":1777464204000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.3233\/ISU-230186"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5]]},"references-count":54,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.3233\/ISU-230186"],"URL":"https:\/\/doi.org\/10.3233\/isu-230186","relation":{},"ISSN":["0167-5265","1875-8789"],"issn-type":[{"value":"0167-5265","type":"print"},{"value":"1875-8789","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5]]}}}