Given that the spread and adoption of health misinformation have become a major public health issue, this study aimed to illuminate the psychological processes through which social media users judge the credibility of health misinformation on social media and adopt misinformed health behaviors, focusing on the role of social endorsement cues, specifically number of "likes".Based on the MAIN (Modality, Agency, Interactivity, and Navigability) model (Sundar, 2008) and the Focus Theory of Normative Conduct (Cialdini et al., 1991), the present study conducted two experimental studies with a 2 (Social endorsement cues by distant ties: a low number of likes vs. a high number of likes) x 2 (Social endorsement cues by close ties in one's network: presence of likes by close ties vs. absence of the likes by close ties) factorial design with two different health topics. The results indicated that social endorsement cues (i.e., number of likes) from the two different referent groups created perception of social norms - both descriptive and injunctive norms around the misinformed health behavior. The likes from one's close ties on the social network were more influential in creating perceived social norms, compared to the ones from distant ties. Further, the perceived social norms, in particular, the injunctive norm of close ties and the descriptive norm of distant ties, increased the perceived credibility of health misinformation. The social endorsement cues from close ties, in particular, increased the two different behavioral intentions related to the spread of health misinformation (i.e., intention to share) and adoption of health misinformation (i.e., intention to engage in the misleading health behavior). Theoretical implications and practical applications of the findings were discussed.
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