How catastrophic misinterpretation triggers health anxiety: health information seeking as a mediator in rural China’s information-poor populations

Introduction. Amid the post-pandemic surge in health anxiety, this study investigates how catastrophic misinterpretation exacerbates health anxiety in Chinese rural populations through maladaptive health information seeking, under the boundary conditions of metacognitive beliefs and health risk perception. Method. Employing a cross-sectional survey design, it collected data from 150 rural residents in Northern China. All were from townships characterized by significant information poverty. Analysis. Structural equation modeling assessed the direct effect, the mediating role, and the moderated mediation within the proposed model. Results. First, catastrophic misinterpretation exhibited a strong direct effect on health anxiety. Second, health information seeking behaviour mediated this relationship. Third, metacognitive factors demonstrated complex moderating influences: positive beliefs about worry weakened the association between catastrophic misinterpretation and information seeking, whereas perceived uncontrollability of worry intensified the impact of information seeking on anxiety. Contrary to expectations, heightened health risk perception reduced the anxiety-provoking effects of information seeking, suggesting a protective regulatory function in information-poor environments. Conclusion. This study proposes the information poverty-amplified anxiety view, bridging health anxiety and information behaviour theory by positioning structural information deficits as catalytic contextual factors. It uniquely establishes maladaptive health information seeking behaviour as a critical mediator that transforms catastrophic misinterpretations into sustained health anxiety within information-poor contexts. It also identifies the paradoxical protective function of health risk perception in populations with low information literacy.