Attitudes toward free speech, content moderation, and punishment of misinformation spreaders during infectious disease outbreaks.

Introduction: During infectious disease outbreaks, the spread of false information online may undermine public health interventions. At the same time, free speech is a core value in democratic societies, and in the early stages of a novel pathogen there is a legitimate need for open discussion among scientists, policymakers, and the public to negotiate responses under conditions of uncertainty. Any restrictions on speech on social media should therefore reflect public attitudes and normative trade-offs. Currently, no standardized instrument exists to measure public attitudes toward free speech, content moderation, and punishment of misinformation spreaders on social media in the context of infectious disease outbreaks. Methods: In this study, we report the development and standardization of a 13-item questionnaire designed to assess these attitudes. The instrument was standardized in an online study conducted with a diverse sample of 1,002 adult, English-speaking participants in the United States recruited via Prolific. Results: Factor analysis identified three distinct dimensions capturing attitudes toward (1) free speech, (2) content moderation, and (3) punishment for misinformation spreaders. Discussion: The questionnaire provides a standardized tool for assessing public attitudes relevant to social media governance during health crises and may inform the design of public health communication strategies and evidence-informed policymaking.