Examining the impact of misinformation on governance efficacy in the health sector: The mediating role of public trust and the moderating effect of social media regulations

• Misinformation erodes trust and weakens health governance • Public trust mediates misinformation–governance relationship • Social media regulation moderates misinformation effects • Misinformation triggers reactive governance responses • Evidence from Pakistan’s healthcare information environment This study examines how misinformation influences governance efficacy in Pakistan’s healthcare sector, focusing on public trust as a mediating factor and social media regulation as a moderating mechanism. Drawing on social trust theory and framing theory, an online survey of 500 social media users was analyzed using structural equation modeling. The findings show that misinformation erodes trust in health institutions, which in turn undermines governance performance. Social media regulation shapes these dynamics by reframing misinformation, moderating its negative effects on both trust and governance efficacy. An unexpected positive association between misinformation and governance efficacy also emerged, reflecting a reactive governance pattern in which institutional visibility increases under public pressure. These results highlight the importance of transparent regulatory frameworks and trust-building strategies tailored to Pakistan’s information environment to strengthen the resilience of healthcare governance.