A Picture Really is Worth a Thousand Words: Public Engagement with the National Cancer Institute on Social Media

Consumption of Health-Related Videos and Human Papillomavirus Awareness: Cross-Sectional Analyses of a US National Survey and YouTube From the Urban-Rural Context

BACKGROUND

Nearly 70% of Americans use the internet as their first source of information for health-related questions. Contemporary data on the consumption of web-based videos containing health information among American adults by urbanity or rurality is currently unavailable, and its link with health topic awareness, particularly for human papillomavirus (HPV), is not known.

OBJECTIVE

We aim to describe trends and patterns in the consumption of health-related videos on social media from an urban-rural context, examine the association between exposure to health-related videos on social media and awareness of health topics (ie, HPV and HPV vaccine), and understand public interest in HPV-related video content through search terms and engagement analytics.

METHODS

We conducted a cross-sectional analysis of the US Health Information National Trends Survey 6, a nationally representative survey that collects data from civilian, noninstitutionalized adults aged 18 years or older residing in the United States. Bivariable analyses were used to estimate the prevalence of consumption of health-related videos on social media among US adults overall and by urbanity or rurality. Multivariable logistic regression models were used to examine the association between the consumption of health-related videos and HPV awareness among urban and rural adults. To provide additional context on the public's interest in HPV-specific video content, we examined search volumes (quantitative) and related query searches (qualitative) for the terms "HPV" and "HPV vaccine" on YouTube.

RESULTS

In 2022, 59.6% of US adults (152.3 million) consumed health-related videos on social media, an increase of nearly 100% from 2017 to 2022. Prevalence increased among adults living in both urban (from 31.4% in 2017 to 59.8% in 2022; P<.001) and rural (from 22.4% in 2017 to 58% in 2022; P<.001) regions. Within the urban and rural groups, consumption of health-related videos on social media was most prevalent among adults aged between 18 and 40 years and college graduates or higher-educated adults. Among both urban and rural groups, adults who consumed health-related videos had a significantly higher probability of being aware of HPV and the HPV vaccine compared with those who did not watch health videos on the internet. The term "HPV" was more frequently searched on YouTube compared with "HPV vaccine." Individuals were most commonly searching for videos that covered content about the HPV vaccine, HPV in males, and side effects of the HPV vaccine.

CONCLUSIONS

The consumption of health-related videos on social media in the United States increased dramatically between 2017 and 2022. The rise was prominent among both urban and rural adults. Watching a health-related video on social media was associated with a greater probability of being aware of HPV and the HPV vaccine. Additional research on designing and developing social media strategies is needed to increase public awareness of health topics.

Engaging the community served: a U.S. Cancer Center's Facebook live cancer awareness campaign for Spanish-speaking Latinos during COVID-19

Cancer is the leading cause of mortality in U.S. Latino adults, a group with limited access to screening, higher rates of advanced disease, and prone to online misinformation. Our project created a Facebook Live social media video campaign on general cancer prevention, screening, risk, information, and resources, targeting Spanish-monolingual Latinos during the COVID-19 pandemic. Content was delivered in Spanish by fluent, ethnically concordant topic experts and cancer center staff. Four prerecorded and three livestream interview videos were produced, amassing over 161 shares, 1,000 engagements, 12,000 views, 19,000 people reached, and 34,000 impressions in a span of four months. Strengths of this project included developing community partnerships and collaborations, providing evidence-based cancer information in a culturally responsive manner to often-excluded community members during COVID-19 pandemic, and presenting our cancer center as an accessible resource to the wider community. Future directions include formalizing evaluation strategies to capture medical engagement via cancer screening and detection rates, delivering focused cancer discussions by disease sites, and further expanding audience base through mixed media formats.

A twitter analysis of patient and family experience in pediatric spine surgery

BACKGROUND

There is little data on patient and caregiver perceptions of spine surgery in children and youth. This study aims to characterize the personal experiences of patients, caregivers, and family members surrounding pediatric spine surgery through a qualitative and quantitative social media analysis.

METHODS

The Twitter application programming interface was searched for keywords related to pediatric spine surgery from inception to March 2022. Relevant tweets and accounts were extracted and subsequently classified using thematic labels. Tweet metadata was collected to measure user engagement via multivariable regression. Sentiment analysis using Natural Language Processing was performed on all tweets with a focus on tweets discussing the personal experiences of patients and caregivers.

RESULTS

2424 tweets from 1847 individual accounts were retrieved for analysis. Patients and caregivers represented 1459 (79.0%) of all accounts. Posts discussed the personal experiences of patients and caregivers in 83.5% of tweets. Pediatric spine surgery research was discussed in few posts (n=90, 3.7%). Within the personal experience category, 975 (48.17%) tweets were positive, 516 (25.49%) were negative, and 533 (26.34%) were neutral. Presence of a tag (beta: -6.1, 95% CI -9.7 to -2.5) and baseline follower count (beta<0.001, 95% CI <0.001 to <0.001) significantly affected tweet engagement negatively and positively, respectively.

CONCLUSIONS

Patients and caregivers actively discuss topics related to pediatric spine surgery on Twitter. Posts discussing personal experience are most prevalent, while posts on research are scarce, unlike previous social media studies. Pediatric spine surgeons can leverage this dialogue to better understand the worries and needs of patients and their families.

When Engagement Leads to Action: Understanding the Impact of Cancer (Mis)information among Latino/a Facebook Users

Latinos/as - the largest minority group in the U.S. - are avid Facebook users, making this an opportune tool to educate on the uptake of cancer prevention and screening behaviors. However, there is a dearth in scholarship exploring how Latinos/as engage with and act upon health content encountered on social media, which may be influenced by cultural values. This qualitatively-driven, mixed-methods study explores how Latinos/as engage with and act upon cancer prevention and screening information (CPSI) on Facebook. During one-on-one, in-depth interviews, participants (n = 20) logged onto their Facebook account alongside the researcher and discussed cancer-related posts they engaged with during the past 12 months. Interview questions included the reasons for engagement, and whether engagement triggered further action. Interviews were analyzed thematically. In parallel, a content analysis of the CPSI posts identified during the interviews was conducted. The majority of CPSI posts participants engaged with contained food-related content and visual imagery. Engagement was most common when individuals had personal relationships to the poster, when posts included videos/images, and when posts contained content promoting the curative properties of popular Latin American foods. Engagement often led to information-seeking and sharing, discussing content with others, and/or changing health behaviors. Findings highlight the importance of adequately contextualizing how cultural values influence the ways in which Latinos/as engage with and act upon CPSI on Facebook, which may lead individuals to bypass evidence-based procedures. Multi-pronged efforts are necessary to adequately leverage social media to empower Latinos/as to partake in behaviors that effectively reduce cancer health disparities.

Evaluating the effectiveness of Internet-based communication for public health: a systematic review (Preprint)

Background

Communicating strategically is a key issue for health organizations. Over the past decade, health care communication via social media and websites has generated a great deal of studies examining different realities of communication strategies. However, when it comes to systematic reviews, there is fragmentary evidence on this type of communication.

Objective

The aim of this systematic review was to summarize the evidence on web institutional health communication for public health authorities to evaluate possible aim-specific key points based on these existing studies.

Methods

Guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, we conducted a comprehensive review across 2 electronic databases (PubMed and Web of Science) from January 1, 2011, to October 7, 2021, searching for studies investigating institutional health communication. In total, 2 independent researchers (AN and SS) reviewed the articles for inclusion, and the assessment of methodological quality was based on the Kmet appraisal checklist.

Results

A total of 78 articles were selected. Most studies (35/78, 45%) targeted health promotion and disease prevention, followed by crisis communication (24/78, 31%), general health (13/78, 17%), and misinformation correction and health promotion (6/78, 8%). Engagement and message framing were the most analyzed aspects. Few studies (14/78, 18%) focused on campaign effectiveness. Only 23% (18/78) of the studies had an experimental design. The Kmet evaluation was used to distinguish studies presenting a solid structure from lacking studies. In particular, considering the 0.75-point threshold, 36% (28/78) of the studies were excluded. Studies above this threshold were used to identify a series of aim-specific and medium-specific suggestions as the communication strategies used differed greatly.

Conclusions

Overall, the findings suggest that no single strategy works best in the case of web-based health care communication. The extreme variability of outcomes and the lack of a unitary measure for assessing the end points of a specific campaign or study lead us to reconsider the tools we use to evaluate the efficacy of web-based health communication.

Contextualizing Engagement With Health Information on Facebook: Using the Social Media Content and Context Elicitation Method

Background

Most of what is known regarding health information engagement on social media stems from quantitative methodologies. Public health literature often quantifies engagement by measuring likes, comments, and/or shares of posts within health organizations’ Facebook pages. However, this content may not represent the health information (and misinformation) generally available to and consumed by platform users. Furthermore, some individuals may prefer to engage with information without leaving quantifiable digital traces. Mixed methods approaches may provide a way of surpassing the constraints of assessing engagement with health information by using only currently available social media metrics.

Objective

This study aims to discuss the limitations of current approaches in assessing health information engagement on Facebook and presents the social media content and context elicitation method, a qualitatively driven, mixed methods approach to understanding engagement with health information and how engagement may lead to subsequent actions.

Methods

Data collection, management, and analysis using the social media content and context elicitation method are presented. This method was developed for a broader study exploring how and why US Latinos and Latinas engage with cancer prevention and screening information on Facebook. The study included 20 participants aged between 40 and 75 years without cancer who participated in semistructured, in-depth interviews to discuss their Facebook use and engagement with cancer information on the platform. Participants accessed their Facebook account alongside the researcher, typed cancer in the search bar, and discussed cancer-related posts they engaged with during the previous 12 months. Engagement was defined as liking, commenting, and/or sharing a post; clicking on a post link; reading an article in a post; and/or watching a video within a post. Content engagement prompted questions regarding the reasons for engagement and whether engagement triggered further action. Data were managed using MAXQDA (VERBI GmbH) and analyzed using thematic and content analyses.

Results

Data emerging from the social media content and context elicitation method demonstrated that participants mainly engaged with cancer prevention and screening information by viewing and/or reading content (48/66, 73%) without liking, commenting, or sharing it. This method provided rich content regarding how US Latinos and Latinas engage with and act upon cancer prevention and screening information on Facebook. We present 2 emblematic cases from the main study to exemplify the additional information and context elicited from this methodology, which is currently lacking from quantitative approaches.

Conclusions

The social media content and context elicitation method allows a better representation and deeper contextualization of how people engage with and act upon health information and misinformation encountered on social media. This method may be applied to future studies regarding how to best communicate health information on social media, including how these affect assessments of message credibility and accuracy, which can influence health outcomes.

Engaging Institutional Stakeholders to Develop and Implement Guidelines for Recruiting Participants in Research Studies Using Social Media: Mixed Methods, Multi-Phase Process

Background

Limited regulatory guidance surrounding the use of social media channels for participant recruitment is an interdisciplinary challenge. Establishing stakeholder-informed procedures is essential for ethical and effective use of social media for participant recruitment.

Objective

This study aims to provide replicable procedures for developing and implementing guidelines for using social media to recruit participants in research studies.

Methods

Social media use cases at the university were used to identify institutional stakeholders for the initiative. After establishing workflow procedures, a scoping review of web-based materials about recruitment and research on the internet and social media from 19 peer institutions and 2 federal agencies was conducted to inform the structure of the policies and procedures. End users (investigators and study coordinators; N=14) also provided feedback on the policies and procedures and implementation.

Results

Representatives (n=7) from 5 institutional offices and 15 subject-matter experts from 5 areas were identified as stakeholders in the development of policies and procedures. Peers with web-based materials (n=16) identified in the scoping review revealed 4 themes that served as a basis for developing our policies and procedures. End user feedback further informed the policies and procedures and implementation. A centrally managed social media account for communicating with participants and hosting advertising campaigns on social media was also established and, when combined with the policies and procedures, resulted in 39 advertising campaigns, and 2846 participants were enrolled in health and clinical research studies.

Conclusions

Our policies and procedures allow research teams to harness the potential of social media to increase study recruitment and participation; the transparent, stakeholder-informed process can be replicated by institutional administrators to establish policies and procedures that meet the interests and needs of their research community.

When Triggers Become Tigers: Taming the Autonomic Nervous System via Sensory Support System Modulation

Personalized recovery technologies may enable individuals with Substance Use Disorder (SUD) to monitor and manage acute craving and drug use urges in ways that improve drug-seeking decisions in real-time. Direct and indirect regulation of the autonomic nervous system through sensory input monitoring and modulation may enhance control over behavioral decisions and prevent relapse. A personalized sensory support system that monitors neurophysiological reactivity and offers non-pharmacological point-in-time personalized digital interventions may increase awareness of and control over craving reactivity. It is critical to be able to detect these warning signs and intervene early and effectively. The use of wearable technologies that assess point-in-time neurophysiological escalation and shape behavioral response through personalized interventions could be transformative in allowing individuals to better manage their recovery as they transition out of institutions and move back into community settings.

Discovering social media topics and patterns in the coronavirus and election era

Purpose

This study aims to understand the relationship between politics and pandemics in shaping the characteristics and themes of people’s Tweets during the US 2020 presidential election. Additionally, the purpose is to detect misinformation and extremism, not only to help online social networks (OSN) to target such content more rapidly but also to provide a close to real-time picture of trending topics, misinformation, and extremism flowing on OSN. This could help authorities to identify the intents behind them and find out how and when they should address such content.

Design/methodology/approach

This study focuses on extracting and verifying knowledge from large-scale OSN data, at the intersection of the Coronavirus pandemic and the US 2020 presidential election. More specifically, this study makes manual, statistical and automatic inferences and extracts knowledge from over a million Tweets related to the two aforementioned major events. On the other hand, disinformation operations intensified in 2020 with the coincidence of the Coronavirus pandemic and presidential election. This study applies machine learning to detect misinformation and extreme opinions on OSN. Over one million Tweets have been collected by our server in real-time from the beginning of April 2020 to the end of January 2021, using six keywords, namely, Covid, Corona, Trump, Biden, Democrats and Republicans. These Tweets are inspected with regard to their topics, opinions, news, and political affiliation, along with misinformation and extremism.

Findings

Our analyses showed that the majority of these Tweets concern death tolls, testing, mask, drugs, vaccine, and travel bans. The second concern among these Tweets is reopening the economy and schools, unemployment, and stimulus bills. The third concern is related to the Coronavirus pandemic’s impacts on politics, voting, and misinformation. This highlights the topics that US voters on Twitter were most concerned about during this time period, among the multitude of other topics that politicians and news media were reporting or discussing. Automatic classification of these Tweets using a long short-term memory network revealed that Tweets containing misinformation formed between 0.5% and 1.1% of Coronavirus-related Tweets every month and Tweets containing extreme opinions formed between 0.5% and 3.1% of them every month, with its pick in October 2020, coinciding with the US presidential election month.

Originality/value

The originality of this study lies in establishing a framework to collect, process, and classify OSN data to detect misinformation and extremism and to provide a close to real-time picture of trending topics, misinformation, and extremism flowing on OSN.

Reducing mental illness stigma: What types of images are most effective?

Public stigma against mental illness is a barrier to treatment and recovery. Research into the design of anti-stigma messages has focused heavily on text; there is limited information on what types of images are most persuasive in eliciting anti-stigma outcomes. This is important to study because the type of image used to depict an illness can influence how the illness is perceived, which in turn can affect how people with the illness are treated. Through an online experiment with 162 American adults, this study investigated whether mental illness narratives about depression illustrated with photographs are more effective than those illustrated with cartoons at reducing stigma. It was found that the illustrated narratives, whether with photo or cartoon, produced more anti-stigma effects than the text-only narrative (control). Further, the photographic narrative was more effective than the cartoon narrative in eliciting closeness to the story protagonist and willingness to donate to mental health services. The study's findings indicate that images should be used in anti-stigma messages on depression; further, regarding image type, photographs should be considered over cartoons as they are more effective in eliciting certain anti-stigma outcomes.Implications for PracticeThis study suggests that images have strong anti-stigma effects and that photographs are sometimes more persuasive than cartoons. These findings can inform best-practice guidelines for designing anti-stigma messages, created and disseminated by organisations such as the United States' National Alliance on Mental Illness and Mental Health America. Images in these messages should be selected carefully as they can influence how people with mental illness are perceived and treated.

Feasibility of a virtual Facebook community platform for engagement on health research

INTRODUCTION

Community engagement is important for advancing Clinical and Translational Science (CTS), but face-to-face engagement has limited reach and scale. We examined the feasibility of a novel virtual Facebook community platform for public engagement on health research statewide in Minnesota.

METHODS

The Facebook platform, MN Research Link, was evaluated from June 19, 2019 to June 30, 2020. Facebook advertisements and boosts were used to recruit followers. Content, based on prior formative work, included health research information and interactive postings (e.g., live interviews with researchers). Standard metrics obtained from Facebook analytics included participation (followers), content reach (views), and engagement (likes, shares, comments, clicks).

RESULTS

During the 12-month period, we acquired 1406 followers (31% rural residents), with a retention of followers of 99.7%. Mean number of views per month was 9379.83 (Mdn = 2791, range 724-41,510). Engagement metrics indicated a mean of 535.2 likes, shares, comments, and/or clicks per month (Mdn = 296.5, range 55-1535). The page continued to acquire new followers, but a slight decrease in engagement was observed in the final months after state COVID-19 mitigation strategies were implemented.

CONCLUSION

As the complexity of CTS continues to grow, along with social distancing measures resulting from the COVID-19 pandemic, the availability of virtual digital platforms to reach and engage community stakeholders in conversations about health and research has increasing importance. Preliminary findings from this program evaluation indicate that a Facebook community platform is feasible to engage Minnesota residents in conversations around health and research topics. Future work will evaluate its potential for reach, scale, and sustainability.

Parent support for social media standards combatting vaccine misinformation

We sought to assess parental support for varying standards that social media sites can employ to combat vaccine misinformation. Between July and August 2019, we conducted a web-based survey with a national sample of 1073 parents of adolescents and who use social media. The survey assessed support for ten standards about vaccine misinformation. Multivariable logistic regression assessed correlates of support. Overall, 61% of parents supported at least one standard. Support for each standard varied greatly (12-51%), with higher support for less restrictive standards. Parents more often supported standards if their child had already initiated human papillomavirus (HPV) vaccination, if they were non-Hispanic black or Hispanic, if they agreed that vaccine misinformation is harmful, or if they saw information on social media in favor of HPV vaccine (all p < .05). Our findings suggest favorable support for standards that social media sites can implement to combat vaccine misinformation.

Dataset on usage and engagement patterns for Facebook Live sellers in Thailand

This article describes a Comma Separated Values (CSV) dataset consisting of 7050 Facebook posts of various types (text, deferred and live videos, images). These posts were extracted from the Facebook pages of 10 Thai fashion and cosmetics retail sellers from March 2012, to June 2018. The dataset was collected via the Facebook API, and anonymized in compliance with the Facebook Platform Policy for Developers [1]. For each Facebook post, the dataset records the resulting engagement metrics comprising shares, comments, and emoji reactions within which we distinguish traditional "likes" from recently introduced emoji reactions, that are "love", "wow", "haha", "sad" and "angry". This dataset could serve as a basis for research on customer engagement with the novel sales channel that is Facebook Live, through comparative studies with other forms of content (text, deferred videos, and images), as well as the statistical analysis of the seasonality of engagement and outlier posts.

Practical and Ethical Considerations for Schools Using Social Media to Promote Physical Literacy in Youth

The rapid development of social media has led to its increased use by children and adolescents for health and well-being purposes. Accordingly, social interactions resulting from social media use can be further integrated into physical and health education pedagogy. Given the relationship between increased physical literacy and positive health outcomes, best practices and lessons learned from social media use in the healthcare industry should be adopted by health and physical educators practicing in schools. Thus, the purpose of this paper is to comment on several practical and ethical challenges and opportunities associated with using social media to improve physical literacy among youth. Specifically, two of the most prominent issues are discussed in depth: (1) integration of social media in physical education settings that educate children and adolescents about the biopsychosocial effects of physical activity, and (2) use of wearable technologies among youth to accrue experiences that enhance physical literacy competencies. In our opinion, health and physical educators who utilize the ALL-ENGAGE Playbook described in this commentary will successfully reach, engage, and impact students with popular social media that adequately promotes physical literacy, including through experiential use of wearable technologies.

Communication strategies for designing Facebook advertising campaigns to recruit rural participants to develop healthcare delivery interventions

Background:

Little is known about designing research recruitment campaigns that connect with underserved, geographically isolated rural populations. A theoretically informed process is needed to assist research teams and practitioners in their evaluation of Facebook’s feasibility as a recruitment tool and development of online materials for recruiting rural adults into healthcare delivery intervention development studies.

Methods:

We drew from research and theory in communication and incorporated process analysis techniques to develop replicable procedures for designing and evaluating Facebook campaigns for rural recruitment. We describe our process and illustrate using two case studies.

Results:

Campaigns received approximately 1000 link clicks from the target rural demographic and successfully enrolled participants using Facebook as a primary method of recruitment. The rural tobacco intervention development study received a total of 477 link clicks, cost only $155.80, and enrolled three (23%) of its 13 participants from Facebook. The rural mental health intervention development study received a total of 518 link clicks, cost only $233.28, and enrolled 178 participants.

Conclusions:

Our process yielded two successful recruitment campaigns. Facebook was an affordable and efficacious strategy for enrolling adults in behavioral research studies on tobacco and mental health. Future work should apply these theoretical techniques to additional study topics and evaluate specific message features associated with recruitment.

Celebrity Cancer on Twitter: Mapping a Novel Opportunity for Cancer Prevention

Social media platforms have the potential to facilitate the dissemination of cancer prevention and control messages following celebrity cancer diagnoses. However, cancer communicators have yet to systematically leverage these naturally occurring interventions on social media as these events are difficult to identify as they are unfolding and little research has analyzed their effect on social media conversations. In this study, we add to the research by analyzing how a celebrity cancer announcement influenced Twitter conversations in terms of the volume of social media messages and the type of content. Over a 9-day period, during which actor Ben Stiller announced that he had been treated for prostate cancer, we collected 1.2 million Twitter messages about cancer. We conducted automated content analyses to identify how often common cancer sites (prostate, breast, colon, or lung) were discussed. Then, we used manual content analysis on a sample of messages to identify cancer continuum content (awareness, prevention, early detection, diagnosis, treatment, survivorship, and end of life). Chi-square analyses were implemented to evaluate changes in cancer site and cancer continuum content before and after the announcement. We found that messages related to prostate cancer increased significantly more than expected for 2 days following Stiller’s announcement. However, the number of cancer messages that described other cancer locations either did not increase or did not increase by the same magnitude. In terms of message content, results showed larger than expected increases in diagnosis messages. These results suggest opportunities to shape social media conversations following celebrity cancer announcements and increase prevention and early detection messages.

Relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt

We described the relative contributions of parental intention and provider recommendation style to HPV and meningococcal vaccine receipt. Parent-child dyads that were eligible for both meningococcal and HPV vaccines participated in pre-visit surveys and consented to audio recording of their clinical interactions with healthcare providers related to vaccination. Surveys were analyzed for parent and child demographics and parental intention to vaccinate children with HPV and/or meningococcal vaccines. Audio recordings were analyzed for provider recommendation style, defined as indicated (provider stated vaccine was due at that visit) or not, and for child receipt of vaccines. Linear and logistic regression models were used to determine the relative contributions of parental intention and provider recommendation style to vaccine receipt. 56 parents/child dyads participated. 79% of children received HPV vaccines, and 93% received meningococcal vaccines. After controlling for demographic variables, parental intention did not differ by vaccine type. However, providers were less likely to use an indicated recommendation for HPV than for meningococcal vaccine. After controlling for demographic factors, parental intention, and provider recommendation style, vaccine type (HPV or meningococcal) was no longer associated with vaccine receipt Differences that were previously attributed to vaccine-specific factors may be explained by parents' and providers' roles in vaccine receipt. These findings suggest that interventions and policy recommendations regarding adolescent vaccination should focus on increasing parental demand for vaccines and ensuring that providers present all vaccines as the medical standard of care.

Evaluation of graphic messages to promote human papillomavirus vaccination among young adults: A statewide cross-sectional survey

Young adults in the United States 18-26 years of age are eligible for human papillomavirus (HPV) vaccination, yet they rarely attend preventive healthcare visits. In contrast, they have a high prevalence of social media use, which could be leveraged to provide healthcare recommendations. Since graphics attract users, the study's primary objective was to determine the most appealing graphic to promote HPV vaccination to young adults. A cross-sectional survey was conducted at the Minnesota State Fair. Participants 18-26 years of age completed a 36-item survey including information on demographics, HPV vaccination status, eHealth literacy, and assessed the appeal of 8 Instagram graphic mock-ups promoting HPV vaccination to prevent cancer. The graphics represented 4 categories: 1) infographics; 2) disease photos; 3) young adult cancer patient photos; 4) humorous graphics. A total of 1037 eligible young adults participated in the study. Median age was 22 years. A majority were women (63%), white (82%), educated (79% post-secondary education or greater), or privately insured (85%). Although 61% reported receiving at least one dose of HPV vaccine, only 48% reported receiving all three recommended doses. Participants were slightly more drawn to posts with humorous graphics or infographics than disease or patient photos (pairwise p-values <0.0001). There were small but statistically significant differences in response to graphics by gender, race, HPV vaccination status, and eHealth literacy. In conclusion, graphic types tested in this study showed only small differences in response, suggesting that factors other than graphic type need to be explored to improve appeal of HPV vaccine promotional messaging.

How to Optimize Health Messages About Cancer on Facebook: Mixed-Methods Study

BACKGROUND

Incidence rate of cancer is increasing worldwide, with longer life expectancy being one of the main causes. Yet, between 30% and 50% of cancer cases are preventable, and early detection contributes to a better prognosis. This makes health communication strategies essential. Facebook, the world's most used social networking site in 2017 and 2018, can be a useful tool for disseminating powerful messages on health promotion, prevention, and early detection.

OBJECTIVE

We aimed to (1) offer ways of optimizing health messages about cancer on Facebook, focusing on topics, such as risk factors, prevention, treatment, early diagnosis, and cure, and (2) investigate which aspects of these messages generate greater engagement.

METHODS

To verify what generates greater engagement in topics related to cancer on Facebook, we analyzed 16 Brazilian pages with the main theme of cancer. We performed a manual analysis of texts, content, and engagement rates. Finally, we developed a software program to operationalize the analysis of Facebook posts. The tool we devised aims to automate the analysis of any Facebook page with cancer as the main theme.

RESULTS

We analyzed 712 posts over a 1-month period. We divided the posts into the following 8 categories: "Testimonies or real-life stories," "Solidarity," "Anniversaries," "Science and health," "Events," "Institutional," "Risk factors," and "Beauty." The pages were also organized into groups according to the type of profile to which they belonged (ie, hospitals or foundations, informative, nongovernmental organizations, and personal pages).The results showed that the categories generating greater engagement in Brazil were not those with the highest percentage of cancer-related content. For instance, in the "Informative" group the "Testimonies or real-life stories" category generated an engagement of 79.5%. However, only 9.5% (25/261) of the content within the relevant time period dealt with such topics. Another example concerns the category "Science and health." Despite being the one with the highest number of posts (129/261, 49.4%), it scored 5th in terms of engagement. This investigation served as the basis for the development of a tool designed to automate the analysis of Facebook pages. The list of categories and keywords generated by this analysis was employed to feed the system, which was then able to categorize posts appearing on a Facebook page. We tested the system on 163 posts and only 34 were classified incorrectly, which amounts to a 20.8% error rate (79.2% accuracy).

CONCLUSIONS

The analysis we conducted by categorizing posts and calculating engagement rates shows that the potential of Facebook pages is often underutilized. This occurs because the categories that generate the greatest engagement are often not those most frequently used. The software developed in this research may help administrators of cancer-related pages analyze their posts more easily and increase public interest as a result.

Messaging for Interventions Aiming to Improve Calcium Intake in Young Adults-A Mixed Methods Study

Social media channels are the preferred communication tools for many young adults and therefore may have applications in health promotion. The framing of messages is important, as an intervention must resonate with the target group. The aim of this study was to determine what type of messaging is preferred by young adults to improve their calcium intake. A cross-sectional web-based survey was conducted and young adults aged 18 to 25 years recruited. A 14-item survey collected information on the participants’ demographics, ranking of text messages, mock Facebook posts with images, preferences related to type of posts they find personally relevant, and frequency and likelihood of engagement with posts and polls in social media. In addition, optional responses from participants about factors that motivate them to consume more calcium-rich foods were included and thematically analysed using NVivo. Eighty-one participants (17 males) completed the survey. No significant difference in ranking of the text messages and Facebook posts were found. Participants indicated that recipe demonstrations (n = 71), cost-saving tips (n = 70), and information on recommended daily intake (n = 62) were personally relevant, while meal inspiration (n = 70), awareness-raising posts (n = 41), and messages about obtaining enough calcium from non-dairy sources (n = 38) would encourage them to eat more calcium-rich foods. The qualitative replies indicated the tone (in young adults’ language) and length (short) of messages preferred, and the messaging they perceived would motivate young adults. In conclusion, short, aesthetically pleasing and personally relevant messages written in the language of young adults were recommended.

Social Media Use for Cancer Education at a Community-Based Cancer Center in South Korea

The main purpose of this study was to evaluate the effectiveness of the education system using social media. Eight educational video clips were developed instructing the viewer on cancer-related issues such as prevention, treatment, and survivorship. Each video was made with participation of medical professors and posted on a YouTube channel. A mobile phone application was produced containing a scheduler function, introduction of a community cancer center program, and cancer information. A medical blog was established to provide stationary materials such as images and articles. Descriptive analysis was done by Google analytics. From May of 2014 to June of 2016, 15,247 total views were recorded on the YouTube channel, and the average view duration was about 3 min. The most popular video was about chemotherapy treatment; 5409 (36%) people watched this video, and 3615 (23.5%) people viewed a video on balanced dietary habits. As well as South Korea, 1,113 (7%) views were confirmed in the United States and 175 (1%) in Japan. The equipment used to watch the contents were mobile phones (59%), laptops (33%), and tablets (6%). Five hundred people installed the smartphone application from March of 2015 to July of 2016. Three hundred eighty-three medical contents were posted on the blog since March of 2015. Cancer education is necessary to address the education needs of patients with cancer and their caregivers. Education based on social media could be an effective method that reaches beyond geographical boundaries.

Using social media to assess care coordination goals and plans for leukemia patients and survivors

Care coordination has been shown to have a positive effect on the management of chronic disease. Specific to the management of leukemia, coordination may occur between primary care physician, medical and radiation oncologists, surgeons, cardiologists, and genetics specialists. Experiencing gaps in communication and care coordination, many health consumers seek instrumental support in their social circles, including online forums and networks. The goal of this theory-guided study was to provide an in-depth assessment of how individuals use online forums to deliberate about their goals and plans for leukemia care coordination. Guided by the planning theory of communication, the data were collected from the American Cancer Society Cancer Survivors Network and included 125 original posts and 1,248 responses. Thematic analysis and axial coding were applied to analyze the data. Goal-related themes included overcoming the diffusion of care coordination and achieving health management cohesion. Planning themes included social health management, communication self-efficacy, and role deliberation. Online patient forums provide an interactive platform for patients and caregivers to engage in active conversations, which in turn can serve as identifiers of care coordination needs. Communication with those who share similar experiences allows cancer patients and survivors to accumulate functional health literacy, gain communication self-efficacy, and articulate a care coordination role acceptable to them.

Cancer and Social Media: A Comparison of Traffic about Breast Cancer, Prostate Cancer, and Other Reproductive Cancers on Twitter and Instagram

Social media are often heralded as offering cancer campaigns new opportunities to reach the public. However, these campaigns may not be equally successful, depending on the nature of the campaign itself, the type of cancer being addressed, and the social media platform being examined. This study is the first to compare social media activity on Twitter and Instagram across three time periods: #WorldCancerDay in February, the annual month-long campaigns of National Breast Cancer Awareness Month (NBCAM) in October and Movember in November, and during the full year outside of these campaigns. Our results suggest that women's reproductive cancers - especially breast cancer - tend to outperform men's reproductive cancer - especially prostate cancer - across campaigns and social media platforms. Twitter overall generates substantially more activity than Instagram for both cancer campaigns, suggesting Instagram may be an untapped resource. However, the messaging for both campaigns tends to focus on awareness and support rather than on concrete actions and behaviors. We suggest health communication efforts need to focus on effective messaging and building engaged communities for cancer communication across social media platforms.

Using social media for health research: Methodological and ethical considerations for recruitment and intervention delivery

As the popularity and diversity of social media platforms increases so does their utility for health research. Using social media for recruitment into clinical studies and/or delivering health behavior interventions may increase reach to a broader audience. However, evidence supporting the efficacy of these approaches is limited, and key questions remain with respect to optimal benchmarks, intervention development and methodology, participant engagement, informed consent, privacy, and data management. Little methodological guidance is available to researchers interested in using social media for health research. In this Tutorial, we summarize the content of the 2017 Society for Behavioral Medicine Pre-Conference Course entitled 'Using Social Media for Research,' at which the authors presented their experiences with methodological and ethical issues relating to social media-enabled research recruitment and intervention delivery. We identify common pitfalls and provide recommendations for recruitment and intervention via social media. We also discuss the ethical and responsible conduct of research using social media for each of these purposes.

Social Media and Mobile Technology for Cancer Prevention and Treatment

Given the number of lives affected by cancer and the great potential for optimizing well-being via lifestyle changes, patients, providers, health care systems, advocacy groups, and entrepreneurs are looking to digital solutions to enhance patient care and broaden prevention efforts. Thousands of health-oriented mobile websites and apps have been developed, with a majority focused upon lifestyle behaviors (e.g., exercise, diet, smoking). In this review, we consider the use and potential of social media and mHealth technologies for cancer prevention, cancer treatment, and survivorship. We identify key principles in research and practice, summarize prior reviews, and highlight notable case studies and patient resources. Further, with the potential for scaled delivery and broad reach, we consider application of social media and mHealth technologies in low-resource settings. With clear advantages for reach, social media and mHealth technologies offer the ability to scale and engage entire populations at low cost, develop supportive social networks, connect patients and providers, encourage adherence with cancer care, and collect vast quantities of data for advancing cancer research. Development efforts have been rapid and numerous, yet evaluation of intervention effects on behavior change and health outcomes are sorely needed, and regulation around data security issues is notably lacking. Attention to broader audiences is also needed, with targeted development for culturally diverse groups and non-English speakers. Further investment in research to build the evidence base and identify best practices will help delineate and actualize the potential of social media and mHealth technologies for cancer prevention and treatment.

Increasing Fruit and Vegetable Consumption Through a Healthy Eating Blog: A Feasibility Study

BACKGROUND

Despite efforts made by public health organizations to improve consumption of fruits and vegetables, populations in developed countries usually eat less than the minimum recommended. Social media, such as blogs, represent a unique opportunity for improving knowledge translation in health care because they facilitate interactive communication between the public and health professionals. However, no studies have yet evaluated the effect of blogs to promote dietary behavior changes.

OBJECTIVE

Our study aims to conduct a preliminary assessment before undertaking a full randomized controlled trial (RCT) of the feasibility of using an evidence-based healthy eating blog promoting the consumption of fruits and vegetables among adult women.

METHODS

A total of 80 women aged 18 years and older (mean 42, SD 13 years) eating less than five servings per day of fruit and vegetables (mean 2.75, SD 1.84 servings) were recruited. Participants were randomized to the healthy eating blog group (n=40), which included a weekly blog post over a 6-month period, or to a control group (n=40) that had no exposure to the healthy eating blog. Blog posts were written by a registered dietitian and focused on the improvement of fruit and vegetable consumption. We targeted four main determinants of the behavior that were identified as the best predictors for fruit and vegetable intake by two systematic reviews: (1) knowledge, (2) attitude, (3) self-efficacy, and (4) motivation. The intervention was considered feasible if (1) more than 70% of questionnaires were completed, (2) attendance rate was more than 90% for in-person appointments with the research coordinator, (3) participants accessed at least 75% of the blog posts, and (4) the attrition rate was less than 25%. Blog access was assessed by collecting the blog browsing history data for each participant.

RESULTS

During the intervention, 26 posts were published on the blog. Pre- (baseline) and postintervention (6 months) questionnaires were completed by mean 97% (SD 3%) of participants. All participants attended their in-person appointments. Women accessed mean 87% (SD 7%) of the posts published during the intervention. Only 3% (2/80) of participants dropped out of the study. Between the healthy eating blog and control groups, a difference of 1.0 servings of fruits and vegetables (P<.001) indicated moderate effects of the intervention (Cohen d=0.54).

CONCLUSIONS

These results suggest that an intervention using a healthy eating blog meets preestablished feasibility criteria. A larger-scale RCT using the same methodology will be conducted to assess the impact of a healthy eating blog on the dietary habits of women.

Facebook dethroned: Revealing the more likely social media destinations for college students' depictions of underage drinking

Studies examining representations of college drinking on social media have almost exclusively focused on Facebook. However, recent research suggests college students may be more influenced by peers' alcohol-related posts on Instagram and Snapchat, two image-based platforms popular among this demographic. One potential explanation for this differential influence is that qualitative distinctions in the types of alcohol-related content posted by students on these three platforms may exist. Informed by undergraduate focus groups, this study examined the hypothesis that, of the three platforms, students tend to use Instagram most often for photos glamourizing drinking and Snapchat for incriminating photos of alcohol misuse and negative consequences. Undergraduate research assistants aided investigators in developing hypothetical vignettes and photographic examples of posts both glamorizing and depicting negative consequences associated with college drinking. In an online survey, vignette and photo stimuli were followed by counterbalanced paired comparisons that presented each possible pair of social media platforms. Undergraduates (N=196) selected the platform from each pair on which they would be more likely to see each post. Generalized Bradley-Terry models examined the probabilities of platform selections. As predicted, Instagram was seen as the most probable destination (and Facebook least probable) for photos depicting alcohol use as attractive and glamorous. Conversely, Snapchat was selected as the most probable destination (and Facebook least probable) for items depicting negative consequences associated with heavy drinking. Results suggest researchers aiming to mitigate the potential influences associated with college students' glamorous and consequential alcohol-related photos posted social media posts should shift their focus from Facebook to Instagram and Snapchat.

Social Media and Mobile Technology for Cancer Prevention and Treatment

Given the number of lives affected by cancer and the great potential for optimizing well-being via lifestyle changes, patients, providers, health care systems, advocacy groups, and entrepreneurs are looking to digital solutions to enhance patient care and broaden prevention efforts. Thousands of health-oriented mobile websites and apps have been developed, with a majority focused upon lifestyle behaviors (e.g., exercise, diet, smoking). In this review, we consider the use and potential of social media and mHealth technologies for cancer prevention, cancer treatment, and survivorship. We identify key principles in research and practice, summarize prior reviews, and highlight notable case studies and patient resources. Further, with the potential for scaled delivery and broad reach, we consider application of social media and mHealth technologies in low-resource settings. With clear advantages for reach, social media and mHealth technologies offer the ability to scale and engage entire populations at low cost, develop supportive social networks, connect patients and providers, encourage adherence with cancer care, and collect vast quantities of data for advancing cancer research. Development efforts have been rapid and numerous, yet evaluation of intervention effects on behavior change and health outcomes are sorely needed, and regulation around data security issues is notably lacking. Attention to broader audiences is also needed, with targeted development for culturally diverse groups and non-English speakers. Further investment in research to build the evidence base and identify best practices will help delineate and actualize the potential of social media and mHealth technologies for cancer prevention and treatment.

Adapting Behavioral Interventions for Social Media Delivery

Patients are increasingly using online social networks (ie, social media) to connect with other patients and health care professionals--a trend called peer-to-peer health care. Because online social networks provide a means for health care professionals to communicate with patients, and for patients to communicate with each other, an opportunity exists to use social media as a modality to deliver behavioral interventions. Social media-delivered behavioral interventions have the potential to reduce the expense of behavioral interventions by eliminating visits, as well as increase our access to patients by becoming embedded in their social media feeds. Trials of online social network-delivered behavioral interventions have shown promise, but much is unknown about intervention development and methodology. In this paper, we discuss the process by which investigators can translate behavioral interventions for social media delivery. We present a model that describes the steps and decision points in this process, including the necessary training and reporting requirements. We also discuss issues pertinent to social media-delivered interventions, including cost, scalability, and privacy. Finally, we identify areas of research that are needed to optimize this emerging behavioral intervention modality.