The role of social influencers for effective public health communication

The Emerging Landscape of Social Media Influencers in Public Health Collaborations: A Scoping Review

Social media content creators or "influencers" are an increasingly influential voice in the public discourse generally, including global perceptions and practices related to health. In response, public health entities are increasingly embracing social media influencers (SMIs) as potential health promotion collaborators. Despite burgeoning interest in the potential of these partnerships, research evaluating this strategy remains limited. To address this gap, we conducted a scoping review to characterize and describe the current landscape of health promotion collaborations with SMIs with a focus on current practices. A search of six electronic databases (PubMed, SCOPUS, Communication & Mass Media Complete, CINAHL Plus, Web of Science, and APA PsycINFO) revealed wide-ranging and inconsistent approaches to these partnerships, including their optimal practices, data reported, and their evaluation criteria. Among the 658 articles initially identified, 15 publications met our inclusion criteria, spanning 7 countries, 8 social media platforms, 11 distinct health topics, and 21 different outcome measures. Basic information necessary for comparing across interventions was often lacking. We noted a lack of consensus on what constitutes an SMI with 53% of included studies lacking any definition or criteria. Although SMIs offer substantial promise as an emerging opportunity for health promotion, particularly for populations that may be otherwise difficult to identify or reach, this review highlights how the current lack of standardized methodologies and metrics prevents meaningful comparisons between collaborations and evaluations of their effectiveness. Based on these findings, we propose four key criteria to aid practitioners in the implementation and evaluation of SMI collaborations.

Health promotion campaigns using social media: association rules mining and co-occurrence network analysis of Twitter hashtags

BACKGROUND

Social media hashtags play a significant role in increasing the visibility of health information by making it easier for people to explore health-related content. Health promotion campaigns use campaign-specific hashtags to disseminate health-related messages, enabling individuals to access accurate and timely resources and updates. The study aims to discover patterns of connection between hashtags and identify the most influential hashtags used on Twitter in the American Heart Month campaigns.

METHOD

We collected a total of 73,288 tweets containing #AmericanHeartMonth between January 2019 and March 2023 and retrieved 18,143 original tweets, 42,930 retweets, 2,519 quotes, and 20,846 likes related to the past five campaigns. We adapted co-occurrence network analysis to explore the patterns of relationships between hashtags and association rules mining to assess the quality and strength of association between the co-occurred hashtags.

RESULT

While #AmericanHeartMonth, #OurHearts, and #HeartMonth play central roles in all hashtag co-occurrence networks, the results of association rules mining indicate a significant association of #OurHearts within the networks. The highest density of hashtags has been observed in the quoted tweets, introducing a new range of hashtags such as #GoRedForWomen, #WearRedDay, #HeartDisease, and #HeartHealth by Twitter users, indicating the positive correlation between co-occurring hashtags and users' engagement. The results of quality measurements of association rules (Lift > 1) indicate positive relationships between the co-occurred hashtags in the top 5 rules in all data subsets.

CONCLUSION

We employed co-occurrence network analysis and association rules mining as powerful techniques to identify influential hashtags that may have a central role in health-related discussions and drive engagement within the co-occurrence hashtag network. In conclusion, we recommend additional hashtag structures in conjunction with heart health-related topics to improve community building and the effectiveness of disseminating messages in future heart health promotion campaigns. The study contributes to knowledge and practice by offering a structured and data-driven approach and providing practical guidance for public health practitioners, professionals, and organisations to optimise content, targeting, and messaging to reach and engage a broader audience with health-related information.

From infodemic to resilience: Exploring COVID-19 protective measures in armed-conflict zone

The proliferation of inaccurate and misleading information about COVID-19 on social media poses a significant public health concern. This study examines the impact of the infodemic and beneficial information on COVID-19 protective behaviors in an armed-conflict country. Using the protective action decision model (PADM), data were collected from 1439 participants through a questionnaire in Yemen between August 2020 and April 2021. Structural equation modeling tested hypotheses generated by the PADM. The findings indicate that the infodemic reduces the likelihood of individuals adopting protective measures against COVID-19. Surprisingly, official announcements by accountable authorities do not moderate the relationship between the infodemic and protective responses. These results highlight the need for further research on resilience in armed-conflict countries. This study contributes to understanding armed-conflict countries' unique challenges in combating health crises. Addressing the infodemic and promoting accurate information is crucial in enhancing protective behaviors and mitigating the negative impact of misinformation. Policymakers and public health authorities can utilize these insights to develop targeted interventions and communication strategies that ensure accurate information dissemination and encourage the adoption of adequate protective measures.

Parenting Information on Social Media: Systematic Literature Review

BACKGROUND

Social media has become extremely popular among parents to seek parenting information. Despite the increasing academic attention to the topic, studies are scattered across various disciplines. Therefore, this study broadens the scope of the existing reviews by transcending narrow academic subdomains and including all relevant research insights related to parents' information seeking on social media and its consequent effects.

OBJECTIVE

The aims of this systematic literature review were to (1) identify influential journals and scholars in the field; (2) examine the thematic evolution of research on parenting and social media; and (3) pinpoint research gaps, providing recommendations for future exploration.

METHODS

On the basis of a criteria for identifying scholarly publications, we selected 338 studies for this systematic literature review. We adopted a bibliometric analysis combined with a content thematic analysis to obtain data-driven insights with a profound understanding of the predominant themes in the realm of parenting and social media.

RESULTS

The analysis revealed a significant increase in research on parenting and social media since 2015, especially in the medical domain. The studies in our review spanned 232 different research fields, and the most prolific journal was JMIR Pediatrics and Parenting. The thematic analysis identified 4 emerging research themes in the studies: parenting motivations to seek information, nature of parenting content on social media, impact of parenting content, and interventions for parents on social media.

CONCLUSIONS

This study provides critical insights into the current research landscape of parenting and social media. The identified themes, research gaps, and future research recommendations provide a foundation for future studies, guiding researchers toward valuable areas for exploration.

Racial Biases Associated With Pulse Oximetry: Longitudinal Social Network Analysis of Social Media Advocacy Impact

BACKGROUND

Pulse oximetry is a noninvasive method widely used in critical care and various clinical settings to monitor blood oxygen saturation. During the COVID-19 pandemic, its application for at-home oxygen saturation monitoring became prevalent. Further investigations found that pulse oximetry devices show decreased accuracy when used on individuals with darker skin tones. This study aimed to investigate the influence of X (previously known as Twitter) on the dissemination of information and the extent to which it raised health care sector awareness regarding racial disparities in pulse oximetry.

OBJECTIVE

This study aimed to explore the impact of social media, specifically X, on increasing awareness of racial disparities in the accuracy of pulse oximetry and to map this analysis against the evolution of published literature on this topic.

METHODS

We used social network analysis drawing upon Network Overview Discovery and Exploration for Excel Pro (NodeXL Pro; Social Media Research Foundation) to examine the impact of X conversations concerning pulse oximetry devices. Searches were conducted using the Twitter Academic Track application programming interface (as it was known then). These searches were performed each year (January to December) from 2012 to 2022 to cover 11 years with up to 52,052 users, generating 188,051 posts. We identified the nature of influencers in this field and monitored the temporal dissemination of information about social events and regulatory changes. Furthermore, our social media analysis was mapped against the evolution of published literature on this topic, which we located using PubMed.

RESULTS

Conversations on X increased health care awareness of racial bias in pulse oximetry. They also facilitated the rapid dissemination of information, attaining a substantial audience within a compressed time frame, which may have impacted regulatory action announced concerning the investigation of racial biases in pulse oximetry. This increased awareness led to a surge in scientific research on the subject, highlighting a growing recognition of the necessity to understand and address these disparities in medical technology and its usage.

CONCLUSIONS

Social media platforms such as X enabled researchers, health experts, patients, and the public to rapidly share information, increasing awareness of potential racial bias. These platforms also helped connect individuals interested in these topics and facilitated discussions that spurred further research. Our research provides a basis for understanding the role of X and other social media platforms in spreading health-related information about potential biases in medical devices such as pulse oximeters.

Health-Related Communication of Social Media Influencers: A Scoping Review

Social media influencers (SMIs) are an essential part of today's digital media landscape and have the ability to significantly impact the health-related attitudes and behavior of their audiences. Despite an increasing number of studies, research has produced mixed results, and a comprehensive overview of the main findings is lacking. Therefore, the goal of this scoping review was to comprehensively map the literature focusing on SMIs and their health-related communication. Specifically, we analyzed the most frequently studied health topics and social media platforms, the methodological characteristics of the studies, as well as the communication techniques employed by SMIs, and the potential positive and negative effects of their communication on their audience. Additionally, we examined the major research gaps in this area. Altogether, we analyzed n = 116 empirical papers. The results reveal a wide range of different outcomes influenced by SMIs, including both positive and negative changes in health-related attitudes and behavioral intentions among their followers. Furthermore, our findings highlight the need for future research to prioritize experimental and longitudinal studies, investigate actual behavioral outcomes resulting from influencer content exposure, and closely examine the potential negative effects of SMIs' health-related communication. More attention needs to be paid to health-related misinformation disseminated by SMIs. Lastly, this study identified several highly relevant health topics and social media platforms that should be the focus of future research.

Exposure to user-generated e-cigarette content on social media associated with greater vulnerability to e-cigarette use among youth non-users

INTRODUCTION

Social media are important venues for youth's exposure to e-cigarette content. This study examined how exposure to user-generated e-cigarette content (i.e., content created and shared by individual social media users) is associated with vulnerabilities to e-cigarette use among youth non-users.

METHODS

We pooled data from the 2021 and 2022 National Youth Tobacco Survey. Youth who have never used e-cigarettes were included. Weighted linear and logistic regressions were conducted to examine how exposure to user-generated e-cigarette content (from real-life friends, online-only friends, and celebrities/influencers) on social media was associated with e-cigarette use vulnerabilities measured by perceived norms, perceived risk, and susceptibility of use, controlling for demographics, advertising exposure, and mental health conditions. Multiple imputations were performed to account for missing data.

RESULTS

Exposure to e-cigarette content on social media posted by real-life friends, online-only friends, and celebrities/influencers were associated with more positive descriptive norm (βs = 1.56, 0.37, and 0.35, respectively, all ps < .001), more positive injunctive norm (βs = 0.46, 0.19, and 0.10, respectively, all ps < .001), and higher odds of e-cigarette use susceptibility (ORs = 1.48, 1.50. 1.29, respectively, all ps < .001). Exposure to content posted by real-life and online-only friends were associated with reduced risk perception of e-cigarette use (β = -0.04, p < 0.05 and β = -0.07, p < 0.001).

CONCLUSIONS

Our study highlighted that friends and celebrities/influencers are important sources on social media that can influence youth non-users' vulnerabilities to e-cigarette use. Interventional messages communicated through friends and influencers on social media may in turn help reduce e-cigarette vulnerability among youth non-users.

Black social media influencers engage higher percentages of Black gay and bisexual men in online outreach for HIV prevention research relative to paid ads

Background

Influencer-based social media marketing campaigns are a popular strategy to engage customers in many non-research industries (e.g., retail), but have been increasingly used in public health campaigns to reach and engage specific populations. However, few studies have directly compared the performance of influencer-based marketing with other ad strategies (e.g., paid ads) in achieving these goals.

Methods

From March to September 2023, we conducted an influencer-focused marketing campaign in which we identified and partnered with predominantly Black LGBTQ + influencers in the United States South to promote engagement in our ongoing research. We then used web analytics and interest form data to compare performance of influencer posts versus paid ads over the same time period.

Results

We contacted a total of 358 influencers, 20 of whom ultimately agreed to post (85% Black/African American) and made a total of 28 posts on our behalf. A significantly higher percentage of users who clicked through influencer posts were Black (40% vs. 15%), were not currently using pre-exposure prophylaxis (PrEP) (67% vs. 62%), had no history of PrEP use (78% vs. 72%), and reported higher medical mistrust (12% vs. 8%) compared to those who clicked through paid ads. The percentage of Black men who have sex with men who were at high HIV risk, who were not taking PrEP, had no history of PrEP, or were high in mistrust, were all 2-3 times higher among those who clicked through influencer posts relative to paid ads.

Conclusions

Influencer-focused marketing may be a powerful tool to efficiently reach and engage high-priority and hard to reach populations.

Factors influencing women to accept diet and exercise messages on social media during COVID-19 lockdowns: A qualitative application of the health belief model

This study investigates how engagement with social media leads women to adopt diet and exercise practices. We base our analysis on qualitative research, including surveys and in-depth interviews, with thirty (30) Australian women aged 18-35 years between April and August 2021. Our findings reveal how healthism discourse on social media, namely Facebook, Instagram and TikTok, underpin the adoption of diet and exercise practices by enhancing experiences of digital intimacy, repeat messages and personal testimonials from other women, and supporting new routines during COVID-19 lockdowns. This article contributes to health marketing literature by providing critical knowledge about women's experiences that prompt and shape complex ideologies of health that are often masked through diet and exercise practices on social media.

TikTok and Attention-Deficit/Hyperactivity Disorder: A Cross-Sectional Study of Social Media Content Quality

OBJECTIVES

Social media platforms are increasingly being used to disseminate mental health information online. User-generated content about attention-deficit/hyperactivity disorder (ADHD) is one of the most popular health topics on the video-sharing social media platform TikTok. We sought to investigate the quality of TikTok videos about ADHD.

METHOD

The top 100 most popular videos about ADHD uploaded by TikTok video creators were classified as misleading, useful, or personal experience. Descriptive and quantitative characteristics of the videos were obtained. The Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V) and Journal of American Medical Association (JAMA) benchmark criteria were used to assess the overall quality, understandability, and actionability of the videos.

RESULTS

Of the 100 videos meeting inclusion criteria, 52% (n = 52) were classified as misleading, 27% (n = 27) as personal experience, and 21% (n = 21) as useful. Classification agreement between clinician ratings was 86% (kappa statistic of 0.7766). Videos on the platform were highly understandable by viewers but had low actionability. Non-healthcare providers uploaded the majority of misleading videos. Healthcare providers uploaded higher quality and more useful videos, compared to non-healthcare providers.

CONCLUSIONS

Approximately half of the analyzed TikTok videos about ADHD were misleading. Clinicians should be aware of the widespread dissemination of health misinformation on social media platforms and its potential impact on clinical care.

Evaluating the elevation of authoritative health content online during the COVID-19 pandemic

Purpose

To respond to the COVID-19 “infodemic” and combat fraud and misinformation about the virus, social media platforms coordinated with government healthcare agencies around the world to elevate authoritative content about the novel coronavirus. These public health authorities included national and global public health organisations, such as the Centers for Disease Control and Prevention (CDC) and the World Health Organisation (WHO). In this article, the authors evaluate the effectiveness of this strategy by asking two key questions: (1) Did people engage with authoritative health content on social media? (2) Was this content trusted?

Design/methodology/approach

The authors explore these issues by drawing on data from a global online questionnaire on “Public Trust in Experts” (n = 429) conducted during the initial phase of the pandemic in May 2020, a crucial period when reliable information was urgently required to influence behaviour and minimise harm.

Findings

The authors found that while the majority of those surveyed noticed authoritative health content online, there remained significant issues in terms of Internet users trusting the information shared by government healthcare agencies and public health authorities online.

Originality/value

In what follows, the authors examine the role of trust in implementing this novel public health strategy and assess the capacity for such policies to reduce individual and social harm.

Peer review

The peer review history for this article is available at: https://publons.com/publon/10.1108/OIR-12-2021-0655