COVID-19 on TikTok: harnessing an emerging social media platform to convey important public health messages

#Bartender: portrayals of popular alcohol influencer's videos on TikTok©

BACKGROUND

Despite widespread use of the short-video social media platform TikTok©, limited research investigates how alcohol is portrayed on the platform. Previous research suggests that a driver of alcohol content on TikTok©, in part, comes from bartenders demonstrating how to make drinks. This study aims to explore the characterizing patterns of how bartender influencers on TikTok© feature and incorporate alcohol in their videos.

METHODS

We identified the global top 15 most followed bartenders on TikTok© in 2021 (cumulative 29.7 million subscribers) and the videos they posted in November and December 2021, the period just before Christmas and New Year, when alcohol tends to be more marketed than in other periods. The videos were coded based on five criteria: (1) the presence of alcohol or not; (2) alcohol categories; (3); alcohol brand(s) if visible; (4) the presence of candies and other sweet products; (5) presence of cues that refer to young people's interests.

RESULTS

In total, we identified 345 videos, which received 270,325,600 views in total, with an average of 18,021,707 views per video. Among these 345 videos, 92% (n = 317) displayed alcohol in their cocktail recipes (249,275,600 views, with an average of 786,358 views). The most common types of alcohol present in videos were liquor, vodka, rum, and whiskey, all of which are high-ABV beverages. 73% (n = 230) displayed or mentioned an alcohol brand. 17% (n = 55) associated alcohol with sweet products such as different types of candy (53,957,900 views, with an average of 981,053 views per video). 13% (n = 43) contained cues appealing to young people (e.g., cartoons, characters) (15,763,300 views, with an average of 366,588 views per video).

CONCLUSIONS

Our findings suggest a large presence of positively framed alcohol content posted by popular bartenders on TikTok©. As exposure to digital marketing is related to an increase in alcohol consumption, particularly among young people, regulations are needed to protect the public from alcohol-related harms.

TikTok as a Source of Health Information and Misinformation for Young Women in the United States: Survey Study

BACKGROUND

TikTok is one of the most-used and fastest-growing social media platforms in the world, and recent reports indicate that it has become an increasingly popular source of news and information in the United States. These trends have important implications for public health because an abundance of health information exists on the platform. Women are among the largest group of TikTok users in the United States and may be especially affected by the dissemination of health information on TikTok. Prior research has shown that women are not only more likely to look for information on the internet but are also more likely to have their health-related behaviors and perceptions affected by their involvement with social media.

OBJECTIVE

We conducted a survey of young women in the United States to better understand their use of TikTok for health information as well as their perceptions of TikTok's health information and health communication sources.

METHODS

A web-based survey of US women aged 18 to 29 years (N=1172) was conducted in April-May 2023. The sample was recruited from a Qualtrics research panel and 2 public universities in the United States.

RESULTS

The results indicate that the majority of young women in the United States who have used TikTok have obtained health information from the platform either intentionally (672/1026, 65.5%) or unintentionally (948/1026, 92.4%). Age (959/1026, 93.47%; r=0.30; P<.001), education (959/1026, 93.47%; ρ=0.10; P=.001), and TikTok intensity (ie, participants' emotional connectedness to TikTok and TikTok's integration into their daily lives; 959/1026, 93.47%; r=0.32; P<.001) were positively correlated with overall credibility perceptions of the health information. Nearly the entire sample reported that they think that misinformation is prevalent on TikTok to at least some extent (1007/1026, 98.15%), but a third-person effect was found because the young women reported that they believe that other people are more susceptible to health misinformation on TikTok than they personally are (t1025=21.16; P<.001). Both health professionals and general users were common sources of health information on TikTok: 93.08% (955/1026) of the participants indicated that they had obtained health information from a health professional, and 93.86% (963/1026) indicated that they had obtained health information from a general user. The respondents showed greater preference for health information from health professionals (vs general users; t1025=23.75; P<.001); the respondents also reported obtaining health information from health professionals more often than from general users (t1025=8.13; P<.001), and they were more likely to act on health information from health professionals (vs general users; t1025=12.74; P<.001).

CONCLUSIONS

The findings suggest that health professionals and health communication scholars need to proactively consider using TikTok as a platform for disseminating health information to young women because young women are obtaining health information from TikTok and prefer information from health professionals.

Myopia information on TikTok: analysis factors that impact video quality and audience engagement

BACKGROUND

TikTok is emerging as a vital platform for health information dissemination. Despite myopia being a global public health issue, the high-quality myopia information shared by health educators often fails to go viral. It is imperative to analyze the factors influencing video quality and popularity, especially from diverse perspectives of researchers, health educators, and audiences.

METHODS

TikTok myopia-related videos were retrieved using TikTok's default comprehensive search (DCS) and most liked search (MLS) strategies. Venn diagrams were employed to illustrate the relationships and commonalities between the two strategies across four sample sizes (top 200, 150, 100, and 50). Video metadata, including details such as creator information, production properties, upload time, video duration, and viewer engagement, were collected. Video quality was assessed using the DISCERN tool. Video content covering six aspects of myopia were evaluated. The impact of search strategies, video sample sizes, production properties, and myopia content on video quality and audience engagement was analyzed through single-factor or multi-factor analysis.

RESULTS

DCS and MLS retrieval strategies, as well as varying sample sizes, resulted in differences in audience engagement for myopia videos (P < 0.039), while The DISCERN quality scores remained comparable (P > 0.221). Videos published by healthcare professionals (HCPs) and non-profit organizations (NPOs) were associated with high-quality (P ≤ 0.014) but comparatively lower popularity (P < 0.033). Videos that reported contents of risk factors, management, and outcomes showed high popularity (P < 0.018), while longer video duration (> 60s) exhibited the opposite trend (P < 0.032). Content on myopia evaluation (P ≤ 0.001) and management (P ≤ 0.022) and video duration were positively correlated with higher DISCERN quality.

CONCLUSION

Videos created by HCPs and NPOs deserve greater attention. Rather than pursuing entertaining effects, professional educators should emphasize producing concise, and high-quality myopia content that readily resonates with the audience and has the potential to go viral on the platform.

A conceptional model integrating geographic information systems (GIS) and social media data for disease exposure assessment

Although previous studies have acknowledged the potential of geographic information systems (GIS) and social media data (SMD) in assessment of exposure to various environmental risks, none has presented a simple, effective and user-friendly tool. This study introduces a conceptual model that integrates individual mobility patterns extracted from social media, with the geographic footprints of infectious diseases and other environmental agents utilizing GIS. The efficacy of the model was independently evaluated for selected case studies involving lead in the ground; particulate matter in the air; and an infectious, viral disease (COVID- 19). A graphical user interface (GUI) was developed as the final output of this study. Overall, the evaluation of the model demonstrated feasibility in successfully extracting individual mobility patterns, identifying potential exposure sites and quantifying the frequency and magnitude of exposure. Importantly, the novelty of the developed model lies not merely in its efficiency in integrating GIS and SMD for exposure assessment, but also in considering the practical requirements of health practitioners. Although the conceptual model, developed together with its associated GUI, presents a promising and practical approach to assessment of the exposure to environmental risks discussed here, its applicability, versatility and efficacy extends beyond the case studies presented in this study.

Adapting to Lockdown: Exploring Stress Coping Strategies on Short Video Social Media During the COVID-19 Pandemic

Introduction

The study addresses a gap in research on media use during the COVID-19 pandemic, focusing on the overlooked role of short video social media platforms in stress management. It builds on transactional stress model and coping flexibility to advance the understanding of the strategy-situation fit, particularly the alignment of coping strategies with platform affordances.

Methods

Our study investigated the detailed use of short video platforms and coping strategies during the pandemic lockdown through an online survey of 1569 respondents conducted immediately after the lockdown. We characterized lockdown duration as a situational stressor attribute and explored variations in the coping process. Assessing changes in user behavior across the top four Chinese short video platforms, we examined anxiety induced by lockdown and the use of problem-focused and emotion-focused coping strategies.

Results

Significant changes in user behavior in response to lockdown-induced stress were observed. Structural model analyses reveal that people employed both coping strategies to manage heightened anxiety, primarily through increased viewing behavior over interaction behavior.

Discussion

The findings underscore the positive implications of short video platforms on individual well-being. This study argues for a deeper research focus on coping flexibility within the realm of social media, accompanied by a comprehensive assessment of platform user behavior. Future research should also consider the influence of algorithms on platform functionality.

Reproductive Health Experiences Shared on TikTok by Young People: Content Analysis

BACKGROUND

TikTok is a popular social media platform that allows users to create and share content through short videos. It has become a place for everyday users, especially Generation Z users, to share experiences about their reproductive health. Owing to its growing popularity and easy accessibility, TikTok can help raise awareness for reproductive health issues as well as help destigmatize these conversations.

OBJECTIVE

We aimed to identify and understand the visual, audio, and written components of content that TikTok users create about their reproductive health experiences.

METHODS

A sampling framework was implemented to narrow down the analytic data set. The top 6 videos from each targeted hashtag (eg, #BirthControl, #MyBodyMyChoice, and #LoveYourself) were extracted biweekly for 16 weeks (July-November 2020). During data collection, we noted video characteristics such as captioning, music, likes, and cited sources. Qualitative content analysis was performed on the extracted videos.

RESULTS

The top videos in each hashtag were consistent over time; for example, only 11 videos appeared in the top 6 category for #BirthControl throughout the data collection. Most videos fell into 2 primary categories: personal experiences and informational content. Among the personal experiences, people shared stories (eg, intrauterine device removal experiences), crafts (eg, painting their pill case), or humor (eg, celebrations of the arrival of their period). Dancing and demonstrations were commonly used in informational content.

CONCLUSIONS

TikTok is used to share messages on myriad reproductive health topics. Understanding users' exposure provides important insights into their beliefs and knowledge of sexual and reproductive health. The study findings can be used to generate valuable information for teenagers and young adults, their health care providers, and their communities. Producing health messages that are both meaningful and accessible will contribute to the cocreation of critical health information for professional and personal use.

Unvaccinated Adolescents' COVID-19 Vaccine Intentions: Implications for Public Health Messaging

PURPOSE

COVID-19 vaccine uptake remains low for US adolescents and contributes to excess morbidity and mortality. Most research has assessed parental intention to vaccinate their children. We explored differences between vaccine-acceptant and vaccine-hesitant unvaccinated US adolescents using national survey data.

METHODS

A nonprobability, quota-based sample of adolescents, aged 13-17 years, was recruited through an online survey panel in April 2021. One thousand nine hundred twenty seven adolescents were screened for participation and the final sample included 985 responses. We assessed responses from unvaccinated adolescents (n = 831). Our primary measure was COVID-19 vaccination intent ("vaccine-acceptant" defined as "definitely will" get a COVID-19 vaccine and any other response classified as "vaccine-hesitant") and secondary measures included reasons for intending or not intending to get vaccinated and trusted sources of COVID-19 vaccine information. We calculated descriptive statistics and chi-square tests to explore differences between vaccine-acceptant and vaccine-hesitant adolescents.

RESULTS

Most (n = 831; 70.9%) adolescents were hesitant, with more hesitancy observed among adolescents with low levels of concern about COVID-19 and high levels of concern about side effects of COVID-19 vaccination. Among vaccine-hesitant adolescents, reasons for not intending to get vaccinated included waiting for safety data and having parents who would make the vaccination decision. Vaccine-hesitant adolescents had a lower number of trusted information sources than vaccine-acceptant adolescents.

DISCUSSION

Differences identified between vaccine-acceptant and vaccine-hesitant adolescents can inform message content and dissemination. Messages should include accurate, age-appropriate information about side effects and risks of COVID-19 infection. Prioritizing dissemination of these messages through family members, state and local government officials, and healthcare providers may be most effective.

The Reach and Accuracy of Information on Autism on TikTok

PURPOSE

Although social media platforms have made information about autism more accessible to the general public, concerns have been raised about the unfiltered nature of the content they host. In the current study, we examined the reach and accuracy of videos providing informational content about autism on TikTok, a popular social media platform.

METHODS

We examined engagement indicators (including views and "likes") for the TikTok videos associated with the #Autism hashtag. Two coders independently fact-checked informational content of the most viewed videos from the #Autism hashtag videos and coded it as either accurate, inaccurate or 'overgeneralization' based on the consistency of the information in the videos with current knowledge on autism.

RESULTS

Videos associated with the "#Autism" hashtag accrued 11.5 billion views collectively. An examination of the top 133 videos providing informational content on autism, which totaled 198.7 million views and 25.2 million likes, showed that 27% of the videos were classified as accurate, while 41% were classified as inaccurate and 32% as overgeneralized. There were no significant differences in engagement between accurate and inaccurate/overgeneralized videos. Videos created by healthcare professionals were more likely to include accurate information.

CONCLUSION

The informational content about autism made available on TikTok reaches a wide number of people. Most of the information provided, however, appears to be misaligned with current knowledge. It is important for healthcare providers and other professionals to be aware of the autism-related content being shared on TikTok so that they can better engage with the large community of TikTok users.

Exploring the vaccine conversation on TikTok in Italy: beyond classic vaccine stances

TikTok, a social media platform for creating and sharing short videos, has seen a surge in popularity during the COVID-19 pandemic. To analyse the Italian vaccine conversation on TikTok, we downloaded a sample of videos with a high play count (Top Videos), identified through an unofficial Application Programming Interface (consistent with TikTok's Terms of Service), and collected public videos from vaccine sceptic users through snowball sampling (Vaccine Sceptics' videos). The videos were analysed using qualitative and quantitative methods, in terms of vaccine stance, tone of voice, topic, conformity with TikTok style, and other characteristics. The final datasets consisted of 754 Top Videos (by 510 single users) plus 180 Vaccine Sceptics' videos (by 29 single users), posted between January 2020 and March 2021. In 40.5% of the Top Videos the stance was promotional, 33.9% were indefinite-ironic, 11.3% were neutral, 9.7% were discouraging, and 3.1% were ambiguous (i.e. expressing an ambivalent stance towards vaccines); 43% of promotional videos were from healthcare professionals. More than 95% of the Vaccine Sceptic videos were discouraging. Multiple correspondence analysis showed that, compared to other stances, promotional videos were more frequently created by healthcare professionals and by females, and their most frequent topic was herd immunity. Discouraging videos were associated with a polemical tone of voice and their topics were conspiracy and freedom of choice. Our analysis shows that Italian vaccine-sceptic users on TikTok are limited in number and vocality, and the large proportion of videos with an indefinite-ironic stance might imply that the incidence of affective polarisation could be lower on TikTok, compared to other social media, in the Italian context. Safety is the most frequent concern of users, and we recorded an interesting presence of healthcare professionals among the creators. TikTok should be considered as a medium for vaccine communication and for vaccine promotion campaigns.

COVID-19 messages targeting young people on social media: content analysis of Australian health authority posts

Health authorities utilized social media during the COVID-19 pandemic to disseminate critical and timely health messages, specifically targeting priority groups such as young people. To understand how social media was used for this purpose, we investigated the content of COVID-19-related social media posts targeting young people (16-29 years old) shared by Australian health departments. Posts targeting young people with COVID-19 information were extracted from all eight Australian State and Territory health department Facebook, Instagram and TikTok accounts over 1 month of the Delta outbreak (September 2021) and analysed thematically. In total, 238 posts targeting young people were identified from 1059 COVID-19 posts extracted. All eight health departments used Facebook, five used Instagram and only one used TikTok. The majority of posts implicitly targeted young people; only 14.7% explicitly mentioned age or 'young people'. All posts included accompanying visuals; 77% were still images like photos or illustrations whilst 23% were moving images like videos and GIFs. Communication techniques included calls to action (63% of posts), responsive communication (32% of posts) and positive emotional appeal (31% of posts). Social marketing techniques catering to young people were used to varying extents despite receiving higher levels of engagement; 45% featured emojis whilst only 16% used humour, 14% featured celebrities and 6% were memes. Priority groups like ethnic/cultural groups and chronic health/disability communities were rarely targeted in this communication. The findings indicate a lack of health communication on social media directed towards young people, highlighting an opportunity for increased use of platforms like TikTok and trends popular with young people online.

Does lower use of academic affiliation by university faculty in top U.S. newspapers contribute to misinformation about abortion?

BACKGROUND

University faculty are considered trusted sources of information to disseminate accurate information to the public that abortion is a common, safe and necessary medical health care service. However, misinformation persists about abortion's alleged dangers, commonality, and medical necessity.

METHODS

Systematic review of popular media articles related to abortion, gun control (an equally controversial topic), and cigarette use (a more neutral topic) published in top U.S. newspapers between January 2015 and July 2020 using bivariate analysis and logistic regression to compare disclosure of university affiliation among experts in each topic area.

RESULTS

We included 41 abortion, 102 gun control, and 130 smoking articles, which consisted of 304 distinct media mentions of university-affiliated faculty. Articles with smoking and gun control faculty experts had statistically more affiliations mentioned (90%, n = 195 and 88%, n = 159, respectively) than abortion faculty experts (77%, n = 54) (p = 0.02). The probability of faculty disclosing university affiliation was similar between smoking and gun control (p = 0.73), but between smoking and abortion was significantly less (Ave Marginal Effects - 0.13, p = 0.02).

CONCLUSIONS

Fewer faculty members disclose their university affiliation in top U.S. newspapers when discussing abortion. Lack of academic disclosure may paradoxically make these faculty appear less 'legitimate.' This leads to misinformation, branding abortion as a 'choice,' suggesting it is an unessential medical service. With the recent U.S. Supreme Court landmark decision, Dobbs v. Jackson Women's Health Organization, and subsequent banning of abortion in many U.S. states, faculty will probably be even less likely to disclose their university affiliation in the media than in the past.

Popular science and education of cosmetic surgery in China: Quality and reliability evaluation of Douyin short videos

BACKGROUND

Douyin APP is the short video APP with the largest number of users in China.

OBJECTIVE

This study aimed to evaluate the quality and reliability of short videos about cosmetic surgery on Douyin.

METHODS

In August 2022, we retrieved and screened 300 short videos related to cosmetic surgery from Douyin, extracted basic video information, encoded the content and identified the video source. The quality and reliability of short video information were evaluated using the DISCERN instrument.

RESULTS

A total of 168 short videos of cosmetic surgery were included in the survey, and the video sources included personal accounts and institutional accounts. Overall, the total proportion of institutional accounts (47/168, 27.98%) is significantly less than that of personal accounts (121/168, 72.02%); nonhealth professionals received the most praises, comments and even collections and reposts, while for-profit academic organizations or institutions received the least. The DISCERN scores of 168 short videos of cosmetic surgery were 3.74-4.58 (average 4.22). Content reliability (p = .04) and overall short video quality (p = .02) are significantly different, but short videos published from different sources have no significant difference in treatment selection (p = .052).

CONCLUSION

The overall information quality and reliability of short videos about cosmetic surgery on Douyin are satisfactory in China.

PATIENT OR PUBLIC CONTRIBUTION

The participants were involved in developing research questions, study design, management and conduct, interpretation of evidence and dissemination.

Quality of Information in Gallstone Disease Videos on TikTok: Cross-sectional Study

BACKGROUND

TikTok was an important channel for consumers to access and adopt health information. But the quality of health content in TikTok remains underinvestigated.

OBJECTIVE

Our study aimed to identify upload sources, contents, and feature information of gallstone disease videos on TikTok and further evaluated the factors related to video quality.

METHODS

We investigated the first 100 gallstone-related videos on TikTok and analyzed these videos' upload sources, content, and characteristics. The quality of videos was evaluated using quantitative scoring tools such as DISCERN instrument, the Journal of American Medical Association (JAMA) benchmark criteria, and Global Quality Scores (GQS). Moreover, the correlation between video quality and video characteristics, including duration, likes, comments, and shares, was further investigated.

RESULTS

According to video sources, 81% of the videos were posted by doctors. Furthermore, disease knowledge was the most dominant video content, accounting for 56% of all the videos. The mean DISCERN, JAMA, and GQS scores of all 100 videos are 39.61 (SD 11.36), 2.00 (SD 0.40), and 2.76 (SD 0.95), respectively. According to DISCERN and GQS, gallstone-related videos' quality score on TikTok is not high, mainly at fair (43/100, 43%,) and moderate (46/100, 46%). The total DISCERN scores of doctors were significantly higher than that of individuals and news agencies, surgery techniques were significantly higher than lifestyle and news, and disease knowledge was significantly higher than news, respectively. DISCERN scores and video duration were positively correlated. Negative correlations were found between DISCERN scores and likes and shares of videos. In GQS analysis, no significant differences were found between groups based on different sources or different contents. JAMA was excluded in the video quality and correlation analysis due to a lack of discrimination and inability to evaluate the video quality accurately.

CONCLUSIONS

Although the videos of gallstones on TikTok are mainly provided by doctors and contain disease knowledge, they are of low quality. We found a positive correlation between video duration and video quality. High-quality videos received low attention, and popular videos were of low quality. Medical information on TikTok is currently not rigorous enough to guide patients to make accurate judgments. TikTok was not an appropriate source of knowledge to educate patients due to the low quality and reliability of the information.

Biasing the neurocognitive processing of videos with the presence of a real cultural other

In the digital age, while short videos present vital events with powerful information, the presence of cultural cues may bias our processing of videos of foreign cultures. However, the underlying neurocognitive processes remain unclear. In this study, we hypothesized that cultural cues might bias video processing by either enhancing cultural perspective-taking or shifting cultural self-schema. To test these hypotheses, we used a novel paradigm in which the cultural cue was a real cultural other (the priming participants) who watched American/Chinese videos together with the primed participants. The results showed that when the cue was present, the right temporoparietal junction (rTPJ) response to videos with other cultural content was shifted, showing a priming effect. Moreover, the activity pattern in the rTPJ was more congruent with the primed culture than with the original culture, reflecting a neural biasing effect. Finally, intersubject representational similarity analysis indicated that the neural biasing effect in the rTPJ was more closely associated with cultural perspective-taking than with cultural self-schema. In summary, these findings support the perspective-taking hypothesis, suggesting that cultural cues can significantly bias our cultural mindset by altering cultural perspective-taking when we are exposed to culture-relevant naturalistic stimuli.

Using TikTok for public and youth mental health - A systematic review and content analysis

Globally, TikTok is now the fastest growing social media platform among children and young people; but it remains surprisingly under-researched in psychology and psychiatry. This is despite the fact that social media platforms have been subject to intense academic and societal scrutiny regarding their potentially adverse effects on youth mental health and wellbeing, notwithstanding the inconsistent findings across the literature. In this two part study, we conducted a systematic review concerning studies that have examined TikTok for any public health or mental health purpose; and a follow-up content analysis of TikTok within an Irish context. For study 1, a predetermined search strategy covering representative public and mental health terminology was applied to six databases - PSYCINFO, Google Scholar, PUBMED, Wiley, Journal of Medical Internet Research, ACM - within the period 2016 to 2021. Included studies were limited to English-speaking publications of any design where TikTok was the primary focus of the study. The quality appraisal tool by Dunne et al., (2018) was applied to all included studies. For study 2, we replicated our search strategy from study 1, and converted this terminology to TikTok hashtags to search within TikTok in combination with Irish-specific hashtags. As quantified by the app, the top two "most liked" videos were selected for inclusion across the following three targeted groups: official public health accounts; registered Irish charities; and personal TikTok creators. A full descriptive analysis was applied in both studies. Study 1 found 24 studies that covered a range of public and mental health issues: COVID-19 (n = 10), dermatology (n = 7), eating disorders (n = 1), cancer (n = 1), tics (n = 1), radiology (n = 1), sexual health (n = 1), DNA (n = 1), and public health promotion (n = 1). Studies were predominately from the USA, applied a content analysis design, and were of acceptable quality overall. In study 2, 29 Irish TikTok accounts were analysed, including the accounts of public health authorities (n = 2), charity or non-profit (n = 5), and personal TikTok creators (n = 22). The overall engagement data from these accounts represented a significant outreach to younger populations: total likes n = 2,588,181; total comments n = 13,775; and total shares n = 21,254. TikTok has been utilised for a range of public health purposes, but remains poorly engaged by institutional accounts. The various mechanisms for connecting with younger audiences presents a unique opportunity for youth mental health practitioners to consider, yet there were distinct differences in how TikTok accounts used platform features to interact. Overall, there is an absence of high quality mixed methodological evaluations of TikTok content for public and mental health, despite it being the most used platform for children and young people.

Clearness qualitative comparative analysis of the spread of TikTok health science knowledge popularization accounts

Objective

This study analyzed the popularity of TikTok health knowledge popularization accounts with the objective of creating a template for accounts suited to widely disseminating information, thereby enhancing the public's access to health knowledge on a broader scale.

Methods

This study is based on 40 Chinese TikTok short video accounts that were active from February to April 2022 and were engaged in health science popularization. Data were validated by structured calibration using three qualitative anchors. It employs the "content-context" and the elaboration likelihood models as the theoretical framework. A qualitative comparative analysis is used to explore the factors affecting the popularity of this type of account mechanism.

Results

Among the nine variables involved in the calculation, one reached 0.909091, demonstrating that the number of followers was both a necessary factor and a condition for the popularity of short health science video accounts. There were 16 paths in the complex solution with a consistency of 1, and their overall coverage reached 0.878788, indicating that approximately 87% of the cases could be explained. From the spread of the content and communication situation, professional medical knowledge, current hot topics, professionals, and serious issues were the most likely combinations for rapid spread. From the perspective of the central and edge paths, "likes" exceeding 100,000 and fans exceeding 1 million were essential combinations.

Conclusions

The dissemination of medical knowledge has gained significant traction, especially with regard to trending and popular topics. When it comes to the tone of communication, a serious style proved effective in fostering what can be termed "hot communication." From the standpoint of central and peripheral paths, it is crucial that the number of likes in the past month and the total number of fans surpass 100,000 and one million, respectively.

Social Media Depictions of Cochlear Implants: An Instagram and TikTok Analysis

OBJECTIVE

To identify populations of authors who post about cochlear implants (CIs) on Instagram and TikTok, to illustrate the content of these posts, and to elucidate factors that might help surgeons better educate CI patients.

STUDY DESIGN

Qualitative study.

SETTING

Instagram and TikTok social media platforms.

PATIENTS

All public social media posts identified with the search terms below. Posts were excluded if unrelated to CIs or if written in a non-English language.

INTERVENTION

Instagram and TikTok were searched for posts from March 2021 through September 2021 with the search terms #cochlearimplant, #cochlearimplants, #cochlearimplantkids, #cochlearkids, and #cochlearfamily.

MAIN OUTCOME MEASURES

Posts were subclassified and analyzed for content including topics of posts, authorship, timeframe of posts, depiction of CIs, and popularity.

RESULTS

Of 1,942 posts included in the final analysis, 1,400 were found on Instagram and 542 on TikTok. Authors were mostly patients (n = 771, 39.7%), companies (n = 568, 29.2%), and patients' family members (n = 482, 24.8%). Only 21 posts were made by physicians (1.1%). Out of 379 total educational posts examined, patients themselves were the most common authors (n = 219, 57.8%) followed by patients' family members (n = 139, 36.7%). Physicians authored only a small fraction of all educational posts (n = 19, 5.0%).

CONCLUSIONS

This study showed minimal physician involvement in the CI social media spheres of Instagram and TikTok. In addition, there were few educational posts on either platform, revealing ample opportunity for physicians to become more involved with CI social media.

How TikTok Is Being Used to Help Individuals Cope With Breast Cancer: Cross-sectional Content Analysis

BACKGROUND

Acknowledging the popularity of TikTok, how quickly medical information can spread, and how users seek support on social media, there is a clear lack of research on breast cancer conversations on TikTok. There is a paucity of information on how these videos can advocate for those impacted by breast cancer as a means to provide support and information as well as raise awareness.

OBJECTIVE

The purpose of this cross-sectional content analysis was to describe the content of videos from the hashtag #breastcancer on TikTok. Content related to breast cancer support and coping, cancer education, and heightening the awareness of breast cancer early detection, prevention, and treatment was evaluated.

METHODS

This study included 100 of the most viewed TikTok videos related to breast cancer through June 30, 2022. Videos were excluded if they were not in the English language or relevant to the topic being studied. Content was deductively coded into categories related to video characteristics and content topics using a screener based on expert breast cancer information sheets. Univariable analyses were conducted to evaluate differences in video characteristics and content when stratified as advocating or not advocating for breast cancer (yes or no) support, education, and awareness.

RESULTS

The cumulative number of views of the videos included in this study was 369,504,590. The majority (n=81, 81%) of videos were created by patients and loved ones of individuals with breast cancer, and the most commonly discussed topic was breast cancer support (n=88, 88%), followed by coping with the myriad issues surrounding breast cancer (n=79, 79%). Overall, <50% of the videos addressed important issues such as body image (n=48, 48%), surgery (n=46, 46%), medication and therapy (n=41, 41%), or the stigma associated with a breast cancer diagnosis (n=44, 44%); however, in videos that were advocacy oriented, body image (40/62, 64% vs 8/38, 21%; P<.001), stigma associated with breast cancer (33/62, 53% vs 11/38, 29%; P=.02), and breast cancer surgery (36/62, 58% vs 10/38, 26%; P=.002) were discussed significantly more often than in videos that did not specifically advocate for breast cancer.

CONCLUSIONS

The use of videos to display health journeys can facilitate engagement by patients, family members, and loved ones interested in information about challenging conditions. Collectively, these findings highlight the level of peer-to-peer involvement on TikTok and may provide insights for designing breast cancer educational campaigns.

TikTok Tourette's: Are We Witnessing a Rise in Functional Tic-Like Behavior Driven by Adolescent Social Media Use?

Perceptions of Tourette syndrome (TS) and tic disorders are often driven by social media. During the COVID-19 pandemic, social media consumption greatly increased, particularly in the adolescent population. In parallel with increased social media consumption, there has also been an increase in tic severity and functional tic-like behavior (FTLB). Given that many of the tic videos posted on social media are misleading, perpetuate false beliefs about TS, or reinforce tic-like behaviors, there is increasing concern that these videos are driving the rapid increase in FTLBs. Several studies have reviewed newly presenting cases of FTLB and have found shared characteristics, including that a higher proportion of affected individuals are female, there is a low proportion with a history of childhood or family tics, and symptom onset is typically acute and develops in the teenage years. In addition, the quality of the tics seen in association with FTLB mirrors many of the tics seen on popular social media channels, with higher rates of coprophenomena, tic attacks, and involvement of the trunk and extremities than is seen with typical tics. FTLBs are likely a specific subgroup of functional tics largely influenced by the portrayal of and growing popularity of functional tics posted on social media during the COVID-19 pandemic. However, several factors, including increased anxiety, social isolation, and social media use in general during the pandemic are likely also contributing factors to the surge of FTLBs seen recently. In this era of increased social media consumption, it will become increasingly important for clinicians to educate patients about where and how medical information is spread, to ensure the best possible diagnosis, treatment, and outcomes for patients.

How public health agencies communicate with the public on TikTok under the normalization of COVID-19: A case of 2022 Shanghai's outbreak

Objective

As life with COVID-19 became a norm in 2022, the public's demand for and perception of COVID-19-related information has changed. This study analyzed the performance and responses of Healthy China and the public at various stages of COVID-19 normalization using the crisis and emergency risk communication (CERC) theory.

Methods

This study was based on the 2022 Shanghai COVID-19 outbreak and data from "Healthy China," the official TikTok account of the National Health Commission of the People's Republic of China (NHCC). First, we divided the Shanghai lockdown into five stages in accordance with the CERC. Second, the videos released by Healthy China were open-coded. Third, to understand the distribution of strategies across the stages, we used counts and percentages to summarize the categorical variables. Fourth, we investigated the distribution of public participation indicators using descriptive statistical analysis. Finally, the relationship between stage and communication strategy was examined using the chi-square test and negative binomial regression.

Results

(1) Healthy China adopted a more flexible approach to communication strategies; (2) new cases per day was the commonly used substrategy for uncertainty reduction; (3) there was a significant difference in the strategies used by Healthy China at different stages; (4) public participation was highest in the pre-crisis period; and (5) the stage had a significant positive impact on the number of views, favorites, likes, and shares.

Conclusions

This research provides insight into effective communication strategies for the government or public health agencies to employ during COVID-19 normalization.

Social media disorder during community quarantine: A mixed methods study among rural young college students during the COVID-19 pandemic

PURPOSE

This study sought to identify determinants of social media disorder (SMD) and describe the social media engagement among rural young (18 to 24 years old) college students during long periods of community quarantine due to COVID-19.

METHODS

This mixed methods study draws from a sample of 500 students from rural Luzon, Philippines. Quantitative and qualitative data collection were done via online survey.

RESULTS

Findings reveal that 24.2 % of the respondents have SMD. Students who are from below middle-income households, and are active on Tiktok have greater odds for SMD. Qualitative analysis of narratives of students with SMD (n = 121) reveal the beneficial and negative impacts of social media.

CONCLUSIONS

Results highlight how social position, and uses and gratifications of social media can facilitate development of SMD.

The effect of a short, animated story-based video on COVID-19 vaccine hesitancy: A study protocol for an online randomized controlled trial

Introduction

Exposure to a high volume of vaccine misinformation on social media can have a negative effect on vaccine confidence and rates. To counteract misinformation, we designed a collage of three short, animated story-based (SAS) videos to convey scientifically informed and accessible information about COVID-19 vaccine applicable to a social media context.

Methods and analysis

We will conduct an online randomized controlled trial primarily to: (1) determine the effectiveness of SAS videos in improving COVID-19 vaccine knowledge; (2) evaluate the effectiveness of SAS videos in increasing behavioral intent for COVID-19 vaccination; and (3) quantify people's interest in watching SAS videos about the COVID-19 vaccine. We also aim to identify barriers and facilitators to COIVD-19 vaccinations that have been shown to minimize vaccine hesitancy between vaccinated and unvaccinated populations. Using a web-based recruitment platform, a total of 10,000 adults from the United States will be recruited and randomly assigned to (1) a SAS video collage arm, (2) an attention placebo control video arm, or (3) no intervention arm (1:1:1). Furthermore, we will measure behavioral intent to obtain information on vaccination regarding COVID-19. At the end of the trial, participants randomized to arm 2 and arm 3 will be given the option of watching one of the intervention videos voluntarily to assess participant engagement with SAS videos. Finally, we will assess individual factors associated with vaccine hesitancy - hope, optimism, COVID-19 perceived risks and benefits, self-efficacy, perceived social norms, and trust - and compare vaccinated and unvaccinated participants across the three arms.

Discussions

Evidence-based information from official channels can be complex and inaccessible to the general public, whereas false information on social media is frequently shared in brief postings, images, or videos that can easily reach the general public, thereby rapidly disseminating (mis-)information. To avoid the spread of misinformation, social media may be used to deliver evidence-based and emotionally compelling information in a readily accessible format in order to pre-empt misinformation. Our findings may help inform future SAS efforts addressing COVID-19 and other important public health challenges.

Ethics and dissemination

The study was approved by the Heidelberg University Hospital's Ethics Committee (S-163/2022). The trial was registered with German Clinical Trials Register (www.drks.de) on 5 January 2022: number DRKS00027938. Findings of the study will be published in peer-reviewed scientific publications and possibly presented at scientific conferences.

Adaptation and Dissemination of a National Cancer Institute HPV Vaccine Evidence-Based Cancer Control Program to the Social Media Messaging Environment

Social media offers a unique opportunity to widely disseminate HPV vaccine messaging to reach youth and parents, given the information channel has become mainstream with 330 million monthly users in the United States and 4.2 billion users worldwide. Yet, a gap remains on how to adapt evidence-based vaccine interventions for the in vivo competitive social media messaging environment and what strategies to employ to make vaccine messages go viral. Push-pull and RE-AIM dissemination frameworks guided our adaptation of a National Cancer Institute video-based HPV vaccine cancer control program, the HPV Vaccine Decision Narratives, for the social media environment. We also aimed to understand how dissemination might differ across three platforms, namely Instagram, TikTok, and Twitter, to increase reach and engagement. Centering theory and a question-answer framework guided the adaptation process of segmenting vaccine decision story videos into shorter coherent segments for social media. Twelve strategies were implemented over 4 months to build a following and disseminate the intervention. The evaluation showed that all platforms increased following, but Instagram and TikTok outperformed Twitter on impressions, followers, engagement, and reach metrics. Although TikTok increased reach the most (unique accounts that viewed content), Instagram increased followers, engagement, and impressions the most. For Instagram, the top performer, six of 12 strategies contributed to increasing reach, including the use of videos, more than 11 hashtags, COVID-19 hashtags, mentions, and follow-for-follow strategies. This observational social media study identified dissemination strategies that significantly increased the reach of vaccine messages in a real-world competitive social media messaging environment. Engagement presented greater challenges. Results inform the planning and adaptation considerations necessary for transforming public health HPV vaccine interventions for social media environments, with unique considerations depending on the platform.

Using Humor to Promote Social Distancing on Tiktok During the COVID-19 Pandemic

Background

During the COVID-19 pandemic, many humorous videos on how to practice social distancing appeared on social media. However, the effect of using humor as a crisis communication strategy to persuade people to conform to social distancing rules is not known.

Objective

Drawing on the literature on humorous message framing and crisis communication, this research explores the effectiveness of a humorous message in communicating social distancing rules in two crisis severity phases (low vs. high severity) and also evaluates how humor affects individuals’ online and offline engagement intentions during the COVID-19 pandemic.

Methods

A 2 (message framing: humorous vs. non-humorous) x 2 (crisis severity phase: low vs. high) between-subjects design experiment was conducted to test the research questions during the first weeks of the COVID-19 pandemic in China from January 30 to February 2, 2020.

Results

The results showed that the severity of the phase of a health crisis can significantly affect stakeholders’ online and offline responses toward the disease. More specifically, in a low severity phase, humor led to increased source likability for the message, and more online and offline engagement intentions. However, no differences between a humorous and non-humorous message in perceived risk were observed. Whereas, in a high severity crisis phase, humor reduced individuals’ offline engagement intentions and a decrease in perceived risk, no significant difference was found between a humorous and non-humorous message on source likeability.

Conclusion

Humor can motivate both more online engagement and offline protective action intention when the crisis severity phase is low, while when crisis severity soars, a non-humorous message should be more desirable. More specifically, using humor in communicating information about an infectious disease can enhance the spokesperson’s likeability in a low severity phase, and also helps to spread health information to a larger audience. While, the negative side of using humor in communicating an infectious disease appears in severe crisis phases, as it then decreased the public’s perception of risk, and triggers less protective actions. Going beyond previous research, this study recognized that crisis severity changes in different phases of the spread of infectious disease, thereby providing actionable strategy selections for crisis practitioners in a dynamic communication environment.

The unintentional spread of misinformation on 'TikTok'; A paediatric urological perspective

INTRODUCTION

'TikTok' is a social media application based on the publication of short videos that has accumulated over 1.1 billion users worldwide since its launch in 2016. With the use of 'TikTok' on the rise, there is an increasing tendency for patients or family members to seek medical information online.

OBJECTIVE

We aim to assess the authenticity of information being spread on 'TikTok' on common paediatric urological presentations by comparison to current up to date guidelines provided by the European Association of Urology (EAU).

MATERIALS AND METHODS

A search for a variety of paediatric urology conditions was performed on 'TikTok'. Videos were subsequently screened based on strict pre-defined criteria. The content and claims of each video were compared to up-to-date guidelines to reveal whether or not they complied with standards set by the European Association of Urology (EAU). Information that correlated with that of the guidelines was then further classified by Oxford levels of evidence.

RESULTS

27 videos met our criteria with a combined total of 6,578,863 views, 308,700 likes and 5782 comments. Only 22.2% of videos contained information that can also be found in guidelines provided by the EAU. None of the included videos contained any cited evidence to reinforce statements that were being made.

DISCUSSION

Misinformation lacking scientific evidence has been reported has been reported for various conditions on 'TikTok'. Patients, family members or caregivers without a medical background can have difficult verifying and ensuring the credibility of information posted on social media.

CONCLUSION

The evolution of 'TikTok' has allowed the layperson to create content that can potentially reach millions of users worldwide. This study demonstrated that 'TikTok' can be used as a resource for health information, however is currently a pit of misinformation with the potential to cause harm to the user.

Deconstructing TikTok Videos on Mental Health: Cross-sectional, Descriptive Content Analysis

Background

Social media platforms that are based on the creation of visual media, such as TikTok, are increasingly popular with adolescents. Online social media networks provide valuable opportunities to connect with each other to share experiences and strategies for health and wellness.

Objective

The aim of this study was to describe the content of the hashtag #mentalhealth on TikTok.

Methods

This cross-sectional, descriptive content analysis study included 100 videos with the hashtag #mentalhealth on TikTok. All videos that included the hashtag #mentalhealth were analyzed and coded for the presence of content categories. Additionally, the comments to each video were viewed and coded for content in the following themes: offering support or validation; mentioning experience with suicide or suicidal ideation; mentioning experience with self-harm; describing an experience with hospitalization for mental health issues; describing other mental health issues; and sharing coping strategies, experiences of healing, or ways to feel better.

Results

Collectively, the 100 videos studied received 1,354,100,000 views; 266,900,000 likes; and 2,515,954 comments. On average, each video received 13,406,930.69 (SD 8,728,095.52) views; 2,657,425.74 (SD 1,449,920.45) likes; and 24,910.44 (SD 21,035.06) comments. The only content category observed in most (51/100, 51%) of the videos included in the sample was “general mental health.” The remaining content categories appeared in less than 50% of the sample. In total, 32% (32/100) of the videos sampled received more than the overall average number of likes (ie, more that 2.67 million likes). Among these 32 videos, 23 (72%) included comments offering support or validation and 20 (62%) included comments that described other mental health issues or struggles.

Conclusions

With over 1 billion cumulative views, almost half of the assessed TikTok videos included in this study reported or expressed symptoms of mental distress. Future research should focus on the potential role of intervention by health care professionals on social media.

The Impact of Government Social Media Information Quality on Public Panic During the Infodemic

The COVID-19 pandemic triggered the first global “Infodemic” in the era of social media. Understanding how governments deal with the negative impacts of the infodemic (e.g., public panic) has become a priority. This paper uses the theoretical framework of the Elaboration Likelihood Model (ELM) to explore mechanisms for alleviating panic associated with the infodemic. It considers, in particular, the quality of information circulated on Government Social Media (GSM) as the central route and local government trust as the peripheral route. An empirical study was conducted using data from a focus group interview and a questionnaire survey collected within the first three weeks following the citywide lockdown of Wuhan, China. The results show that as: (1) Quality of GSM information does not significantly reduce public panic, but local government trust significantly increases people’s pandemic prevention knowledge; (2) Pandemic prevention knowledge is a critical mediator between information quality of GSM and public panic, as well as local government trust and public panic; and (3) Information quality of GSM significantly increases people’s trust in local governments. This paper contributes to the literature on infodemic and government social media and provides implications for practice.

Takotsubo syndrome on TikTok: An analysis of information quality and audience engagement (Preprint)

Background

The incidence of Takotsubo syndrome (TTS), also known as the broken heart syndrome or stress cardiomyopathy, is increasing worldwide. The understanding of its prognosis has been progressively evolving and currently appears to be poorer than previously thought, which has attracted the attention of researchers. An attempt to recognize the awareness of this condition among the general population drove us to analyze the dissemination of this topic on TikTok, a popular short-video–based social media platform. We found a considerable number of videos on TTS on TikTok; however, the quality of the presented information remains unknown.

Objective

The aim of this study was to analyze the quality and audience engagement of TTS-related videos on TikTok.

Methods

Videos on the TikTok platform were explored on August 2, 2021 to identify those related to TTS by using 6 Chinese keywords. A total of 2549 videos were found, of which 80 met our inclusion criteria and were evaluated for their characteristics, content, quality, and reliability. The quality and reliability were rated using the DISCERN instrument and the Journal of the American Medical Association (JAMA) criteria by 2 reviewers independently, and a score was assigned. Descriptive statistics were generated, and the Kruskal-Wallis test was used for statistical analysis. Multiple linear regression was performed to evaluate the association between audience engagement and other factors such as video content, video quality, and author types.

Results

The scores assigned to the selected video content were low with regard to the diagnosis (0.66/2) and management (0.34/2) of TTS. The evaluated videos were found to have an average score of 36.93 out of 80 on the DISCERN instrument and 1.51 out of 4 per the JAMA criteria. None of the evaluated videos met all the JAMA criteria. The quality of the relayed information varied by source (All P<.05). TTS-related videos made by health care professionals accounted for 28% (22/80) of all the evaluated videos and had the highest DISCERN scores with an average of 40.59 out of 80. Multiple linear regression analysis showed that author types that identified as health professionals (exponentiated regression coefficient 17.48, 95% CI 2.29-133.52; P=.006) and individual science communicators (exponentiated regression coefficient 13.38, 95% CI 1.83-97.88; P=.01) were significant and independent determinants of audience engagement (in terms of the number of likes). Other author types of videos, video content, and DISCERN document scores were not associated with higher likes.

Conclusions

We found that the quality of videos regarding TTS for patient education on TikTok is poor. Patients should be cautious about health-related information on TikTok. The formulation of a measure for video quality review is necessary, especially when the purpose of the published content is to educate and increase awareness on a health-related topic.

Using Structural Equation Modeling to Examine Pathways between Physical Activity and Sleep Quality among Chinese TikTok Users

TikTok, the most popular social media, brings various benefits to nowadays living. However, the problematic use of TikTok has also elicited a range of health problems, such as sleep problems. Physical activity (PA) appears to play a protective role in the problematic use of TikTok and its health consequences, but the pathways between PA and sleep health are understudied. Therefore, we aimed to propose a framework to check whether PA can benefit the sleep health of TikTok users by reducing bedtime delays for TikTok. Stress and mental health issues were also considered as they are potential mediators between PA and sleep health and may also influence the problematic use of smartphones. A cross-sectional investigation that involved 660 Chinese TikTok users was conducted in April 2021. The volume of PA, perceived stress (PSS-10), depression (PHQ-9), anxiety (GAD-7), bedtime delay for TikTok use, and sleep quality (PSQI) were investigated through an online questionnaire survey. Structural equation modeling was employed to examine pathways from PA to sleep quality through stress, mental health issues (depression and anxiety), and bedtime delay for TikTok. We found that PA exerted a significant effect on sleep quality through indirect pathways (β = −0.056, p = 0.001). Stress was a critical mediator of all indirect pathways, and the pathway mediated by stress and mental health issues made a major contribution to the total effect (β = −0.048, p = 0.002). The identified pathways mediated by bedtime delay for TikTok were relatively weak but significant. PA showed a distinct effect on bedtime delay for TikTok through stress and mental health issues (β = −0.043, p = 0.001). In conclusion, our framework highlights some pathways to understanding the benefits of PA on TikTok users’ sleep quality. Future research is warranted to explore extra indirect pathways and re-examine the causal relationships between variables.

Social Media, Public Health, and Community Mitigation of COVID-19: Challenges, Risks, and Benefits

Shortly after the first case reports in 2019, COVID-19 was declared a pandemic. Early messages from trusted experts, which later proved to be inadequate or incorrect, highlight the need for continual adjustment of messages to the public as scientific knowledge evolves. During this time, social media exploded with greatly sought-after information, some of which was misinformation based on incomplete or incorrect facts or disinformation purposefully spread to advance a specific agenda. Because of the nature of social media, information, whether accurate or not at the time posted, lives on and remains accessible to the public even when its usefulness has been discredited. While the impact of mis/disinformation on COVID-19 risk-reducing behaviors is debatable, it is clear that social media has played a significant role in both extending the reach of COVID-19-related falsehoods and promoting evidence-based content. Over the last decade, social media has become a dominant source of information that consumers turn to for health information. A great deal of misinformation and disinformation has reached large numbers of social media users, which points to a need for the agencies of the US Public Health Service to create communications to convey accurate and current information and appeals that will actually be viewed. This viewpoint highlights the challenges, risks, and potential benefits that social media present in mitigating the COVID-19 pandemic.

The Evolving Role of Social Media in Pediatric Orthopaedics

BACKGROUND

Social media has grown significantly and its application in health care has been dramatically accentuated by the COVID-19 pandemic. It is often considered as a "new dimension" of health care, particularly in its ability to provide health information. In 2017, the top social media sites utilized by pediatric orthopaedic surgeons included Facebook, LinkedIn, and Twitter. In our study, we analyze the current social media usage, trends in Instagram and TikTok content, and the perceptions on social media usage among pediatric orthopaedic surgeons.

METHODS

The Pediatric Orthopaedic Society of North America (POSNA) membership directory was searched for the presence of social media. A review of all Instagram and TikTok posts made by the POSNA members were reviewed. A survey regarding the perception of social media networks and content was distributed to all POSNA members.

RESULTS

A total of 1231 POSNA members actively practicing in the United States were included in our study. In all, 327 (26.6%) had a LinkedIn profile, 34 (2.8%) had a professional Facebook profile, 15 (1.2%) had a public Instagram account, 0 (0%) had TikTok, and 72 (5.8%) had a professional Twitter account. Fifteen POSNA members with public Instagram accounts had 10,878 followers. A total of 907 Instagram posts were made, 134 (14.8%) of which were education and 462 (50.9%) of which were personal or political. The perception of various social media networks such as Instagram (3.02), Facebook (3.16), and LinkedIn (3.51) were positive on a 5-point Likert scale, while perceptions of TikTok (2.36) and Twitter (2.99) were negative. Educational posts on Instagram (3.19) and Facebook (3.37) were positive.

CONCLUSIONS

We provide an update to the utilization of social media by pediatric orthopaedists. Use of Instagram and TikTok accounts remain rare. Educational posts, when hosted on an appropriate social media platform, are perceived positively among pediatric orthopaedists.

LEVEL OF EVIDENCE

Level IV.

Analysis of Acute Non-specific Back Pain Content on TikTok: An Exploratory Study

Introduction

In this study, we evaluated the scope of acute non-specific back pain (ANSBP) content available on TikTok (ByteDance Ltd, Beijing, China) in 2021. It is plausible that TikTok’s popularity among teenagers, adolescents, and young adults may influence decision-making about what constitutes appropriate ANSBP self-care among a younger age cohort.

Methods

We examined 157 of the most viewed videos available through the hashtag #backpain available on TikTok in September 2021. We examined the following research questions: (1) What are the metadata characteristics of the videos in the final data set?, (2) What are the creator identities reflected in the final data set in this study?, (3) What are the ANSBP self-care content themes in the final data set?, and (4) What are the characteristics of the data set based on a low back pain reference checklist based on consensus guidelines?.

Results

We identified clear differences based on TikTok creator identity in our data set of most popular videos. We examined videos created by chiropractors, fitness professionals, influencers, physicians, physiotherapists, and other creator identities. We found that the TikTok videos created by chiropractors were consistently among the most viewed, most commented, and most shared. Conversely, chiropractic TikTok videos consistently had the lowest self-care reference checklist scores relative to all other disciplines. That is, TikTok videos created by chiropractors were least likely to reflect the scientific consensus on treating ANSBP.

Discussion

TikTok is an increasingly popular medium for disseminating short health messages. The main cohort using TikTok is young and at risk of ANSBP. However, we postulate that the messages reaching young TikTok users overall do not generally reflect the self-care advice described in consensus guidelines. 

Conclusion

TikTok is a popular social media channel among young people. However, the most viewed TikTok videos about ANSBP are not produced by mainstream health professionals and the videos featuring the #backpain hashtag do not generally reflect contemporary evidence-based practice. There is considerable scope for mainstream health professionals to provide evidence-informed self-management and self-care content for ANSBP on TikTok.

Investigating #covidnurse Messages on TikTok: Descriptive Study

Background

During a time of high stress and decreased social interaction, nurses have turned to social media platforms like TikTok as an outlet for expression, entertainment, and communication.

Objective

The purpose of this cross-sectional content analysis study is to describe the content of videos with the hashtag #covidnurse on TikTok, which included 100 videos in the English language.

Methods

At the time of the study, this hashtag had 116.9 million views. Each video was coded for content-related to what nurses encountered and were feeling during the COVID-19 pandemic.

Results

Combined, the 100 videos sampled received 47,056,700 views; 76,856 comments; and 5,996,676 likes. There were 4 content categories that appeared in a majority (>50) of the videos: 83 showed the individual as a nurse, 72 showed the individual in professional attire, 58 mentioned/suggested stress, 55 used music, and 53 mentioned/suggested frustration. Those that mentioned stress and those that mentioned frustration received less than 50% of the total views (n=21,726,800, 46.17% and n=16,326,300, 34.69%, respectively). Although not a majority, 49 of the 100 videos mentioned the importance of nursing. These videos garnered 37.41% (n=17,606,000) of the total views, 34.82% (n=26,759) of the total comments, and 23.85% (n=1,430,213) of the total likes. So, despite nearly half of the total videos mentioning how important nurses are, these videos received less than half of the total views, comments, and likes.

Conclusions

Social media and increasingly video-related online messaging such as TikTok are important platforms for social networking, social support, entertainment, and education on diverse topics, including health in general and COVID-19 specifically. This presents an opportunity for future research to assess the utility of the TikTok platform for meaningful engagement and health communication on important public health issues.

Short-Video Apps as a Health Information Source for Chronic Obstructive Pulmonary Disease: Information Quality Assessment of TikTok Videos

BACKGROUND

Chronic obstructive pulmonary disease (COPD) has become one of the most critical public health problems worldwide. Because many COPD patients are using video-based social media to search for health information, there is an urgent need to assess the information quality of COPD videos on social media. Recently, the short-video app TikTok has demonstrated huge potential in disseminating health information and there are currently many COPD videos available on TikTok; however, the information quality of these videos remains unknown.

OBJECTIVE

The aim of this study was to investigate the information quality of COPD videos on TikTok.

METHODS

In December 2020, we retrieved and screened 300 videos from TikTok and collected a sample of 199 COPD-related videos in Chinese for data extraction. We extracted the basic video information, coded the content, and identified the video sources. Two independent raters assessed the information quality of each video using the DISCERN instrument.

RESULTS

COPD videos on TikTok came mainly from two types of sources: individual users (n=168) and organizational users (n=31). The individual users included health professionals, individual science communicators, and general TikTok users, whereas the organizational users consisted of for-profit organizations, nonprofit organizations, and news agencies. For the 199 videos, the mean scores of the DISCERN items ranged from 3.42 to 4.46, with a total mean score of 3.75. Publication reliability (P=.04) and overall quality (P=.02) showed significant differences across the six types of sources, whereas the quality of treatment choices showed only a marginally significant difference (P=.053) across the different sources.

CONCLUSIONS

The overall information quality of COPD videos on TikTok is satisfactory, although the quality varies across different sources and according to specific quality dimensions. Patients should be selective and cautious when watching COPD videos on TikTok.

Medical and Health-related Misinformation on Social Media: Analysis of the Scientific Literature

Background

Social media has been extensively used for the communication of health-related information and consecutively for the potential spread of medical misinformation. Conventional systematic reviews have been published on this topic to identify original articles and to summarize their methodological approaches and themes. A bibliometric study could complement their findings, for instance, by evaluating the geographical distribution of the publications and determining if they were well cited and disseminated in high-impact journals.

Objective

The aim of this study was to perform a bibliometric analysis of the current literature to discover the prevalent trends and topics related to medical misinformation on social media.

Methods

The Web of Science Core Collection electronic database was accessed to identify relevant papers with the following search string: ALL=(misinformati* OR “wrong informati*” OR disinformati* OR “misleading informati*” OR “fake news*”) AND ALL=(medic* OR illness* OR disease* OR health* OR pharma* OR drug* OR therap*) AND ALL=(“social media*” OR Facebook* OR Twitter* OR Instagram* OR YouTube* OR Weibo* OR Whatsapp* OR Reddit* OR TikTok* OR WeChat*). Full records were exported to a bibliometric software, VOSviewer, to link bibliographic information with citation data. Term and keyword maps were created to illustrate recurring terms and keywords.

Results

Based on an analysis of 529 papers on medical and health-related misinformation on social media, we found that the most popularly investigated social media platforms were Twitter (n=90), YouTube (n=67), and Facebook (n=57). Articles targeting these 3 platforms had higher citations per paper (>13.7) than articles covering other social media platforms (Instagram, Weibo, WhatsApp, Reddit, and WeChat; citations per paper <8.7). Moreover, social media platform–specific papers accounted for 44.1% (233/529) of all identified publications. Investigations on these platforms had different foci. Twitter-based research explored cyberchondria and hypochondriasis, YouTube-based research explored tobacco smoking, and Facebook-based research studied vaccine hesitancy related to autism. COVID-19 was a common topic investigated across all platforms. Overall, the United States contributed to half of all identified papers, and 80% of the top 10 most productive institutions were based in this country. The identified papers were mostly published in journals of the categories public environmental and occupational health, communication, health care sciences services, medical informatics, and medicine general internal, with the top journal being the Journal of Medical Internet Research.

Conclusions

There is a significant platform-specific topic preference for social media investigations on medical misinformation. With a large population of internet users from China, it may be reasonably expected that Weibo, WeChat, and TikTok (and its Chinese version Douyin) would be more investigated in future studies. Currently, these platforms present research gaps that leave their usage and information dissemination warranting further evaluation. Future studies should also include social platforms targeting non-English users to provide a wider global perspective.

Characterizing the Content Related to Oral Health Education on TikTok

Neglecting oral hygiene in adolescents negatively affects dental caries and periodontal diseases, in addition to social and emotional well-being. Thus, the TikTok platform (ByteDance, Beijing, China)as a social media could be a powerful channel to provide health-related information and educational content. This study aims to assess the quality of the TikTok videos corresponding to #oralhealtheducation. Sixty-nine videos were identified. Three oral health professionals (OHP), three health education professionals (HEP), and ten of TikTok's target audience watched and evaluated the videos from a qualitative questionnaire. OHP detected false or incorrect information in 11.6% (8/69) of the videos. At least two HEPs reported being unable to detect this type of content or whether the video met dental ethics standards in both the videos. Disagreement was observed among the professionals themselves. The evaluation indicated that TikTok's target audience was satisfied with the products viewed with an average score of >2.5, unlike the professionals, whose average score was <2.5 on a scale of 0 to 5. Users are advised to think critically and to consider the content of TikTok oral health videos with caution. The involvement of health professionals in the writing and validation of the videos could be an added value to positively respond to the needs of the adolescents.

Examining TikTok's Potential for Community-Engaged Digital Knowledge Mobilization With Equity-Seeking Groups

Social media is increasingly being leveraged by researchers to engage in public debates and rapidly disseminate research results to health care providers, health care users, policy makers, educators, and the general public. This paper contributes to the growing literature on the use of social media for digital knowledge mobilization, drawing particular attention to TikTok and its unique potential for collaborative knowledge mobilization with underserved communities who experience barriers to health care and health inequities (eg, equity-seeking groups). Setting the TikTok platform apart from other social media are the unique audiovisual video editing tools, together with an impactful algorithm, that make knowledge dissemination and exchange with large global audiences possible. As an example, we will discuss digital knowledge mobilization with trans and nonbinary (trans) communities, a population that experiences barriers to health care and is engaged in significant peer-to-peer health information sharing on the web. To demonstrate, analytics data from 13 selected TikTok videos on the topic of research on gender-affirming medicine (eg, hormonal therapy and surgeries) are presented to illustrate how knowledge is disseminated within the trans community via TikTok. Considerations for researchers planning to use TikTok for digital knowledge mobilization and other related community engagement with equity-seeking groups are also discussed. These include the limitations of TikTok analytics data for measuring knowledge mobilization, population-specific concerns related to community safety on social media, the spread of disinformation, barriers to internet access, and commercialization and intellectual property issues. This paper concludes that TikTok is an innovative social media platform that presents possibilities for achieving transformative, community-engaged knowledge mobilization among researchers, underserved health care users, and their health care providers, all of whom are necessary to achieve better health care and population health outcomes.

Serious information in hedonic social applications: affordances, self-determination and health information adoption in TikTok

Purpose

Hedonic social applications have been increasingly popular among health information consumers. However, it remains unclear what motivates consumers to adopt health information in hedonic applications when they have alternative choices of more formal health information sources. Building on the self-determination theory and the affordances lens, this study aims to investigate how different affordances on hedonic social applications affect consumers' basic psychological needs and further influence their intention to adopt health information on such applications.

Design/methodology/approach

As TikTok demonstrated great potential in disseminating health information, we developed a model that we analyze using the PLS-SEM technique with data collected from a valid research sample of 384 respondents with health information seeking or encountering experience in TikTok.

Findings

The results suggested that health information adoption in hedonic social applications is significantly predicted by the satisfaction of consumers' basic psychological needs, namely autonomy, relatedness and competence. Moreover, the satisfaction of basic psychological needs is positively affected by affordances provided by the hedonic social applications. The hedonic affordances positively influence autonomy satisfaction, while the connective affordances positively affect relatedness satisfaction, and the utilitarian affordances positively support competence satisfaction.

Originality/value

The study indicates that hedonic social applications such as TikTok could be an important channel for consumers to access and adopt health information. The study contributes to the literature by proposing a theoretical model that explains consumers' health information adoption and yields practical implications for designers and service providers of hedonic social applications.

Handwashing videos on TikTok during the COVID-19 pandemic: Potential for disease prevention and health promotion

Background

Handwashing has long been promoted to maintain health and in preventing disease transmission. One of the most valuable ways to convey messages related to handwashing is through visual display, such as video for educational purposes and to enhance learning. Social media is an important and popular way to disseminate messages to a wide audience.

Methods

In this cross-sectional, descriptive study, two hashtags, #WashYourHands and #SafeguardSplash were used to select the sample of 100 from available TikTok videos. In order to code each video, the same coding categories were used for both hashtags, including (1) wetting and rinsing hands (2) lathering soap (3) time used for scrubbing (4) drying hands (5) mentions COVID-19 (6) mentions using hand sanitizer instead of soap (7) mentions how germs spread (8) mentions key times to wash hands (9) and actual depiction of washing hands. Additional descriptive categories were coded as well. The observations recorded were tabulated and descriptive statistics were performed. Independent one-tailed t-tests (α = .05) were calculated to determine if a video's hashtag had a significant association with its garnered views, likes, and/or comments.

Results

In total, the 100-video sample received 1,990,834,567 views, 40,355,468 likes, and 173,422 comments. Despite the fact that each hashtag made up an equal proportion (50%) of the total sample, videos with #WashYourHands accounted for 93.3% of the total views. Coverage of the important steps involved in handwashing, such as drying hands, was minimal as was relevant background information.

Conclusion

The results indicate that while this opportunity is being realized to some degree, the majority of videos did not cover topics related important concepts of hand hygiene. Given the high engagement of younger audiences with TikTok, this could be a powerful mechanism for demonstrating and encouraging proper handwashing, especially in a population with low rates of handwashing.

Navigating and Leveraging Social Media

Social media has made a noteworthy impact in health care both in public health efforts as well as transforming how physicians connect and exchange ideas. Learning how to navigate and leverage social media across multiple platforms is becoming increasingly difficult with more platforms and features constantly being introduced. Different physicians working in the same field will have different purposes behind getting on social media, but each physician plays a different role within this social media ecosystem. This article aims to identify the common benefits of health care social media use as well as navigate the unfortunate pitfalls of social media use.

'Falsehood flies, and the truth comes limping after it': social media and public health

PURPOSE OF REVIEW

To highlight the various uses of social media by public health practitioners and organizations, with special emphasis on how social media has been successfully applied and where applications have struggled to achieve the desired effects.

RECENT FINDINGS

Social media has been used effectively in improving the timeliness and accuracy of public health surveillance. Social media has also been used to communicate information between public health organizations and reinforce consistent messaging about enduring threats to public health. It has been applied with some success to coordinate of disaster response and for keeping the public informed during other emergency situations. However, social media has also been weaponized against the public health community to spread disinformation and misinformation, and the public health community has yet to devise a successful strategy to mitigate this destructive use of social media.

SUMMARY

Social media can be an effective tool for public health practitioners and organizations who seek to disseminate information on a daily basis, rapidly convey information in emergent situations, and battle misinformation. Social media has been uniquely valuable and distinctly destructive when it comes to protecting and improving public health.

Characterizing COVID-19 Content Posted to TikTok: Public Sentiment and Response During the First Phase of the COVID-19 Pandemic

PURPOSE

The purpose of this study was to characterize COVID-19 content posted by users and disseminated via TikTok, a social media platform that has become known largely as an entertainment platform for viral video-sharing. We sought to capture how TikTok videos posted during the initial months of the COVID pandemic changed over time as cases accelerated.

METHODS

This study is an observational analysis of sequential TikTok videos with #coronavirus from January to March 2020. Videos were independently coded to assess content (e.g., health relatedness, humor, fear, empathy), misinformation, and public sentiment. To assess engagement, we also codified how often videos were shared relative to their content.

RESULTS

We coded 750 videos and approximately one in four videos tagged with #coronavirus featured health-related content such as featuring objects such as face masks, hand sanitizer, and other cleaning products. Most videos evoked "humor/parody," whereas 15% and 6% evoked "fear" and "empathy", respectively. TikTok videos posted in March 2020 had the largest number of shares and comments compared with January and February 2020. The proportion of shares and comments for "misleading and incorrect information" featured in videos was lower in March than in January and February 2020. There was no statistical difference between the share and comment counts of videos coded as "incorrect/incomplete" and "correct" over the entire time period.

CONCLUSIONS

Analyzing readily available social media platforms, such as TikTok provides real-time insights into public views, frequency and types of misinformation, and norms toward COVID-19. Analyzing TikTok videos has the potential to be used to inform public health messaging and public health mitigation strategies.

Usage of eHealth/mHealth Services among Young Czech Adults and the Impact of COVID-19: An Explorative Survey

Various mHealth/eHealth services play an increasingly important role in healthcare systems and personal lifestyle management. Yet, the relative popularity of these services among the young population of the Czech Republic was not known. Therefore, we carried out an on-line survey with a convenience sample (n = 299) of young adults aged 18–29 and living in the Czech Republic. To this end, we adapted the survey instrument which was previously used in a similar study conducted in a different cultural context (Hong Kong). In our study, we found out that health tutorial activities (i.e., acquiring information on diet, exercise, fitness) were the most common among our respondents (M = 2.81, SD = 1.14). These were followed by health information seeking activities (i.e., acquiring information on medical problems) (M = 2.63, SD = 0.89) and medical services (i.e., the eHealth/mHealth services that provide infrastructural support, such as ePrescription and doctor appointment organizers) (M = 2.18, SD = 0.97). Based on the grouping according to gender and existing health condition, pairwise comparisons showed statistically significant differences. We also briefly analyzed the influence of the COVID-19 pandemic on the examined activities. Based on their relative popularity, we suggest leveraging the potential of health tutorial activities to improve public health.

Community Mitigation of COVID-19 and Portrayal of Testing on TikTok: Descriptive Study

BACKGROUND

COVID-19 testing remains an essential element of a comprehensive strategy for community mitigation. Social media is a popular source of information about health, including COVID-19 and testing information. One of the most popular communication channels used by adolescents and young adults who search for health information is TikTok-an emerging social media platform.

OBJECTIVE

The purpose of this study was to describe TikTok videos related to COVID-19 testing.

METHODS

The hashtag #covidtesting was searched, and the first 100 videos were included in the study sample. At the time the sample was drawn, these 100 videos garnered more than 50% of the views for all videos cataloged under the hashtag #covidtesting. The content characteristics that were coded included mentions, displays, or suggestions of anxiety, COVID-19 symptoms, quarantine, types of tests, results of test, and disgust/unpleasantness. Additional data that were coded included the number and percentage of views, likes, and comments and the use of music, dance, and humor.

RESULTS

The 100 videos garnered more than 103 million views; 111,000 comments; and over 12.8 million likes. Even though only 44 videos mentioned or suggested disgust/unpleasantness and 44 mentioned or suggested anxiety, those that portrayed tests as disgusting/unpleasant garnered over 70% of the total cumulative number of views (73,479,400/103,071,900, 71.29%) and likes (9,354,691/12,872,505, 72.67%), and those that mentioned or suggested anxiety attracted about 60% of the total cumulative number of views (61,423,500/103,071,900, 59.59%) and more than 8 million likes (8,339,598/12,872,505, 64.79%). Independent one-tailed t tests (α=.05) revealed that videos that mentioned or suggested that COVID-19 testing was disgusting/unpleasant were associated with receiving a higher number of views and likes.

CONCLUSIONS

Our finding of an association between TikTok videos that mentioned or suggested that COVID-19 tests were disgusting/unpleasant and these videos' propensity to garner views and likes is of concern. There is a need for public health agencies to recognize and address connotations of COVID-19 testing on social media.

Human Papillomavirus Vaccine Messaging on TikTok: Social Media Content Analysis

BACKGROUND

The human papillomavirus (HPV) vaccine is viewed as a critical tool to protect against six HPV-related cancers. Vaccination is recommended from early adolescence through age 26 years. As young people have become increasingly involved in personal health-related decisions, there is a need to tailor HPV vaccine messaging and reach this priority population on social media and digital outlets. TikTok is a growing social media platform with approximately 70% of its users between the ages of 13 and 24 years.

PURPOSE

The aim of this study was to understand HPV vaccine messaging and interactions on TikTok as a needed first step to identifying effective strategies to reach young people with important health messaging.

METHODS

Content analysis was performed on 170 top TikToks focused on the HPV vaccine. TikToks were assessed for content, classification type, and number of interactions.

RESULTS

Most TikToks were provaccine, while antivaccine TikToks had more user interactions. Cancer and prevention were the main content areas of the analyzed provaccine TikToks, while the side effects were the primary focus of antivaccine messages. Approximately 30% of all top TikToks analyzed were developed by health professionals. TikToks without an explicit vaccine opinion primarily described personal experiences and mentioned side effects most often.

IMPLICATIONS

TikTok is a growing social media platform that can be used to reach young people and encourage HPV vaccine uptake. Health professionals need to consider the interest that users have in personal experiences and address antivaccine narratives related to side effects.

How did individuals on Instagram discuss COVID-19 in the month following official pandemic status? A examination of user content

OBJECTIVES

Instagram is a popular social media site used by high numbers of young people. This study was designed to investigate COVID-19 content on Instagram during the month following official pandemic status from the World Health Organization (WHO).

METHODS

A total of 200 posts were collected and analyzed over a four-week period between mid-February and mid-March 2020.

RESULTS

The vast majority of posts did not address recommended prevention measures. Further, only approximately one-third of the posts referenced a reputable source. Finally, the nature of posts changed over time was impacted by type of poster and reflected a tone of anxiety.

CONCLUSIONS

The findings underscore the urgent need for public health officials to be aware of and address social media content on novel health threats. Furthermore, it is imperative that communicating risk on social media, such as Instagram be geared to young people. Failure to do so may hinder prevention, mitigation, and suppression strategies.

Creative social media use for Covid-19 prevention in Bangladesh: a structural equation modeling approach

In recent years, information dissemination has been quicker than earlier years with the sky-high development of diverse social media platforms, e.g., Facebook, WhatsApp, Twitter, YouTube and so on, which are more used in creative production. This advancement of social media disclosures has numerous merits and demerits to prevent and control contagious diseases like the Covid-19 pandemic. In this respect, this research scrutinizes the role of creative social media use in preventing the Covid-19 outbreak in Bangladesh utilizing the structural equation modeling (SEM) approach. To this end, this study uses an online survey from June to October 2020 engaging 265 (N = 265) Bangladeshi people as respondents at different ages. The study results establish that creative social media use helps enhance the knowledge of Covid-19 precautions online, and this pertinent knowledge contributes to preventing Covid-19 outbreak in Bangladesh. It implies that creative social media use has a significant indirect effect on Covid-19 prevention, whereas knowledge of Covid-19 precautions online mediates this relationship between creative social media use and Covid-19 prevention. The results also discover that the educational level of the people has a significant direct and positive impact on Covid-19 prevention. Therefore, the study suggests more creative use of social media in preventing the spread of the Covid-19 epidemic in Bangladesh.

A global pandemic in the time of viral memes: COVID-19 vaccine misinformation and disinformation on TikTok

Misinformation and disinformation regarding COVID-19 and vaccination against it may be contributing to vaccine hesitancy. Social media outlets have reportedly made efforts to limit false information yet untruths related to COVID-19 persist online. The purpose of this study was to describe the content on COVID-19 vaccination on TikTok, an emerging social media platform. One-hundred trending videos were identified from the hashtag #covidvaccine and were coded for content. Collectively, these videos garnered over 35 million views. The coding category with the highest number of videos was "Discouraged a Vaccine" (n = 38), followed by "Encouraged a Vaccine" (n = 36). While only 36 videos encouraged a vaccine, these videos garnered over 50% of the total cumulative views and just under 50% of the total likes; the 38 videos that discouraged a vaccine garnered 39.6% of the total cumulative views, 44.3% of likes, and 47.4% of comments. Of the 38 videos discouraging the vaccine, 25 (65.79%) showed a parody of an adverse reaction and, collectively, received 71.07% of the total views among videos in this category. Twenty-two of these 38 videos (57.89%) falsely conveyed that a vaccine was available, as they were not at the time of the study. Anti-vaccination messaging may undermine efforts to ensure widespread uptake of the various COVID-19 vaccines, particularly for young people who are more likely than other age cohorts to use TikTok.

On the Psychology of TikTok Use: A First Glimpse From Empirical Findings

TikTok (in Chinese: DouYin; formerly known as musical.ly) currently represents one of the most successful Chinese social media applications in the world. Since its founding in September 2016, TikTok has seen widespread distribution, in particular, attracting young users to engage in viewing, creating, and commenting on "LipSync-Videos" on the app. Despite its success in terms of user numbers, psychological studies aiming at an understanding of TikTok use are scarce. This narrative review provides a comprehensive overview on the small empirical literature available thus far. In particular, insights from uses and gratification theory in the realm of TikTok are highlighted, and we also discuss aspects of the TikTok platform design. Given the many unexplored research questions related to TikTok use, it is high time to strengthen research efforts to better understand TikTok use and whether certain aspects of its use result in detrimental behavioral effects. In light of user characteristics of the TikTok platform, this research is highly relevant because TikTok users are often adolescents and therefore from a group of potentially vulnerable individuals.