January 2024: Social media for health behavior change
This month’s Digital Health Research Roundup is focused on the use of social media in social and behavior change (SBC). We’ve invited Marla Shaivitz and Dr. Radha Rajan to share their thoughts on the role of social media as a research and communications tool in the field of SBC.
Guest Editor's Remarks:
Communication, at the heart of SBC, is about creating shared symbols and shared understandings transmitted through interactions. Print media, mass media, and face-to-face communication have long influenced people’s decisions, but social media communication has increasingly served to generate and transmit novel information (and unfortunately, misinformation), leverage trusted figures to shift public perceptions and attitudes, and open dialogues to shift social norms. These factors can bring about supportive social environments in which people can consider adopting healthful behaviors.
Compared to print media, mass media, and community-based interventions, social media offers SBC programmers distinct advantages, including:
Reduced geographic constraint, allowing the large-scale reach of communication messages,
Targeted focus to direct communication to tailored audience segments ,
The ability for real-time interaction with an audience, as well as facilitating interaction within the audience,
An unobtrusive means of quantifying engagement and collecting an audience’s public viewpoints on a topic,
Potential for cost savings for programs with limited budgets, and
Ability to iterate on messaging, as conditions evolve.
While leveraging social media in SBC has become standard practice, questions remain about how to effectively reach diverse audiences. The articles selected for this month’s Research Roundup provide a primer for harnessing social media for behavior change, exploring questions on the effectiveness of social media interventions, particularly in low- and middle-income country (LMIC) settings, outlining the benefits social media offers SBC, and describing a robust evaluation of a behavioral theory-informed social media intervention implemented in a LMIC-country context.
Leveraging Social Media for Health Behaviour Change
CGDHI key takeaways and comments on the research articles hand-picked by our guest editor:
Social media-based interventions for health behavior change in low- and middle- income countries
Journal of Medical Internet Research, 2022
Seiler J et al.
“Behavior change can take time, and the potential for regression to earlier states is well known... In addition, there was a lack of evidence on the effectiveness of theories of change in social media interventions, and future research should focus on testing processes of change.”
Key Takeaways:
While several studies have demonstrated the effectiveness of social media-based interventions for health behavior change in high-income settings, there is a lack of formative research studies assessing the feasibility and acceptability of social media behavior change interventions in LMICs. As smartphone and internet access are growing rapidly, behavior change interventions can be delivered through social media.
While many authors of the studies reviewed concluded that a social media-based intervention had been effective, only 42% of studies used quantitative measures to assess engagement. The studies that did assess impact often paired engagement measurements with an evaluation outside of social media usage.
There was a gap in the application of theoretical or conceptual behavior change models that could explain how a particular intervention was intended to work. Past studies have found sharing-enabled features were often associated with positive outcomes across a wide range of behaviors, and while not discussed, social aspects relate to several frameworks for behavior change.
Additionally, none of the reviewed studies commented on the methods used to reduce the risk of data theft or interference on behalf of the participants.
Comment from the Center for Global Digital Health Innovation:
With growing social media coverage, these platforms present an opportunity to tap into diverse populations and intervene to improve health. This review highlights the need for further research, especially in LMIC settings, to develop successful social media-based projects. There is a lack of data on the long-term health impacts of such social media-based interventions and a need to develop evidence on the theories of change in future research studies. The studies also lacked a discussion of data security measures, which are of paramount importance when participants are sharing data with third-party users, further highlighting a research and policy gap.
Evaluating a youth-designed sexual and reproductive health mass and social media campaign in Côte d’Ivoire
Triangulation of three independent evaluations
Sexual and Reproductive Health Matters, 2023
Silva M et al.
“...Social change cannot happen in a vacuum, but rather is shaped and often necessitates reciprocal shifts at the individual, peer or household, community, and structural level.”
Key Takeaways
This study describes the findings of a multi-method evaluation of Merci Mon Héros (Thank you, My Hero), a youth-led multi-media campaign that sought to improve sexual and reproductive health and family planning information and service access in French-speaking West Africa, one of the regions with some of the highest annual adolescent birth rates in the world.
The study focuses on intermediate outcomes: changes in attitudes, social norms, and self-efficacy. Authors triangulate the findings of three evaluations: 1) social listening, which describes online conversations and engagement; 2) an exposure survey that investigates associations between exposure and outcome; and 3) a qualitative analysis of the most significant changes realized through this campaign.
The social listening study assessed online engagement, demographics reached, and popular topics. The exposure surveys found a significant association between a positive behavioral outcome (having spoken to someone about sexual health or family planning) and the campaign, with the outcome more observed among women. This was reinforced by the qualitative study, which described the lived experiences of program participants.
The triangulation of three independent study results provides a comprehensive evaluation of this multimedia behavioral health campaign and demonstrates its success in initiating conversations around sometimes stigmatized health topics online and offline.
In the discussion of study limitations, the authors point to a common evaluative challenge in assessing causal relationships between online social media engagement and real-life outcomes.
Comment from the Center for Global Digital Health Innovation:
The triangulation of three separate evaluation studies fosters a stronger understanding of the processes by which the multimedia campaign generated behavioral changes in participants. The campaign's theory of change outlined how the program expected to affect change, and the data partially supported these pathways leading to discussion about sexual and reproductive health and family planning. Additional research is needed to delve deeply into how digital platforms can increase adult self-efficacy and enhance the descriptive norm that this audience engages in supportive communication with young people.
Digital media for behavior change
Review of an Emerging Field of Study
International Journal of Environmental Research and Public Health, 2022
Evans WD et al.
“Behavior change interventions that rely on social networks for their success are hypothesized to have greater impact, and to generate greater interactivity and feedback, than interventions that rely on changes in individual behavior, due to the amplifying effects of social support and social participation.”
Key Takeaways
Digital media can be used to change behaviors through digital interventions, provide formative research to guide projects, and conduct evaluations. This paper shares an overview of these methodologies through the presentation of use cases and provides insight into the prospects and research gaps in the field.
Researchers can serve microtargeted ads to individuals with specific characteristics, harness the reach of social media influencers, or conduct randomized trials through private social media groups to deliver and study behavior-change digital media campaigns. These campaigns can promote positive social norms. For example, the paper explores a use case on digital interventions to promote vaccine uptake.
Formative research is crucial to determining what makes digital media campaigns effective and guiding program design and implementation.
Digital media presents an opportunity for low-cost evaluative research through platforms such as the Facebook Messenger app or the Virtual Lab, which can be used to share surveys with study participants. The platforms offer added advantages of optional randomization and longitudinal data collection.
A use case of a social media intervention for weight loss for young adults on university campuses offered sample language for ensuring informed consent of participants, as well as specific participant safety protocols that were implemented. These points raise important considerations about the need to clearly provide participants with risk information and implement a safety monitoring plan, similar to in-person interventions.
There is scope to further explore the full range of digital tools in this growing field, the dose-response relationship of campaigns, and the dimension of digital health literacy, which affects the effectiveness of interventions in generating behavioral change.
Comment from the Center for Global Digital Health Innovation:
Digital media presents an opportunity to not only develop behavioral change interventions but also develop formative research and evaluative strategies that can guide intervention design. While this is a novel area of research, there is a need for rigorous studies that evolve with the rapid development of digital technologies. Reach and engagement data can help evaluators assess the dose-response relationships of digital media interventions. Given that social media interventions have multiple behavioral factors involved, testing interventions with added or subtracted features could also contribute to our understanding of processes of change. Within the scope of digital media tools, social media interventions offer ripe opportunities to assess the appropriateness and acceptability of personal self-management tools across the range of digital health literacy.
Assessing COVID-19 vaccine hesitancy, confidence, and public engagement
A Global Social Listening Study
Journal of Medical Internet Research, 2021
Hou Z et al.
“Compared with traditional surveys, social media listening can not only monitor public
attitudes in a timely manner but also assess the dissemination of and public engagement with these opinions.”
Key Takeaways
Social media listening, or ‘infoveillance’, aids in monitoring public attitudes about various topics. The authors assess global hesitancy and confidence during the rollout of COVID-19 vaccines in five major global cities by assessing tweets on Twitter (now known as ‘X’).
Their findings showed a much lower willingness to accept vaccines in the high-income cities of London (51.3%) and New York (36.4%) as compared to the low- and middle-income cities in the study.
There was a greater proportion of ‘tweets’ from lower- and middle-income countries expressing concerns about vaccine accessibility and supply capacity. The differences in the concerns in these two settings highlight the importance of social media campaigns tailored to address local concerns.
An assessment of user engagement with the different types of ‘tweets’ found that negative messages, such as those with misinformation or a lack of vaccine confidence, had greater engagement than positive messages. This reinforces the findings of previous studies that have found that false information travels faster on social media.
Social media listening is an important tool to assess public attitudes and allows public health agencies such as departments of health to understand the beliefs and concerns of populations that may otherwise be missed in traditional research designs, or unfeasible to do at a scale of multi-country comparison.
Comment from the Center for Global Digital Health Innovation:
Digital media, such as social media platforms used for assessing population views and concerns, is a novel resource to capture large quantities of real-time data that describes public attitudes. Resulting insights can drive the timely design of public health communication campaigns responsive to local concerns, with the potential for two-way dialogue between scientists and the communities with whom they are engaged. The authors report important findings of diverging vaccine acceptance rates and differences in public concerns between social media users in the cities studied. They emphasize the important role of social media communication strategies in modifying public attitudes and behaviors. There is a need for more proactive public health efforts to combat misinformation and negative messaging on social media platforms. The study reported several limitations, including reporting on a short study period and limited geographies due to the burden of manual coding, which they said can be overcome by using machine learning programs.
Click the links below to read previous editions of Research Roundup and to receive the latest updates in global digital health!
MEET OUR GUEST EDITORs
We invited Marla Shaivitz and Dr. Radha Rajan to share their thoughts on the role of social media as a research and communications tool in the field of SBC. Both work at the Johns Hopkins Bloomberg School of Public Health’s storied Center for Communication Programs. Marla Shaivitz serves as the Director of Digital Strategy and Dr. Rajan as Research & Evaluation Officer II.