Building Strong Futures: The Feasibility of Using a Targeted Digital Media Campaign to Improve Knowledge About Pregnancy and Low Birthweight Among Black Women

Evaluating Messaging on Prenatal Health Behaviors Using Social Media Data: Systematic Review

BACKGROUND

Social media platforms are increasingly being used to disseminate messages about prenatal health. However, to date, we lack a systematic assessment of how to evaluate the impact of official prenatal health messaging and campaigns using social media data.

OBJECTIVE

This study aims to review both the published and gray literature on how official prenatal health messaging and campaigns have been evaluated to date in terms of impact, acceptability, effectiveness, and unintended consequences, using social media data.

METHODS

A total of 6 electronic databases were searched and supplemented with the hand-searching of reference lists. Both published and gray literature were eligible for review. Data were analyzed using content analysis for descriptive data and a thematic synthesis approach to summarize qualitative evidence. A quality appraisal tool, designed especially for use with social media data, was used to assess the quality of the included articles.

RESULTS

A total of 11 studies were eligible for the review. The results showed that the most common prenatal health behavior targeted was alcohol consumption, and Facebook was the most commonly used source of social media data. The majority (n=6) of articles used social media data for descriptive purposes only. The results also showed that there was a lack of evaluation of the effectiveness, acceptability, and unintended consequences of the prenatal health message or campaign.

CONCLUSIONS

Social media is a widely used and potentially valuable resource for communicating and evaluating prenatal health messaging. However, this review suggests that there is a need to develop and adopt sound methodology on how to evaluate prenatal health messaging using social media data, for the benefit of future research and to inform public health practice.

A scoping review of health promotion interventions delivered via social media to women of reproductive age

OBJECTIVE

Adult women of reproductive age are highly engaged with social media, suggesting its utility for conveying health information to this population, at scale. This scoping review aimed to describe health promotion interventions conducted via social media and assess their effectiveness to improve health outcomes, engagement and acceptability in adult women of reproductive age.

DESIGN

Six databases were searched on 13 May 2022. Two reviewers independently screened studies. Data were extracted and risk of bias assessed using the Joanna Briggs Critical Appraisal Tools.

SETTING

Eligible studies conducted an intervention primarily via social media, with or without a comparison intervention, and reported health-related outcomes/behaviours pre- and post-intervention. Results were presented in narrative form.

PARTICIPANTS

Adult women (mean age 18-45 years).

RESULTS

Nine eligible studies were identified: six randomised control trials, two quasi-experimental studies and one cross-sectional study. Interventions focused on prenatal, antenatal or postpartum health or physical activity. Seven studies utilised Facebook for intervention delivery, one conducted a digital campaign across four platforms and one used WeChat. Studies reported significant improvements in a range of outcomes, including increased parenting competence, longer duration of breast-feeding and higher rates of physical activity. Social media interventions had greater engagement than control interventions.

CONCLUSIONS

We identified nine diverse health promotion interventions conducted via social media, which appear acceptable and effective for improving various health outcomes in adult women of reproductive age. While this supports the utility of social media to convey health information, further research is required to prove effectiveness and superiority over other intervention strategies.

Prenatal Care Utilization Challenges and Facilitators for a Growing Latino Community in the Midwest

BACKGROUND

Latina women are less likely to start prenatal care in the first trimester and to attend the recommended amount of prenatal visits compared to their non-Latina white counterparts.

OBJECTIVES

This study aimed to assess challenges and facilitators to first-trimester prenatal care (FTPNC) and prenatal care utilization (PNCU) in a Midwestern urban area with a growing immigrant Latino community.

METHODS

This study used a mixed-method approach based on the Theoretical Domains Framework. Nine semi-structured interviews were conducted with healthcare professionals that worked in birth centers, clinics, or hospitals that provided prenatal care (PNC) services for Latina women. Eight focus groups and quantitative surveys were conducted with Latina women and their supporters in Kansas City metropolitan area.

RESULTS

FTPNC was challenged by women's immigrant status, lack of healthcare coverage due to immigrant status, and complexity of Medicaid application. PNCU was challenged by the cost of PNC when diagnosed with gestational diabetes, lack of healthcare coverage, PNC literacy, late access to gynecologists/obstetricians, inadequate interpretation services, transportation, and mental health distress. Meanwhile, FTPNC was facilitated by social support and connectedness. PNCU was facilitated by Spanish-proficient providers and interpreters, effective nonverbal communication and education techniques, and pregnancy prevention access and education.

CONCLUSIONS FOR PRACTICE

Results from this study highlight important targets to improve PNC for Latina women. Participants called for various types of support to address identified challenges, ranging from information on social media about PNC services to broader efforts such as building trust from the community toward PNC providers and making PNC services affordable for women with gestational diabetes.

A Model of Social Media Effects in Public Health Communication Campaigns: Systematic Review

BACKGROUND

Social media platforms are frequently used in health communication campaigns. Common understandings of campaign effects posit a sequential and linear series of steps from exposure to behavior change, commonly known as the hierarchy of effects model (HOE). These concepts need to be reevaluated in the age of social media, which are interactional and communal.

OBJECTIVE

This review aims to update the traditional HOE for health communication campaigns in the context of social media, including identifying indicators of effectiveness and how these are conceptualized to lead to health-related outcomes.

METHODS

We conducted a systematic review of studies following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines reporting on the use of social media as part of health communication campaigns, extracting campaign information such as objectives, platforms used, and measures of campaign performance. We used these data, combined with our understanding of the HOE, to develop an updated conceptual model of social media campaign effects.

RESULTS

We identified 99 eligible studies reporting on 93 campaigns, published between 2012 and 2022. The campaigns were conducted in over 20 countries, but nearly half (n=42) were conducted in the United States. Campaigns targeted a variety of health issues and predominantly used Facebook, Twitter, Instagram, and YouTube. Most campaigns (n=81) set objectives targeting awareness or individual behavior change. Process measures (n=68; eg, reach and impressions) and engagement measures (n=73; eg, likes and retweets) were reported most frequently, while two-fifths (n=42) did not report any outcomes beyond engagement, such as changes in knowledge, behavior, or social norms. Most campaigns (n=55) collected measures that did not allow them to determine if the campaign objective had been met; that is, they were process evaluations only. Based on our review, our updated model suggests that campaign exposure can lead to individual behavior change and improved health outcomes, either through a direct or indirect pathway. Indirect pathways include exposure through social and policy changes. "Engagement" is positioned as critical to success, replacing awareness in the traditional HOE, and all types of engagement are treated as equal and good. No consideration is being given to potential negative engagement, such as the distribution of misinformation. Additionally, the process is no longer linear and sequential, with circular pathways evident, such as engagement not only influencing behavior change but also generating additional exposure to campaign messages.

CONCLUSIONS

Our review has highlighted a change in conventional understandings of how campaigns can influence health outcomes in the age of social media. The updated model we propose provides social media campaigners with a starting point to develop and tailor campaign messages and allows evaluators to identify critical assumptions to test, including the role and value of "engagement."

TRIAL REGISTRATION

PROSPERO CRD42021287257; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=287257.

Effect of a social media-based health education program on postnatal care (PNC) knowledge among pregnant women using smartphones in Dhulikhel hospital: A randomized controlled trial

INTRODUCTION

Postnatal care services helps in detecting and subsequently managing life threatening complications. With the ubiquitous use of the mobile phone in Nepal, social media based postpartum education has the potential to increase PNC knowledge among pregnant women. This study aimed to assess the effect of social media-based health education program on PNC knowledge among pregnant women attending Dhulikhel hospital, Nepal.

MATERIALS AND METHODS

We conducted a two-arm open-label randomized controlled trial among literate pregnant women visiting Dhulikhel hospital for ANC check-up from May to August, 2021. A computer-based program allocated 229 pregnant women owning smartphones with internet connectivity in a 1:1 ratio to either intervention (n = 109) or usual care (n = 120). We assessed PNC knowledge in the participants by interviewing in-person or via phone. The intervention group received a 16 minutes video on PNC and the participants were reminded to view the video every week via telephone for a month. Control group received usual care. The primary outcome of the study was change in PNC knowledge score. We utilized intent-to-treat analysis and measured the effect of the intervention on PNC knowledge score using simple linear regression analysis.

RESULTS AND DISCUSSION

The mean PNC knowledge score increased by additional 8.07 points among pregnant women in the intervention group compared to the control group (95% CI: 2.35: 13.80; p-value = 0.006). The maternal care attribute knowledge increased by 4.31 points (95% CI: 1.51-7.10, p-value = 0.03) and newborn care attribute knowledge increased by 3.39 points (95% CI: 0.41-6.37, p-value = 0.02) among pregnant women in the intervention compared to the control group.

CONCLUSION

A social media-based health education is effective in improving PNC knowledge score among pregnant women. Further research is needed to evaluate if this increased knowledge is translated into the increased utilization of PNC care.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT05132608.

Atividade das Unidades de Saúde Familiares da Área Metropolitana do Porto no Facebook em ano de COVID-19

Introdução: As redes sociais têm possibilitado, nos últimos anos, novas formas de interação entre pessoas e entidades e a partilha escalável de conteúdos de diversas áreas, embora nem sempre de forma criteriosa. Objetivos: Caracterizar a presença de páginas das Unidades de Saúde Familiar da Área Metropolitana do Porto (Portugal) na plataforma Facebook à data de dezembro de 2020, suas métricas de idade, seguidores, publicações e interações num dado intervalo de tempo e sua distribuição por modelo organizacional (Unidades de Saúde Familiar–A/B) e Agrupamento de Centros de Saúde; verificar a tendência de criação de páginas em 2020 – ano de pandemia por COVID-19 – e aferir as temáticas abordadas pelas 50 publicações dos últimos 60 dias que obtiveram mais interações. Métodos: Estudo exploratório transversal, descritivo e analítico, com verificação individual das páginas das Unidades de Saúde Familiar da Área Metropolitana do Porto a 30 de dezembro de 2020 e obtenção de métricas relativas a um intervalo de 60 dias de atividade por meio da página Fanpage Karma. Foram calculadas frequências, intervalos, médias e medianas e aplicados testes paramétricos e não paramétricos. Resultados: Das 135 Unidades de Saúde Familiar funcionantes (64% Unidades de Saúde Familiar–B), 53% tinham página ativa (61% Unidades de Saúde Familiar–B, p<0,05), variando entre 0 e 81,3% das Unidades de Saúde Familiar em cada Agrupamento de Centros de Saúde, criadas nos últimos dez anos (mediana 4,6 anos, Unidades de Saúde Familiar–A 1,5 versus Unidades de Saúde Familiar–B 5,3, p<0,05), com crescimento de 44% no ano de 2020. O número de seguidores distribui-se heterogeneamente entre diferentes Unidades de Saúde Familiar e Agrupamento de Centros de Saúde, contudo sem diferenças entre modelos de Unidades de Saúde Familiar, não ultrapassando o milhar em 69% das páginas, e com apenas cinco páginas alcançando mais de 2 mil seguidores. Das páginas ativas, 75% (54/72) publicaram em média 0,3 vez por dia nos últimos 60 dias. Não se verificam associações significativas entre o número de seguidores ou entre modelos Unidades de Saúde Familiar–A/B e o tempo da última publicação ou o número de publicações a 60 dias. Durante esse tempo, foram geradas 15.913 interações (média de 18,8 por publicação). Analisadas as 50 publicações com mais interações dos últimos 60 dias, verifica-se o predomínio de temas relacionados com a COVID-19 e com questões organizacionais e burocráticas, efemérides relativas às Unidades de Saúde Familiar e informação/promoção da vacina contra a COVID-19. Discussão: Admite-se haver aplicação reduzida pelas Unidades de Saúde Familiar (embora crescente em ano de pandemia) do potencial comunicacional e colaborativo das redes sociais. Havendo margem de progressão, estas podem constituir uma ferramenta complementar e interativa para a promoção do acesso e a melhoria da qualidade dos serviços, o combate à desinformação, a capacitação para a saúde dos cidadãos e a melhoria de resultados em saúde.

Growing and Glowing: A Digital Media Campaign to Increase Access to Pregnancy-Related Health Information for Black Women During the COVID-19 Pandemic

BACKGROUND

Low birthweight is a health issue disproportionately experienced by Black women. In Hillsborough County, Florida, Black women experience higher rates of low birthweight compared to the rest of Florida. This study examines the feasibility of a second attempt to use a digital low birthweight campaign to increase knowledge about low birthweight and pregnancy among Black women in Hillsborough.

METHODS

Content for the Growing and Glowing campaign was delivered on social media through a web series with local prenatal care providers and educational images. Two cross-sectional surveys examined changes in pregnancy-related knowledge, attitudes, and behaviors among Black women in Hillsborough. Digital metrics showed campaign reach and engagement.

RESULTS

Growing and Glowing attained 1,234 followers, 805,437 impressions, and a reach of 19,875. Web series videos were viewed almost 27,000 times, with 89% average viewer retention. The website attracted 2,634 unique page views. Evaluation surveys showed significant improvements in positive pregnancy-related intentions. Women aware of the campaign showed significantly higher awareness of the importance of prenatal care, and higher awareness of local resources.

CONCLUSION

Results from the second study of this campaign approach suggest that using a highly targeted digital intervention can be a well-received and potentially effective way to deliver pregnancy-related health information to Black women, even during a global pandemic. This approach has numerous benefits in reaching women who may fall outside traditional health marketing approaches.