Feasibility of using social networking technologies for health research among men who have sex with men: a mixed methods study

Feasibility of using Facebook for HIV prevention: Implications for translational research among justice-involved women who use drugs in rural Appalachia

Background

Justice-involved women from rural Appalachia face significant barriers to the utilization of evidence-based HIV prevention interventions in spite of high rates of injection drug use and risky sexual practices. Adapting evidence-based practices to incorporate the cultural uniqueness of the target population is needed in order to advance translational and clinical science in this area. This study provides a descriptive overview of indicators of feasibility and acceptability of an adapted version of the National Institute on Drug Abuse Standard HIV prevention intervention for delivery using Facebook through a small randomized controlled pilot study with rural Appalachian women.

Method

Study methods include the random selection of rural Appalachian women from two local jails, screening for study eligibility, baseline data collection, random assignment to study interventions, and follow-up in the community three months post-release.

Results

Results indicate that the feasibility of the approach was supported through study enrollment of the target population who reported regular Facebook use and HIV risk behaviors including drug use and sex. Acceptability of the intervention was demonstrated through enrollment in the study intervention, engagement in the intervention through Facebook, and indicators of HIV/HCV knowledge.

Conclusions

Study findings contribute to the critical and unmet need to advance translational science on the delivery of evidence-based prevention interventions in real-world rural Appalachian settings to understudied, vulnerable individuals who are often overlooked in targeted prevention efforts.

Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population

BACKGROUND

Social networking platforms offer a wide reach for public health interventions allowing communication with broad audiences using tools that are generally free and straightforward to use and may be combined with other components, such as public health policies. We define interactive social media as activities, practices, or behaviours among communities of people who have gathered online to interactively share information, knowledge, and opinions.

OBJECTIVES

We aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects. Our secondary objective was to assess the effects of these interventions on the health of populations who experience health inequity as defined by PROGRESS-Plus. We assessed whether there is evidence about PROGRESS-Plus populations being included in studies and whether results are analysed across any of these characteristics.

SEARCH METHODS

We searched CENTRAL, CINAHL, Embase, MEDLINE (including trial registries) and PsycINFO. We used Google, Web of Science, and relevant web sites to identify additional studies and searched reference lists of included studies. We searched for published and unpublished studies from 2001 until June 1, 2020. We did not limit results by language.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), controlled before-and-after (CBAs) and interrupted time series studies (ITSs). We included studies in which the intervention website, app, or social media platform described a goal of changing a health behaviour, or included a behaviour change technique. The social media intervention had to be delivered to adults via a commonly-used social media platform or one that mimicked a commonly-used platform. We included studies comparing an interactive social media intervention alone or as a component of a multi-component intervention with either a non-interactive social media control or an active but less-interactive social media comparator (e.g. a moderated versus an unmoderated discussion group). Our main outcomes were health behaviours (e.g. physical activity), body function outcomes (e.g. blood glucose), psychological health outcomes (e.g. depression), well-being, and adverse events. Our secondary outcomes were process outcomes important for behaviour change and included knowledge, attitudes, intention and motivation, perceived susceptibility, self-efficacy, and social support.

DATA COLLECTION AND ANALYSIS

We used a pre-tested data extraction form and collected data independently, in duplicate. Because we aimed to assess broad outcomes, we extracted only one outcome per main and secondary outcome categories prioritised by those that were the primary outcome as reported by the study authors, used in a sample size calculation, and patient-important.

MAIN RESULTS

We included 88 studies (871,378 participants), of which 84 were RCTs, three were CBAs and one was an ITS. The majority of the studies were conducted in the USA (54%). In total, 86% were conducted in high-income countries and the remaining 14% in upper middle-income countries. The most commonly used social media platform was Facebook (39%) with few studies utilising other platforms such as WeChat, Twitter, WhatsApp, and Google Hangouts. Many studies (48%) used web-based communities or apps that mimic functions of these well-known social media platforms. We compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. We only reported the RCT results in our 'Summary of findings' table. We found a range of effects on health behaviours, such as breastfeeding, condom use, diet quality, medication adherence, medical screening and testing, physical activity, tobacco use, and vaccination. For example, these interventions may increase physical activity and medical screening tests but there was little to no effect for other health behaviours, such as improved diet or reduced tobacco use (20,139 participants in 54 RCTs). For body function outcomes, interactive social media interventions may result in small but important positive effects, such as a small but important positive effect on weight loss and a small but important reduction in resting heart rate (4521 participants in 30 RCTs). Interactive social media may improve overall well-being (standardised mean difference (SMD) 0.46, 95% confidence interval (CI) 0.14 to 0.79, moderate effect, low-certainty evidence) demonstrated by an increase of 3.77 points on a general well-being scale (from 1.15 to 6.48 points higher) where scores range from 14 to 70 (3792 participants in 16 studies). We found no difference in effect on psychological outcomes (depression and distress) representing a difference of 0.1 points on a standard scale in which scores range from 0 to 63 points (SMD -0.01, 95% CI -0.14 to 0.12, low-certainty evidence, 2070 participants in 12 RCTs). We also compared studies assessing interactive social media interventions with those with an active but less interactive social media control (11 studies). Four RCTs (1523 participants) that reported on physical activity found an improvement demonstrated by an increase of 28 minutes of moderate-to-vigorous physical activity per week (from 10 to 47 minutes more, SMD 0.35, 95% CI 0.12 to 0.59, small effect, very low-certainty evidence). Two studies found little to no difference in well-being for those in the intervention and control groups (SMD 0.02, 95% CI -0.08 to 0.13, small effect, low-certainty evidence), demonstrated by a mean change of 0.4 points on a scale with a range of 0 to 100. Adverse events related to the social media component of the interventions, such as privacy issues, were not reported in any of our included studies. We were unable to conduct planned subgroup analyses related to health equity as only four studies reported relevant data.

AUTHORS' CONCLUSIONS

This review combined data for a variety of outcomes and found that social media interventions that aim to increase physical activity may be effective and social media interventions may improve well-being. While we assessed many other outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of our included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase our understanding of the potential effect of these interventions on reducing health inequities.

Design Considerations for Implementing eHealth Behavioral Interventions for HIV Prevention in Evolving Sociotechnical Landscapes

PURPOSE OF REVIEW

Despite tremendous potential for public health impact and continued investments in development and evaluation, it is rare for eHealth behavioral interventions to be implemented broadly in practice. Intervention developers may not be planning for implementation when designing technology-enabled interventions, thus creating greater challenges for real-world deployment following a research trial. To facilitate faster translation to practice, we aimed to provide researchers and developers with an implementation-focused approach and set of design considerations as they develop new eHealth programs.

RECENT FINDINGS

Using the Accelerated Creation-to-Sustainment model as a lens, we examined challenges and successes experienced during the development and evaluation of four diverse eHealth HIV prevention programs for young men who have sex with men: Keep It Up!, Harnessing Online Peer Education, Guy2Guy, and HealthMindr. HIV is useful for studying eHealth implementation because of the substantial proliferation of diverse eHealth interventions with strong evidence of reach and efficacy and the responsiveness to rapid and radical disruptions in the field. Rather than locked-down products to be disseminated, eHealth interventions are complex sociotechnical systems that require continual optimization, vigilance to monitor and troubleshoot technological issues, and decision rules to refresh content and functionality while maintaining fidelity to core intervention principles. Platform choice and sociotechnical relationships (among end users, implementers, and the technology) heavily influence implementation needs and challenges. We present a checklist of critical implementation questions to address during intervention development. In the absence of a clear path forward for eHealth implementation, deliberate design of an eHealth intervention's service and technological components in tandem with their implementation plans is critical to mitigating barriers to widespread use. The design considerations presented can be used by developers, evaluators, reviewers, and funders to prioritize the pragmatic scalability of eHealth interventions in research.

Indicators of adolescents' preference to receive oral health information using social media

OBJECTIVES

To assess (1) adolescents' preference to use social media (SM) to receive oral health information (OHI) and (2) factors associated with this preference.

MATERIALS AND METHODS

A cross-sectional survey was conducted in 2016, Eastern Province, Saudi Arabia including male middle school students. A questionnaire assessed explanatory variables including background, previous OHI seeking practices, internet use purposes, convenience of using SM for OHI and perceived usefulness of obtained OHI. The outcome variable was respondents' preference to use SM to receive OHI. Simple and multiple logistic regression models were used for statistical analysis.

RESULTS

The response rate was 91.2% (456/500). Of those, 57.5% preferred using SM to receive OHI. The odds for this were significantly associated with being Saudi (OR = 3.12, 95%CI = 1.36, 7.18), previously using Twitter (OR = 4.59, 95%CI = 1.77, 11.89) and Instagram for OHI (OR = 2.60, 95%CI = 1.51, 4.45), frequent use of the internet to obtain OHI (OR = 1.25, 95%CI = 1.02, 1.54) and ease of obtaining OHI using the Internet (OR = 2.69, 95%CI = 1.5, 4.39).

CONCLUSION

Most adolescents preferred using SM to receive OHI. This was associated with previous OHI seeking practices and convenience of using SM. These findings have implications for designing SM-based health education campaigns targeting adolescents.

The Use of Social Networking Sites (SNSs) in Health Communication Campaigns: Review and Recommendations

The past decade has witnessed a rapid increase in the use of Social Networking Sites (SNSs) in health communication campaigns seeking to achieve an ambitious range of health-related impacts. This article provides a review of 40 studies and research protocols, with a focus on two key factors that differentiate SNSs from more traditional health communication approaches of the past. The first is the potential dualism between message sender and receiver, in which receivers become receiver-sources who forward and amplify the content and reach of health messages. The second is the potential dualism between message and message impact, in which the act of forwarding and modifying messages by receiver-sources itself becomes a measure of message impact. Each of these dualisms has implications for the design and evaluation of contemporary health communication campaigns. The review concludes with a series of observations and recommendations for future health communication research.

Reaching Egyptian Gays Using Social Media: A Comprehensive Health Study and a Framework for Future Research

The Internet has revolutionized research on sexual minorities by providing direct and safe access to hidden, stigmatized, and high-risk populations. This study investigated the possibility of using Facebook to reach Egyptian gays. The questionnaire was manually distributed to an extensive list of Facebook pages and groups related to the topic that has been collected using a snowball-like technique. The recruitment lasted from August 2015 to May 2016. Among the 461 eligible participants, the mean age was 26.6 (SD = 7.6), and the majority (74%) were highly educated. Only 17% use condoms consistently, and 34% have ever tested for HIV. Guilt feelings and trying to change sexual orientation were very high and were associated with higher religiosity and low condom use and HIV testing (p < .05). Also, 10% have ever tried to end their life. Most of the participants did not disclose their sexual orientation to anybody other than their partners, and 60% will not disclose it to health care providers even if needed. The low health awareness among Egyptian gays requires Internet-based health campaigns.

Facebook network structure and awareness of preexposure prophylaxis among young men who have sex with men

BACKGROUND

Young Black men who have sex with men (YBMSM) are the only population in the United States who have experienced rising human immunodeficiency virus incidence over the past decade. Consistent pre-exposure prophylaxis (PrEP) use can substantially reduce the risk of human immunodeficiency virus acquisition. What differentiates those who become aware of PrEP, and those who do not, remains largely unknown.

METHODS

The social networks of YBMSM can impact their awareness of PrEP; to examine this impact, we used two waves of Facebook data from "uConnect"-a longitudinal cohort study of YBMSM in Chicago (n = 266).

RESULTS

While PrEP awareness increased from 45% at baseline to 75% at follow-up, its use remained low (4% and 6%). There were 88 PrEP-unaware individuals at baseline who became aware (BA) by follow-up, and 56 who remained persistently unaware. While the persistently unawares had a higher median number of total Facebook friends, the BAs had a higher median numbers of friends who participated in uConnect, who were PrEP-aware, and who practiced behaviors previously found to be associated with individual-level awareness of PrEP at baseline. The BAs also had substantially more "influential" friends.

CONCLUSION

These findings demonstrate the potential of social networks in raising PrEP awareness and use among YBMSM.

The Harnessing Online Peer Education (HOPE) Intervention for Reducing Prescription Drug Abuse: A Qualitative Study

Social media technologies are newly emerging tools that can be used to address the growing prescription drug epidemic. In this study, we sought to determine the feasibility and acceptability of using social media to reduce complications of opioid use among patients experiencing chronic pain. Specifically, we evaluated the utility of the Harnessing Online Peer Education (HOPE) social media intervention to reduce the risk of addiction and overdose among non-cancer pain patients receiving chronic opioid therapy. University of California, Los Angeles (UCLA) patients receiving chronic opioid therapy and UCLA staff were invited to participate in interviews regarding the HOPE intervention. Questions focused on resources used to manage pain, the limitations and benefits of these approaches, and the likelihood of using an online community to reduce complications of opioid therapy. Using an open-coding process, three topics were identified for the patients: 1) online social support is important for improving outcomes, 2) offline social support is helpful for some patients but has limitations, and 3) a tailored, online peer support intervention is needed. Interviews with staff confirmed these results. The HOPE social media intervention and other online communities appear to be an acceptable technology for patients on chronic opioid therapy.

Using Real-Time Social Media Technologies to Monitor Levels of Perceived Stress and Emotional State in College Students: A Web-Based Questionnaire Study

BACKGROUND

College can be stressful for many freshmen as they cope with a variety of stressors. Excess stress can negatively affect both psychological and physical health. Thus, there is a need to find innovative and cost-effective strategies to help identify students experiencing high levels of stress to receive appropriate treatment. Social media use has been rapidly growing, and recent studies have reported that data from these technologies can be used for public health surveillance. Currently, no studies have examined whether Twitter data can be used to monitor stress level and emotional state among college students.

OBJECTIVE

The primary objective of our study was to investigate whether students' perceived levels of stress were associated with the sentiment and emotions of their tweets. The secondary objective was to explore whether students' emotional state was associated with the sentiment and emotions of their tweets.

METHODS

We recruited 181 first-year freshman students aged 18-20 years at University of California, Los Angeles. All participants were asked to complete a questionnaire that assessed their demographic characteristics, levels of stress, and emotional state for the last 7 days. All questionnaires were completed within a 48-hour period. All tweets posted by the participants from that week (November 2 to 8, 2015) were mined and manually categorized based on their sentiment (positive, negative, neutral) and emotion (anger, fear, love, happiness) expressed. Ordinal regressions were used to assess whether weekly levels of stress and emotional states were associated with the percentage of positive, neutral, negative, anger, fear, love, or happiness tweets.

RESULTS

A total of 121 participants completed the survey and were included in our analysis. A total of 1879 tweets were analyzed. A higher level of weekly stress was significantly associated with a greater percentage of negative sentiment tweets (beta=1.7, SE 0.7; P=.02) and tweets containing emotions of fear (beta=2.4, SE 0.9; P=.01) and love (beta=3.6, SE 1.4; P=.01). A greater level of anger was negatively associated with the percentage of positive sentiment (beta=-1.6, SE 0.8; P=.05) and tweets related to the emotions of happiness (beta=-2.2, SE 0.9; P=.02). A greater level of fear was positively associated with the percentage of negative sentiment (beta=1.67, SE 0.7; P=.01), particularly a greater proportion of tweets related to the emotion of fear (beta=2.4, SE 0.8; P=.01). Participants who reported a greater level of love showed a smaller percentage of negative sentiment tweets (beta=-1.3, SE 0.7; P=0.05). Emotions of happiness were positively associated with the percentage of tweets related to the emotion of happiness (beta=-1.8, SE 0.8; P=.02) and negatively associated with percentage of negative sentiment tweets (beta=-1.7, SE 0.7; P=.02) and tweets related to the emotion of fear (beta=-2.8, SE 0.8; P=.01).

CONCLUSIONS

Sentiment and emotions expressed in the tweets have the potential to provide real-time monitoring of stress level and emotional well-being in college students.

A survey of social media data analysis for physical activity surveillance

Social media data can provide valuable information regarding people's behaviors and health outcomes. Previous studies have shown that social media data can be extracted to monitor and predict infectious disease outbreaks. These same approaches can be applied to other fields including physical activity research and forensic science. Social media data have the potential to provide real-time monitoring and prediction of physical activity level in a given region. This tool can be valuable to public health organizations as it can overcome the time lag in the reporting of physical activity epidemiology data faced by traditional research methods (e.g. surveys, observational studies). As a result, this tool could help public health organizations better mobilize and target physical activity interventions. The first part of this paper aims to describe current approaches (e.g. topic modeling, sentiment analysis and social network analysis) that could be used to analyze social media data to provide real-time monitoring of physical activity level. The second aim of this paper was to discuss ways to apply social media analysis to other fields such as forensic sciences and provide recommendations to further social media research.

The Use of Social Media for Health Promotion in Hispanic Populations: A Scoping Systematic Review

Background

The Internet is an increasingly popular platform for public health interventions due to its distinct ability to communicate with, engage, and educate communities. Given the widespread use of the Internet, these interventions could be a means of equalizing access to information to address health disparities in minority populations, such as Hispanics. Hispanics are disproportionately affected by poor health outcomes, including obesity, diabetes, and human immunodeficiency virus/acquired immune deficiency syndrome. Although underserved and underrepresented, Hispanics are among the leading users of social media in the United States. Previous reviews have examined the use of social media in public health efforts, but, to our knowledge, none have focused on the Hispanic population.

Objective

To conduct a scoping systematic review of the published literature to capture the ways social media has been used in health interventions aimed at Hispanic populations and identify gaps in existing knowledge to provide recommendations for future research.

Methods

We performed a systematic review of the literature related to social media, public health, and Hispanics using the PubMed, PsycINFO, and EMBASE databases to locate peer-reviewed studies published between January 1, 2010, and December 31, 2015. Each article was reviewed for the following inclusion criteria: social media as a main component of study methodology or content; public health topic; majority Hispanic/Latino study population; English or Spanish language; and original research study. Relevant data were extracted from articles meeting inclusion criteria including publication year, location, study design, social media platform, use of social media, target population, and public health topic.

Results

Of the 267 articles retrieved, a total of 27 unique articles met inclusion criteria. All were published in 2012 or later. The most common study design was a cross-sectional survey, which was featured in 10 of the 27 (37%) articles. All articles used social media for at least one of the following three purposes: recruiting study participants (14 of 27, 52%), promoting health education (12 of 27, 44%), and/or describing social media users (12 of 27, 44%). All but one article used multiple social media platforms, though Facebook was by far the most popular appearing in 24 of the 27 (89%). A diverse array of Hispanic populations was targeted, and health topics featured. Of these, the most highly represented were articles on sexual health directed toward Latino men who have sex with men (12 of 27, 44%). Healthy eating and active living received the second greatest focus (4 of 27, 15%).

Conclusions

Social media offers a potential accessible venue for health interventions aimed at Hispanics, a group at disproportionate risk for poor health outcomes. To date, most publications are descriptive in nature, with few indicating specific interventions and associated outcomes to improve health.

Barriers and Motivators to Participating in mHealth Research Among African American Men

Most African American (AA) men own a smartphone, which positions them to be targeted for a variety of programs, services, and health interventions using mobile devices (mHealth). The goal of this study was to assess AA men's use of technology and the barriers and motivators to participating in mHealth research. A self-administered survey was completed by 311 men. Multinomial logistic regression examined associations between three age groups (18-29 years, 30-50 years, and 51+ years), technology access, and motivators and barriers to participating in mHealth research. Sixty-five percent of men owned a smartphone and a laptop. Men aged 18 to 29 years were more likely willing to use a health app and smartwatch/wristband monitor than older men ( p < .01). Men aged 18 to 29 years were also more likely than older men to be motivated to participate for a free cell phone/upgraded data plan and contribution to the greater good ( p < .05). Older men were more likely than younger ones to be motivated to become more educated about the topic ( p < .05). Younger men were more likely than older ones to report lack of interest in the topic as a barrier to participating ( p < .01), while older men were more likely than younger ones to cite lack of research targeted to minority communities as a barrier ( p < .05). This study suggests that culturally tailored mHealth research using smartphones may be of interest to AA men interested in risk reduction and chronic disease self-management. Opportunities also exist to educate AA men about the topic at hand and why minority men are being targeted for the programs and interventions.

Project HOPE: online social network changes in an HIV prevention randomized controlled trial for African American and Latino men who have sex with men

OBJECTIVES

We examined whether and how an HIV prevention diffusion-based intervention spread throughout participants' online social networks and whether changes in social network ties were associated with increased HIV prevention and testing behaviors.

METHODS

We randomly assigned 112 primarily racial/ethnic minority men who have sex with men (MSM) to receive peer-delivered HIV (intervention) or general health (control) information over 12 weeks through closed Facebook groups. We recorded participants' public Facebook friend networks at baseline (September 2010) and follow-up (February 2011), and assessed whether changes in network growth were associated with changes in health engagement and HIV testing.

RESULTS

Within-group ties increased in both conditions from baseline to follow-up. Among the intervention group, we found a significant positive relation between increased network ties and using social media to discuss sexual behaviors. We found a positive trending relationship between increased network ties and likelihood of HIV testing, follow-up for test results, and participation in online community discussions. No significant differences were seen within control groups.

CONCLUSIONS

Among high-risk MSM, peer-led social media HIV prevention interventions can increase community cohesion. These changes appear to be associated with increased HIV prevention and testing behaviors.

Online Technologies for Health Information and Education: A literature review

There is a growing body of research focused on the use of social media and Internet technologies for health education and information sharing. The authors reviewed literature on this topic, with a specific focus on the benefits and concerns associated with using online social technologies as health education and communication tools. Studies suggest that social media technologies have the potential to safely and effectively deliver health education, if privacy concerns are addressed. Utility of social media-based health education and communication will improve as technology developers and public health officials determine ways to improve information accuracy and address privacy concerns.