Click "like" to change your behavior: a mixed methods study of college students' exposure to and engagement with Facebook content designed for weight loss

Occupational Health Applied Infodemiological Studies of Nutritional Diseases and Disorders: Scoping Review with Meta-Analysis

(1) Objective: to identify and review existing infodemiological studies on nutritional disorders applied to occupational health and to analyse the effect of the intervention on body mass index (BMI) or alternatively body weight (BW); (2) Methods: This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American, and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Nutrition Disorders, "Occupational Health" and "Infodemiology", applying the filters "Humans" and "Adult: 19+ years". The search was conducted on 29 May 2021; (3) Results: a total of 357 references were identified from the bibliographic database searches; after applying the inclusion and exclusion criteria, a total of 11 valid studies were obtained for the review. Interventions could be categorised into (1) interventions related to lifestyle, physical activity, and dietary changes through education programmes, (2) interventions associated with lifestyle, physical activity, and dietary changes through the use of telemonitoring systems or self-help applications, (3) interventions tied to lifestyle, physical activity, and dietary changes through control and/or social network support groups, and (4) interventions linked to changes in the work environment, including behavioural change training and work environment training tasks. The meta-analysis demonstrated that the heterogeneity present when analysing the results for BMI was 72% (p < 0.01), which decreased to 0% (p = 0.57) when analysing the outcomes for weight, in which case the null hypothesis of homogeneity could be accepted. In all instances, the final summary of the effect was on the decreasing side for both BMI and BW; (4) Conclusions: Despite the high heterogeneity of the results reported, the trend shown in all cases indicates that the intervention methodologies implemented by empowering individuals through Web 2.0 technologies are positive in terms of the problem of overweight. Further implementation of novel strategies to support individuals is needed to overcome obesity, and, at least in the early studies, these strategies seem to be making the necessary change.

The Impact of Social Media Interventions on Weight Reduction and Physical Activity Improvement Among Healthy Adults: Systematic Review

BACKGROUND

A sedentary lifestyle and being overweight or obese are well-established cardiovascular risk factors and contribute substantially to the global burden of disease. Changing such behavior is complex and requires support. Social media interventions show promise in supporting health behavior change, but their impact is unclear. Moreover, previous reviews have reported contradictory evidence regarding the relationship between engagement with social media interventions and the efficacy of these interventions.

OBJECTIVE

This review aimed to critically synthesize available evidence regarding the impact of social media interventions on physical activity and weight among healthy adults. In addition, this review examined the effect of engagement with social media interventions on their efficacy.

METHODS

CINAHL and MEDLINE were searched for relevant randomized trials that were conducted to investigate the impact of social media interventions on weight and physical activity and were published between 2011 and 2021 in the English language. Studies were included if the intervention used social media tools that provided explicit interactions between the participants. Studies were excluded if the intervention was passively delivered through an app website or if the participants had a known chronic disease. Eligible studies were appraised for quality and synthesized using narrative synthesis.

RESULTS

A total of 17 papers reporting 16 studies from 4 countries, with 7372 participants, were identified. Overall, 56% (9/16) of studies explored the effect of social media interventions on physical activity; 38% (6/16) of studies investigated weight reduction; and 6% (1/16) of studies assessed the effect on both physical activity and weight reduction. Evidence of the effects of social media interventions on physical activity and weight loss was mixed across the included studies. There were no standard metrics for measuring engagement with social media, and the relationship between participant engagement with the intervention and subsequent behavior change was also mixed. Although 35% (6/16) of studies reported that engagement was not a predictor of behavior change, engagement with social media interventions was found to be related to behavior change in 29% (5/16) of studies.

CONCLUSIONS

Despite the promise of social media interventions, evidence regarding their effectiveness is mixed. Further robust studies are needed to elucidate the components of social media interventions that lead to successful behavior change. Furthermore, the effect of engagement with social media interventions on behavior change needs to be clearly understood.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42022311430; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=311430.

"The potential of social media in health promotion beyond creating awareness: an integrative review"

BACKGROUND

Developing strategies to change health behaviour is one of the biggest challenges of health promotion programs. Social media, as a popular and innovative communication and education tool, offers opportunities to modify health behaviour. While literature on using social media for health promotion campaigns is growing, there is a need to evaluate the approaches used to change health behaviour, rather than only creating awareness.

OBJECTIVE

The paper reviewed the literature on application of social media in health promotion campaigns with a particular focus on the methodologies used in assessing the outcome of the programs for behaviour change. This fills the void in collating evidence to extend health promotion campaigns to effect sustainable behavioural change.

METHOD

Peer-reviewed articles were identified through multiple science databases. A systematic electronic search was conducted to retrieve review and original papers published between January 2010 and April 2022. The titles and abstracts of the articles were screened according to inclusion and exclusion criteria. All authors independently read the full texts and discussed them to reach a consensus about the themes. Concept mapping was used to present results from analysis of the included papers.

RESULTS

Of the 674 citations, 28 (4.1%) studies were included in this review. The methodology approaches of 18 (2.7%) papers, that aimed to evaluate the impact of social media in health promotion campaigns towards behaviour change, were analysed further using concept mapping. The results showed that 10 studies (55.5%) adopted quantitative methods and five studies (27.7%) used mixed methods and three studies (16.6%) used qualitative methods. Facebook and YouTube were used more for intervention purposes to change health behaviour. Twitter and Instagram were used more to observe the trend of changes in health behaviour. Six studies (33.3%) adopted Social Cognitive Theory and one study (5.5%) applied the Transtheoretical Model as the framework to evaluate the outcome. Overall, the results show that though social media has potential in promoting behaviour change, the estimation of this change in long-term lies outside the scope of social media health campaigns. This is also reflected in the methodologies used in existing studies to assess such sustainable changes. The employed measures usually target immediate behaviour or social media engagement rather than addressing the change on a behavioural level.

CONCLUSION

Evaluating the performance of social media campaigns to promote health behaviours towards a sustainable outcome is a complex process. Emerging research is focused on evaluating the potential of social media as an opportunity to create awareness. Such measures require less effort in quantifying and isolating the effect. The design of the campaigns is required to be aligned in relation to stages of the behaviour change. The study provides suggestions on how this can be achieved.

Smokers' Engagement Behavior on Facebook: Verbalizing and Visual Expressing the Smoking Cessation Process

The "processes of change" and "motivational language" are common in smoker Facebook users' comments under smoking cessation support contents. Smokers can combine this verbalization of the smoking cessation process with visual expression when they use comments and Facebook reactions at the same time. The aim of this study was to understand the relationship between processes of change, motivational language, and the Facebook reaction buttons. A total of 821 smokers' comments were analyzed in the current study (n = 821), which responded to image-based smoking cessation support contents. The processes of change and the motivational language used in the investigated comments were identified. These linguistic categories were compared with the usage of reaction buttons. The Facebook users who used the "Haha" reaction button wrote a significantly higher proportion of sustain talk than those who used the "Like" or "Love" reaction buttons. The Facebook users who combined the comment and "Love" reaction wrote significantly more change talk than those who did not utilize these buttons. We suggest that the "Haha" reaction may be a negative indicator, the "Like" reaction may be a neutral indicator, and the "Love" reaction may be a positive engagement indicator in terms of the smoking cessation process during Facebook-based interventions. These results may highlight how to evaluate Facebook reactions relating to smoking cessation support contents.

Use of Focus Groups to Inform a New Community-Based Youth Diabetes Prevention Program

There have been few youth-led diabetes prevention programs. Our objective was to conduct focus groups to explore peer influences on adolescent lifestyle behaviors and strategies for implementing a youth peer education model for diabetes prevention. We conducted six focus groups with 52 youth (ages 13-22; 62% male, 38% female; 64% Hispanic, 36% non-Hispanic Black) from East Harlem, NYC. We used a Thematic Analysis approach to identify major themes, compared findings, and resolved differences through discussion and consensus. Three dominant themes arose: (1) Adolescents generally encounter more unhealthy peer influences on diet and more healthy peer influences on physical activity; (2) Adolescents endorse youth-led diabetes prevention strategies and describe ideal qualities for peer leaders and methods to support and evaluate leaders; (3) Adolescents prefer text messaging to monitor behaviors, track goals, and receive personalized guidance. Using study findings, our Community Action Board developed a peer-led diabetes prevention program for prediabetic adolescents.

Searching for Sustainability in Health Systems: Toward a Multidisciplinary Evaluation of Mobile Health Innovations

Mobile health (mHealth) innovations are considered by governments as game changers toward more sustainable health systems. The existing literature focuses on the clinical aspects of mHealth but lacks an integrated framework on its sustainability. The foundational idea for this paper is to include disciplinary complementarities into a multi-dimensional vision to evaluate the non-clinical aspects of mHealth innovations. We performed a targeted literature review to find how the sustainability of mHealth innovations was appraised in each discipline. We found that each discipline considers a different outcome of interest and adopts different time horizons and perspectives for the evaluation. This article reflects on how the sustainability of mHealth innovation can be assessed at both the level of the device itself as well as the level of the health system. We identify some of the challenges ahead of researchers working on mobile health innovations in contributing to shaping a more sustainable health system.

Social Mobile Approaches to Reducing Weight (SMART) 2.0: protocol of a randomized controlled trial among young adults in university settings

Background

Excess weight gain in young adulthood is associated with future weight gain and increased risk of chronic disease. Although multimodal, technology-based weight-loss interventions have the potential to promote weight loss among young adults, many interventions have limited personalization, and few have been deployed and evaluated for longer than a year. We aim to assess the effects of a highly personalized, 2-year intervention that uses popular mobile and social technologies to promote weight loss among young adults.

Methods

The Social Mobile Approaches to Reducing Weight (SMART) 2.0 Study is a 24-month parallel-group randomized controlled trial that will include 642 overweight or obese participants, aged 18–35 years, from universities and community colleges in San Diego, CA. All participants receive a wearable activity tracker, connected scale, and corresponding app. Participants randomized to one intervention group receive evidence-based information about weight loss and behavior change techniques via personalized daily text messaging (i.e., SMS/MMS), posts on social media platforms, and online groups. Participants in a second intervention group receive the aforementioned elements in addition to brief, technology-mediated health coaching. Participants in the control group receive a wearable activity tracker, connected scale, and corresponding app alone. The primary outcome is objectively measured weight in kilograms over 24 months. Secondary outcomes include anthropometric measurements; physiological measures; physical activity, diet, sleep, and psychosocial measures; and engagement with intervention modalities. Outcomes are assessed at baseline and 6, 12, 18, and 24 months. Differences between the randomized groups will be analyzed using a mixed model of repeated measures and will be based on the intent-to-treat principle.

Discussion

We hypothesize that both SMART 2.0 intervention groups will significantly improve weight loss compared to the control group, and the group receiving health coaching will experience the greatest improvement. We further hypothesize that differences in secondary outcomes will favor the intervention groups. There is a critical need to advance understanding of the effectiveness of multimodal, technology-based weight-loss interventions that have the potential for long-term effects and widespread dissemination among young adults. Our findings should inform the implementation of low-cost and scalable interventions for weight loss and risk-reducing health behaviors.

Trial registration

ClinicalTrials.govNCT03907462. Registered on April 9, 2019

Feasibility of a social media-based weight loss intervention designed for low-SES adults

Low-socioeconomic status (SES) individuals have higher rates of obesity. Social media platforms are used frequently by low-SES individuals and facilitate important weight loss program components including social support. Very few social media-based weight loss interventions, however, have enrolled or been tailored to low-SES participants. The purpose of this article is to examine the feasibility of a social media-based weight loss intervention among low-SES adults. We conducted a one-group pretest post-test pilot intervention study with two groups (group 1, n = 39, group 2, n = 16) of low-SES overweight/obese adults who were enrolled in a 12-week social media-based weight loss intervention including self-monitoring via Fitbits and participation in a private Facebook group. A moderator provided educational content and encouraged social support via Facebook. Descriptive statistics were used to assess intervention acceptability and engagement. Exploratory analyses were conducted to examine changes in study outcomes and engagement patterns. The study had good retention (86%). Among 55 total participants enrolled, there were 9,175 participant interactions within the Facebook group. Among completers (n = 47), 96% indicated they would recommend the intervention to a friend. Mean weight loss was 1.07 kg (SD = 3.96, p = .0498), and participants reported increases in positive dietary social support (mean = 2.47, SD = 5.09, p = .0007). Engagement in this social media-based pilot intervention was high and exceeded results from previous studies using similar formats. Participants evaluated the intervention favorably. Changes in weight loss and several theoretical mediators were in the desired direction. Overall, our results indicate social media groups as a platform for weight loss intervention delivery among low-SES adults are feasible and should be studied in larger randomized trials.

Experiences of parent-adolescent dyads regarding a Facebook-based intervention to improve overweight/obesity treatment in adolescents: A qualitative study

APOLO-Teens is a Facebook-based psychological intervention aiming to optimize hospital treatment for adolescents with overweight/obesity. The present qualitative study aims to explore (1) how adolescents experienced participation in APOLO-Teens and (2) how parents perceived adolescents' participation. Sixteen adolescent-parent dyads were interviewed by telephone using semistructured guides. An inductive approach of thematic analysis was used to analyze data by two independent codifiers. The consensus was used to resolve differences in coding/themes, and two independent auditors reviewed the codes and the themes proposed. We identified four themes from adolescents' interviews, namely, expectations, perception of outcomes, participation in the intervention, and sharing of acquired knowledge. From parents' interviews, we identified five themes: expectations for son/daughter participation, perception of adolescents' outcomes, son/daughter participation, parental role, and use of social networks in intervention programs for adolescents. Both elements of the dyad indicated that adolescents' participation in APOLO-Teens contributed to favorable outcomes, further highlighting the use of online interventions to complement the hospital treatment of adolescents with overweight/obesity. Future studies should address the viewpoints of adolescents and parents in the design of Facebook-based interventions, namely, to implement tailored, shorter, less time-demanding interventions that favor engagement between participants and parental involvement.

Participant perspectives of a telehealth trial investigating the use of telephone and text message support in obesity management: a qualitative evaluation

Background: Quantitative evidence suggests that interventions involving telephone calls and text message are feasible and effective for improving lifestyle intervention adherence and clinical outcomes among adults with obesity. The aim of this article is to provide qualitative insight into the perspectives and experiences of participants who completed a telehealth trial exploring the use of telephone and text support as adjunctive tools to support a community-based obesity management program. Methods: Focus groups were conducted in order to evaluate program acceptability and overall participant perceptions of the clinical trial. Thematic content analysis was used to analyse the data, aided by the development of a thematic network. Results: The telehealth trial was well received. Participants found the telephone and text message support highly beneficial, providing encouragement, motivation and accountability via a simple and convenient mode of communication. Conclusions: These findings suggest a high degree of promise for the incorporation of telephone and text support in obesity management.

Facebook Users' Interactions, Organic Reach, and Engagement in a Smoking Cessation Intervention: Content Analysis

Background

Facebook can be a suitable platform for public health interventions. Facebook users can express their reaction to the given social media content in many ways using interaction buttons. The analysis of these interactions can be advantageous in increasing reach and engagement of public health interventions.

Objective

This research aimed at understanding how Facebook users’ interactions correlate with organic reach and engagement regarding the same smoking cessation support contents.

Methods

The study population consisted of Facebook users who were reached by a public smoking cessation support page without advertising. We included 1025 nonpaid Facebook posts (N=1025) which used smoking cessation strategies based on a motivational interviewing counseling style. The following data were collected from the “Post Details”: the number of people who saw the given nonpaid content (organic reach) which consisted of fan and nonfan reach according to previous “page like” activity; each rate of “engagement indicators” (such as the symbols of “like,” “love,” “haha,” “wow,” “sad,” “angry”; or other interactions: “shares,” “comments,” “clicks”); and the rate of negative Facebook interactions (eg, “post hides” or “unlike of page”). Overall, these data were analyzed with the Spearman correlation method.

Results

Surprisingly, we found a significant negative correlation between organic reach and the “like” reaction (r_s=–0.418; P<.001). The strongest significant positive correlations of organic reach were observed with the “haha” reaction (r_s=0.396; P<.001), comments (r_s=0.368; P<.001), and the “love” reaction (r_s=0.264; P<.001). Furthermore, nonfan reach correlated positively with “shares” (r_s=0.388; P<.001) and clicks (r_s=0.135; P<.001), while fan reach correlated positively with the “haha” reaction (r_s=0.457; P<.001), comments (r_s=0.393; P<.001), and the “love” reaction (r_s=0.310; P<.001). Contrary to expectations, the “like” reaction was sharply separated by significant negative correlations from “wow” (r_s=–0.077; P=.013), “sad” (r_s=–0.120; P<.001), “angry” reactions (r_s=–0.136; P<.001), and comments (r_s=–0.130; P<.001). Additionally, a high rate of negative Facebook interactions was significantly associated with “wow” (r_s=0.076; P=.016) and “sad” reactions (r_s=0.091; P=.003).

Conclusions

This study has shown that it is possible to hypothesize a disadvantage of the “like” reaction and advantages of other interactions (eg, the “haha” reaction or “comments”) in content algorithmic ranking on Facebook. In addition, the correlational analysis revealed a need of a further categorization to fan-specific interactions (eg, “haha” or “love” reactions) and nonfan-specific interactions (eg, “shares” and “clicks”). Regarding the direction of the correlations, these findings suggest that some interactions (eg, negative Facebook interactions, “wow,” “sad,” and “angry” reactions) may decrease the engagement, while other interactions (“like,” “love,” “haha” reactions, “shares,” and “clicks”) may increase the engagement during Facebook-based smoking cessation interventions. This hypothesis-generating research offers an important insight into the relationship between organic reach, engagement, and Facebook users’ interactions for public health professionals who design Facebook-based interventions.

Social Advertising Effectiveness in Driving Action: A Study of Positive, Negative and Coactive Appeals on Social Media

Background: Social media offers a cost-effective and wide-reaching advertising platform for marketers. Objectively testing the effectiveness of social media advertising remains difficult due to a lack of guiding frameworks and applicable behavioral measures. This study examines advertising appeals’ effectiveness in driving engagement and actions on and beyond social media platforms. Method: In an experiment, positive, negative and coactive ads were shared on social media and promoted for a week. The three ads were controlled in an A/B testing experiment to ensure applicable comparison. Measures used included impressions, likes, shares and clicks following the multi-actor social media engagement framework. Data were extracted using Facebook ads manager and website data. Significance was tested through a series of chi-square tests. Results: The promoted ads reached over 21,000 users. Significant effect was found for appeal type on engagement and behavioral actions. The findings support the use of negative advertising appeals over positive and coactive appeals. Conclusion: Practically, in the charity and environment context, advertisers aiming to drive engagement on social media as well as behavioral actions beyond social media should consider negative advertising appeals. Theoretically, this study demonstrates the value of using the multi-actor social media engagement framework to test advertising appeal effectiveness. Further, this study proposes an extension to evaluate behavioral outcomes.

Social Network Analysis of the Effects of a Social Media-Based Weight Loss Intervention Targeting Adults of Low Socioeconomic Status: Single-Arm Intervention Trial

Background

Obesity is a known risk factor for cardiovascular disease risk factors, including hypertension and type II diabetes. Although numerous weight loss interventions have demonstrated efficacy, there is considerably less evidence about the theoretical mechanisms through which they work. Delivering lifestyle behavior change interventions via social media provides unique opportunities for understanding mechanisms of intervention effects. Server data collected directly from web-based platforms can provide detailed, real-time behavioral information over the course of intervention programs that can be used to understand how interventions work.

Objective

The objective of this study was to demonstrate how social network analysis can facilitate our understanding of the mechanisms underlying a social media–based weight loss intervention.

Methods

We performed secondary analysis by using data from a pilot study that delivered a dietary and physical activity intervention to a group of participants via Facebook. We mapped out participants’ interaction networks over the 12-week intervention period and linked participants’ network characteristics (eg, in-degree, out-degree, network constraint) to participants’ changes in theoretical mediators (ie, dietary knowledge, perceived social support, self-efficacy) and weight loss by using regression analysis. We also performed mediation analyses to explore how the effects of social network measures on weight loss could be mediated by the aforementioned theoretical mediators.

Results

In this analysis, 47 participants from 2 waves completed the study and were included. We found that increases in the number of posts, comments, and reactions significantly predicted weight loss (β=–.94, P=.04); receiving comments positively predicted changes in self-efficacy (β=7.81, P=.009), and the degree to which one’s network neighbors are tightly connected with each other weakly predicted changes in perceived social support (β=7.70, P=.08). In addition, change in self-efficacy mediated the relationship between receiving comments and weight loss (β=–.89, P=.02).

Conclusions

Our analyses using data from this pilot study linked participants’ network characteristics with changes in several important study outcomes of interest such as self-efficacy, social support, and weight. Our results point to the potential of using social network analysis to understand the social processes and mechanisms through which web-based behavioral interventions affect participants’ psychological and behavioral outcomes. Future studies are warranted to validate our results and to further explore the relationship between network dynamics and study outcomes in similar and larger trials.

Evaluating a Technology-Mediated HPV Vaccination Awareness Intervention: A Controlled, Quasi-Experimental, Mixed Methods Study

College-aged women and men are an important catch-up population for human papillomavirus (HPV) vaccination interventions. Limited research has explored technology-mediated HPV vaccination awareness interventions aimed at college students. The purpose was to evaluate a novel, technology-mediated, social media-based intervention to promote HPV vaccination among college students. A controlled, quasi-experimental, mixed methods study examined the feasibility of a technology-based intervention among two undergraduate classes (n = 58) at a public university in the southeastern United States of America. Classes were randomized to receive one of two cancer prevention programs (i.e., HPV vaccination (intervention) or healthy weight (control)). Both programs contained eight technology-mediated sessions, including weekly emails and private Facebook group posts. Participants completed pre-/post-test surveys and submitted weekly qualitative reflections. Data were analyzed using descriptive statistics and thematic review for qualitative data. Knowledge improved among participants in the HPV vaccination intervention relative to those in the control condition. Participants (97%) interacted on Facebook by "liking" a post or comment or posting a comment. Participants demonstrated robust engagement and high treatment satisfaction. Results suggests that social media is an effective platform to reach college students with health promotion interventions and increase HPV vaccination awareness in this important catch-up population.

Factors influencing engagement and dietary behaviour change of mothers and their children in a blog-delivered healthy eating intervention: a process evaluation of a randomised controlled trial

OBJECTIVE

A randomised controlled trial found no evidence of an impact of a blog written by a registered dietitian (RD) on vegetables and fruit and milk and alternatives (e.g. soya-based beverages, yogurt and cheese) consumption - two food groups included in the 2007 version of the Canadian Food Guide - in mothers and their children compared with a control condition. To investigate these null findings, the current study explored participants' perceptions of engagement with the blog and its influence on their dietary behaviours.

DESIGN

Mixed methods process evaluation using a post-intervention satisfaction questionnaire and a content analysis of mothers' comments on the blog (n 213 comments).

SETTING

French-speaking adult mothers living in Quebec City, Quebec, Canada (n 26; response rate = 61·9 % of the total sample randomised to exposure to the blog).

RESULTS

Most mothers (n 20/26; 76·9 %) perceived the blog useful to improve their dietary habits - with the most appreciated blog features being nutritional information and healthy recipes and interactions with fellow participants and the RD. Mothers reported several facilitators (e.g. meal planning and involving children in household food activities) and few barriers (e.g. lack of time and children's food preferences) to maternal and child consumption of vegetables and fruit and milk and alternatives. Lack of time was the principal reported barrier affecting blog engagement.

CONCLUSIONS

The findings from the current study suggest that blogs written by an RD may be an acceptable format of intervention delivery among mothers, but may not alleviate all the barriers to healthy eating and engagement in a dietary intervention.

Using Social Media to Understand Online Social Factors Concerning Obesity: A Systematic Review (Preprint)

Background

Evidence in the literature surrounding obesity suggests that social factors play a substantial role in the spread of obesity. Although social ties with a friend who is obese increase the probability of becoming obese, the role of social media in this dynamic remains underexplored in obesity research. Given the rapid proliferation of social media in recent years, individuals socialize through social media and share their health-related daily routines, including dieting and exercising. Thus, it is timely and imperative to review previous studies focused on social factors in social media and obesity.

Objective

This study aims to examine web-based social factors in relation to obesity research.

Methods

We conducted a systematic review. We searched PubMed, Association for Computing Machinery, and ScienceDirect for articles published by July 5, 2019. Web-based social factors that are related to obesity behaviors were studied and analyzed.

Results

In total, 1608 studies were identified from the selected databases. Of these 1608 studies, 50 (3.11%) studies met the eligibility criteria. In total, 10 types of web-based social factors were identified, and a socioecological model was adopted to explain their potential impact on an individual from varying levels of web-based social structure to social media users’ connection to the real world.

Conclusions

We found 4 levels of interaction in social media. Gender was the only factor found at the individual level, and it affects user’s web-based obesity-related behaviors. Social support was the predominant factor identified, which benefits users in their weight loss journey at the interpersonal level. Some factors, such as stigma were also found to be associated with a healthy web-based social environment. Understanding the effectiveness of these factors is essential to help users create and maintain a healthy lifestyle.

A review of social media analytic tools and their applications to evaluate activity and engagement in online sexual health interventions

•

Social media analytic tools offer ways to evaluate online sex health interventions.

•

Most tools measure reach, aggregate activity, and page- and post-level engagement.

•

User-level activity and engagement metrics are rarely provided.

•

Various metrics comprising composite engagement scores are difficult to discern.

•

Most tools have limited or no capabilities in text and social network analytics.

Unprecedented public engagement with social media has provided viable and culturally relevant platforms for application in sexual health interventions, yet there are concerns that methods for evaluating engagement in these interventions have not kept pace with their implementation. More recently, the rise of social media analytics (SMA) and online marketing has spawned the development of analytic tools that boast promise for such a task. In this paper, we review a sample of the most popular of these tools, paying particular attention to: (1) the social media platforms that can be analyzed; (2) analytic capabilities; and (3) measures of engagement. We follow this with a review of sexual health intervention studies that apply these tools in evaluation efforts. Our findings suggest that these tools have numerous analytic capabilities that would be useful for evaluating interventions more efficiently. However, in nearly all cases, the tools we reviewed alone would not be sufficient to fully grasp engagement dynamics, as they need to be complemented with additional tools for textual analysis and social network analysis. Therefore, we consider this fertile ground for future collaborations between software developers and behavioral health scientists to develop more comprehensive analytic platforms with applications for public health research.

Effectiveness of Facebook Groups to Boost Participation in a Parenting Intervention

Although family-based prevention programs have been shown to be effective at reducing adolescent substance use, it is often difficult and costly to recruit and retain parents in programs administered in person. The current study tested whether program engagement and parenting practices could be improved by offering parents in a self-directed family program access to a private Facebook group. Parents of middle school children (N = 103) were recruited through paid Facebook ads to a 5-week self-directed teen substance use prevention program to be completed at home together by parents and their children. Two thirds of parents (N = 72) were randomly assigned to a moderated private Facebook group that provided a forum for parents in the study to interact with each other, and one third (N = 31) were randomized to use the intervention materials without additional support. Relatively few parents participated in the Facebook group and most did not find the experience useful. However, satisfaction with the program assessed 3 months after program completion was high among all parents and most parents engaged with the materials, irrespective of Facebook group assignment. Overall, parents reported significantly lower conflict and more household rules 6 months post-intervention compared to baseline. Parenting practices did not change more among those assigned to the Facebook group than among parents who used the materials on their own. The current findings suggest that providing opportunities for parents to interact online while participating in a self-directed family intervention may not help to increase engagement or improvements in parenting practices, particularly when few parents engage with each other.

Exploring the role of social support and social media for lifestyle interventions to prevent weight gain with young adults: Focus group findings

BACKGROUND

Young adults gain more weight annually than other adults and may be destined for future obesity. Effective interventions are needed, and social support may be a key element for success. The present study explores how best to leverage social media to support young adults with their health goals in a healthy lifestyle programme.

METHOD

Young adults aged 18-25 years were recruited from the community to a series of four focus groups led by an experienced facilitator who used a discussion guide developed a priori. The discussion explored their opinions regarding which social media platforms were appropriate for providing social support, the types of support that were relevant (family and friends versus strangers) and factors that would encourage peer-to-peer communication in a healthy lifestyle intervention. Sessions were audio-taped, transcribed and analysed using the qualitative software, nvivo, version 11 (QSR International Pty Ltd., Melbourne, VIC, Australia). Themes were generated using an inductive approach informed by the Theory of Social Identity and Social Influence Model of Consumer Participation.

RESULTS

Thirty-three people (12 male) participated. Facebook was the most popular platform for facilitating social support as a result of its private group capabilities and already being embedded into their daily routines. The preference was to be grouped with strangers who shared similar goals in smaller groups of participants. The discussions highlighted the integral role of a credible and relatable health coach to serve as a mentor, mediator and role model.

CONCLUSIONS

The learnings from this research will be applied to optimise engagement within social media support groups in lifestyle interventions.

Understanding Weight Loss via Online Discussions: Content Analysis of Reddit Posts Using Topic Modeling and Word Clustering Techniques

BACKGROUND

Maintaining a healthy weight can reduce the risk of developing many diseases, including type 2 diabetes, hypertension, and certain types of cancers. Online social media platforms are popular among people seeking social support regarding weight loss and sharing their weight loss experiences, which provides opportunities for learning about weight loss behaviors.

OBJECTIVE

This study aimed to investigate the extent to which the content posted by users in the r/loseit subreddit, an online community for discussing weight loss, and online interactions were associated with their weight loss in terms of the number of replies and votes that these users received.

METHODS

All posts that were published before January 2018 in r/loseit were collected. We focused on users who revealed their start weight, current weight, and goal weight and were active in this online community for at least 30 days. A topic modeling technique and a hierarchical clustering algorithm were used to obtain both global topics and local word semantic clusters. Finally, we used a regression model to learn the association between weight loss and topics, word semantic clusters, and online interactions.

RESULTS

Our data comprised 477,904 posts that were published by 7660 users within a span of 7 years. We identified 25 topics, including food and drinks, calories, exercises, family members and friends, and communication. Our results showed that the start weight (β=.823; P<.001), active days (β=.017; P=.009), and median number of votes (β=.263; P=.02), mentions of exercises (β=.145; P<.001), and nutrition (β=.120; P<.001) were associated with higher weight loss. Users who lost more weight might be motivated by the negative emotions (β=-.098; P<.001) that they experienced before starting the journey of weight loss. In contrast, users who mentioned vacations (β=-.108; P=.005) and payments (β=-.112; P=.001) tended to experience relatively less weight loss. Mentions of family members (β=-.031; P=.03) and employment status (β=-.041; P=.03) were associated with less weight loss as well.

CONCLUSIONS

Our study showed that both online interactions and offline activities were associated with weight loss, suggesting that future interventions based on existing online platforms should focus on both aspects. Our findings suggest that online personal health data can be used to learn about health-related behaviors effectively.

How Could Peers in Online Health Community Help Improve Health Behavior

Human behavior is the largest source of variance in health-related outcomes, and the increasingly popular online health communities (OHC) can be used to promote healthy behavior and outcomes. We explored how the social influence (social integration, descriptive norms and social support) exerted by online social relationships does affect the health behavior of users. Based on an OHC, we considered the effect of three types of social relationships (friendship, mutual support group and competing group) in the OHC. We found that social integration, descriptive norms and social support (information and emotional support) from the OHC had a positive effect on dietary and exercise behavior. Comparing the effects of different social relationships, we found that the stronger social relationship—friendship—had a stronger effect on health behavior than the mutual support group and competing group. Emotional support had a stronger effect on health behavior than informational support. We also found that the effects of social integration and informational support became stronger as membership duration increased, but the effects of the descriptive norms and emotional support became smaller. This study extended the research on health behavior to the online social environment and explored how the social influence exerted by various social relationships in an OHC affected health behavior. The results could be used for guiding users to make use of online social relationships for changing and maintaining healthy behavior, and helping healthcare websites improve their services.

Mental illness on Instagram: a mixed method study to characterize public content, sentiments, and trends of antidepressant use

BACKGROUND

Individuals with mental illness use social media to share treatment experiences and anecdotal information. Despite the significant impact of social media on individuals with mental illness, posts related to antidepressants have not been studied systematically.

AIMS

This study evaluates public sentiments and content posted on Instagram regarding the use of antidepressants.

METHODS

Instagram posts from July 2010 to June 30, 2018 containing hashtags of commonly prescribed antidepressants and anxiety/depression-related terms were gathered (n = 13,096). Approximately 1,000 posts were randomly selected and evaluated for photo content, anecdotal experiences, sentiments towards antidepressants, and mentions of psychotherapy, comorbidities, polypharmacy, or adverse effects.

RESULTS

Instagram posts describing antidepressant use have increased exponentially from 2010, and 43% provided anecdotal experiences. Among these posts, 58% expressed negative sentiments towards antidepressant usage, citing adverse effects and lack of improvement. Posts that also mentioned psychotherapy, comorbidities, or polypharmacy differed in their collective sentiments. Misinformation was present in analyzed posts, and none mentioned recovery-oriented materials (i.e., mental health facility, hotline, etc.).

CONCLUSIONS

Instagram is a useful resource for exploring public sentiments related to antidepressant use. Mental health professionals should be cognizant of these sentiments/perceptions in order to tailor communication with patients and should consider increasing their social media presence.

A Multi-Modal Family Peer Support-Based Program to Improve Quality of Life among Pediatric Brain Tumor Patients: A Mixed-Methods Pilot Study

Background: Pediatric brain tumor (PBT) survivors and their families are at risk for diminished psychosocial and quality of life outcomes. Community-based programs that leverage peer support in the context of integrative modalities such as traditional Chinese medicine (TCM) represent a promising avenue for meeting the multidimensional needs of survivors and their families. Methods: Parents and children were enrolled in a 12-week program that included weekly group TCM, a moderated private Facebook support group designed through social support and modeling theory, and weekly parent-only health behavior education and yoga. Process measures and quantitative and qualitative survey data was collected to gauge participant adherence, acceptability, and satisfaction, as well as exploratory outcomes. Results: Eleven parents completed surveys at all time points. Six of nine families attended at least 80% of the group TCM sessions, and eight of nine families interacted in the Facebook support group at least five days a week. Parents reported high levels of satisfaction and perceived benefits for the program. Baseline emotional distress, health behaviors, and QoL measurements improved during the three-month intervention. Qualitative data indicated parents perceived both in-person and the Facebook group peer support contributed to the benefits of the program. Conclusion: This feasibility study demonstrated that a multimodal peer support-based intervention that included in-person and online group interaction is feasible and acceptable to parents of pediatric brain tumor patients. Further research on interventions for caregivers that include in-person and online group-based peer support is warranted, with the goal of exploring similar outcomes in other childhood cancer diagnoses.

APOLO-Teens, a web-based intervention for treatment-seeking adolescents with overweight or obesity: study protocol and baseline characterization of a Portuguese sample

PURPOSE

APOLO-Teens is an ongoing web-based program combining a manualized intervention delivered by Facebook^®, a self-monitoring web application and monthly chat sessions to optimize treatment as usual for adolescents with overweight and obesity. The aims of this paper are twofold: (1) to describe the study protocol of the APOLO-Teens randomized controlled effectiveness trial and (2) to present baseline descriptive information of the Portuguese sample.

METHODS

APOLO-Teens includes adolescents aged between 13 and 18 years with BMI percentile ≥ 85 (N = 210; 60.00% girls, BMI z-score 2.40 ± 0.75) undergoing hospital ambulatory treatment for overweight/obesity. Participants completed a set of self-report measures regarding eating behaviors and habits, psychological functioning (depression, anxiety, stress, and impulsivity), physical activity, and quality of life.

RESULTS

Depression, anxiety, stress, impulsivity, and percentage body fat were inversely associated with health-related quality of life (r_s = - 0.39 to - 0.62), while physical activity out-of-school was positively correlated with health-related quality of life (r_s = 0.22). When compared to boys, girls demonstrated statistically significant higher scores on psychological distress, disturbed eating behaviors, impulsivity, were less active at school and had lower scores on the health-related quality of life (p < 0.05).

CONCLUSION

The results showed that there were gender differences in key psychological constructs that are likely to determine success with the treatment and that, therefore, need to be considered in future interventions. The results of APOLO-Teens randomized controlled trial will determine the impact of these constructs on the efficacy and adherence to a web-based intervention for weight loss in the Portuguese population.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Perspectives of adolescents with severe obesity on social Media in Preparation for weight-loss surgery: a qualitative study

Background

Currently the most effective treatment for severe obesity in adolescents is weight-loss surgery coupled with lifestyle behavior change. In preparation for weight-loss surgery, adolescents are required to make changes to eating and activity habits (lifestyle changes) to promote long term success. Social media support groups, which are popular among adolescents, have the potential to augment preoperative lifestyle changes. The purpose of this study was to qualitatively assess the perceived role of social media as a support tool for weight-loss, and to identify motivators and constraints to lifestyle changes and social media use in adolescents preparing for weight-loss surgery.

Methods

Thematic analysis of social media comments from 13 (3 male, 10 female) adolescents aged 16 ± 1.3 years with a body mass index (BMI) 45 ± 7.3 kg/m² enrolled in a weight-management program preparing for bariatric surgery and who participated in a 12-week pilot social media intervention was performed. Participants commented on moderator posts and videos of nutrition, physical activity, and motivation that were shared three to four times per week. Social media comments were coded using NVivo 11.0 to identify recurrent themes and subthemes.

Results

1) Social media provided accountability, emotional support, and shared behavioral strategies. 2) Motivators for lifestyle changes included family support, personal goals, and non-scale victories. 3) Challenges included negative peers, challenges with planning and tracking, and time constraints.

Conclusion

Adolescents considering bariatric surgery identified social media as a tool for social support and reinforcement of strategies for successful behavior change. Important motivators and challenges to lifestyle changes were identified.

Improving Calcium Knowledge and Intake in Young Adults Via Social Media and Text Messages: Randomized Controlled Trial

BACKGROUND

Calcium is an important nutrient for the attainment of peak bone mass during adolescence and young adulthood. However, these life phases are characterized as hard to reach for health promotion. Social media platforms offer a promising channel as they are relatively low cost but used ubiquitously by youth.

OBJECTIVE

The aim of the CAlcium Nutrition-Dietary Opportunities (CAN-DO) study was to conduct a randomized controlled trial to test the effectiveness of Facebook alone or with text messaging as channels to deliver a theory-based program to encourage optimal calcium intake.

METHODS

The intervention was a 3-arm parallel trial. Young adults aged 18 to 25 years were recruited through university and social media for a 6-week trial. Participants were randomized to 1 of the 3 arms (ie, Facebook posts, Facebook posts plus text messages, and control group that received an electronic leaflet containing information on calcium intake). The primary outcome was change in intake of milk and other calcium-rich foods, and secondary outcomes were knowledge, self-efficacy, motivation, and habit formation concerning calcium-rich foods. Changes were assessed before and after the intervention, and the differences in change between groups were compared using multivariate regression models with multiple imputations for missing data.

RESULTS

A total of 211 participants (64/211, 30.3% males) participated (mean age 21.4 years, SD 2.1) in this study. At the end of the program, no increase in milk intake (odds ratio [OR] 1.51, 95% CI 0.61-3.75 Facebook; OR 1.77, 95% CI 0.74-4.24 Facebook plus text messages; P=.41) nor calcium-rich food was detected (P=.57). There was a significant improvement in knowledge in the Facebook plus text messages group (P<.001), but habit formation improved less than that in the other 2 groups (P=.01). Our results showed a moderate level of engagement with intervention content and positive qualitative feedback from participants.

CONCLUSIONS

The CAN-DO study delivered via Facebook (with the additional support of text messages) was found to improve knowledge and was acceptable among young adults. However, further research is needed to better understand social media engagement and how to optimize the program for participants to be sufficiently motivated to increase their intake of calcium-rich foods.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12620000097943; http://www.anzctr.org.au/ACTRN12620000097943.aspx.

Using social media for vaccination promotion: Practices and challenges

OBJECTIVE

Vaccination misinformation is widespread on social media. Vaccine-promoting organisations are working to curb its influence, but face obstacles. We aimed to analyse their social media strategies and the challenges they encounter.

METHODS

In this qualitative study, we purposively sampled 21 participants responsible for social media from vaccine-promoting organisations. We used Framework Analysis to explore the data.

RESULTS

Vaccine-promoting organisations faced obstacles using social media, including fast-paced change, limited resources, and insufficient organisational buy-in. They experienced difficulties reaching audiences, exploiting social media listening, and measuring impact. Consequently, they may miss opportunities to counter misinformation, connect with groups low in vaccine confidence, and determine diverse audience responses. They lack strong evidence linking social media strategies with behaviour change, and have difficulty understanding silent audiences.

CONCLUSIONS

Vaccine-promoting organisations have an opportunity to embrace the participatory nature of social media. They could share listening insights with like-minded groups, and conduct research exploring associations between social media strategies and community attitude/behaviour change. Social media platforms could assist by renewing vaccine-promoting organisations' organic reach, supporting the development of tailored listening and credibility tools, and strengthening collaborations to promote credible content.

Remotely Delivered Interventions for Obesity Treatment

PURPOSE OF REVIEW

This review synthesizes recent research on remotely delivered interventions for obesity treatment, including summarizing outcomes and challenges to implementing these treatments as well as outlining recommendations for clinical implementation and future research.

RECENT FINDINGS

There are a wide range of technologies used for delivering obesity treatment remotely. Generally, these treatments appear to be acceptable and feasible, though weight loss outcomes are mixed. Engagement in these interventions, particularly in the long term, is a significant challenge. Newer technologies are rapidly developing and enable tailored and adaptable interventions, though research in this area is in its infancy. Further research is required to optimize potential benefits of remotely delivered interventions for obesity.

Hashtag Health: College Health on Social Media and Students’ Motivations to Follow, Interact, and Share Their Social Media Content

Social media are advocated as a prime channel through which to reach college students with health-related information. However, how well are colleges and universities utilizing social media as it was intended—a means to be truly social and not just promotional? Social media can only be effective if students actually follow, interact, and share the content being produced. The following study completed a census of student health center Facebook accounts in the United States as well as investigated students’ motivations to follow, interact with, and share health-related content. Facebook pages were found for about 20% of student health centers, and about two thirds posted content within the past 14 days. However, their median number of “likes” was between 191 and 496 despite being in existence for an average of 6 years. Additionally, the majority of these centers’ most recent posts were promotional, instead of trying to socially engage with their followers. Students indicated that they would be likely to follow, interact, or share social media content from college health accounts if they were incentivized to do so, if they thought the content could be relevant to them, or if they simply knew that the account existed. Unless more attention is given to growing their followings, resources used by student health organizations to consistently post content might be better placed elsewhere. Recommendations for increasing engagement with students are discussed.

Young Adults' Engagement With a Self-Monitoring App for Vegetable Intake and the Impact of Social Media and Gamification: Feasibility Study

Background

Social media and gamification have been used in digital interventions for improving nutrition behaviors of young adults, but few studies measure engagement.

Objective

This feasibility study aimed to explore user engagement with a 4-week smartphone program for improving vegetable intake.

Methods

A goal setting and self-monitoring app was developed for feasibility testing. We assessed if additional components of gaming and/or social media support increased engagement. A 2 × 2 factorial study design was used with participants randomly allocated to each group. Engagement with the app (usage) was captured via inbuilt software, which recorded total days of app usage (duration) and the frequency of logging vegetable intake. Uptake of the social media (Facebook) content was measured by tracking views, likes, and comments on posts.

Results

Out of the 110 potential participants who completed the prescreening questionnaire online, 97 were eligible (mean age 24.8 [SD 3.4]). In total, 49% (47/97) of participants were retained at 4 weeks. Attrition within the first week was the highest among users of the gamified app without social support (Facebook; P<.001). Over the intervention period, 64% (62/97) of participants logged into their app, with vegetable intake recorded on average for 11 out of 28 days. The frequency of recording decreased each week (mean 4 [SD 2] days in week 1 versus mean 2 [SD 2] days in week 4). No effects of gaming or social support on the frequency of recording vegetables or the duration of app engagement were found. However, regardless of the app type, the duration of app engagement was significantly associated with vegetable intake post intervention (P<.001). In total, 60% of Facebook posts were viewed by participants but engagement was limited to likes, with no comments or peer-to-peer interaction observed.

Conclusions

As duration of usage was associated with vegetable intake, a deeper understanding of factors influencing engagement is needed. Dimensions such as personal attributes and the setting and context require further exploration in addition to content and delivery.

Posts, pics, or polls? Which post type generates the greatest engagement in a Facebook physical activity intervention?

Social networking websites have attracted considerable attention as a delivery platform for physical activity interventions. Current evidence highlights a need to enhance user engagement with these interventions to actualize their potential. The purpose of this study was to determine which post type generates the most engagement from participants and whether engagement was related to change in physical activity in an intervention delivered via Facebook. Subgroup analysis of the intervention condition of a randomized controlled trial was conducted. The group moderator posted a new message to the private Facebook group each day of the program. The Facebook posts (n = 118) were categorized into the following types: moderator-initiated running program, multimedia, motivational, opinion polls, or discussion question and participant-initiated experience shares, or questions. Four metrics were used to measure volume of engagement with each post type, "likes," "comments," "poll votes," and "photo uploads." One-way ANOVA was used to determine whether engagement differed by post type and an independent samples t-test to determine differences in engagement between moderator and participant-initiated posts. Pearson correlation was used to examine associations between total engagement and change in physical activity. Engagement varied by post type. Polls elicited the greatest engagement (p ≤ .01). The most common form of engagement was "likes," and engagement was higher for moderator-initiated rather than participant-initiated posts (mean = 8.0 [SD 6.8] vs. 5.3 [SD 3.2]; p ≤ .01). Total engagement with the Facebook group was not directly associated with change in physical activity (r = -.13, p = .47). However, engagement was associated with compliance with the running program (r = .37, p = .04) and there was a nonsignificant positive association between compliance and change in physical activity (r = .32, p = .08). Posts requiring a simple response generated the most engagement. Intervention moderators should facilitate familiarity between participants at the intervention outset, to encourage engagement between participants. Engagement was related to change in physical activity, and these recommendations should be incorporated to enhance engagement and efficacy of interventions.

Strategies to Increase Latino Immigrant Youth Engagement in Health Promotion Using Social Media: Mixed-Methods Study

BACKGROUND

Generating participant engagement in social media applications for health promotion and disease prevention efforts is vital for their effectiveness and increases the likelihood of effecting sustainable behavior change. However, there is limited evidence regarding effective strategies for engaging Latino immigrant youth using social media. As part of the Avance Center for the Advancement of Immigrant/Refugee Health in Washington, DC, USA, we implemented Adelante, a branded primary prevention program, to address risk factors for co-occurring substance use, sexual risk, and interpersonal violence among Latino immigrant adolescents aged 12 to 19 years in a Washington, DC suburb.

OBJECTIVE

The objectives of this study were to (1) characterize Adelante participant Facebook reach and engagement and (2) identify post content and features that resulted in greater user engagement.

METHODS

We established the Adelante Facebook fan page in October of 2013, and the Adelante social marketing campaign used this platform for campaign activities from September 2015 to September 2016. We used Facebook Insights metrics to examine reach and post engagement of Adelante Facebook page fans (n=743). Data consisted of Facebook fan page posts between October 1, 2013 and September 30, 2016 (n=871). We developed a 2-phased mixed-methods analytical plan and coding scheme, and explored the association between post content categories and features and a composite measure of post engagement using 1-way analysis of variance tests. P<.05 determined statistical significance.

RESULTS

Posts on the Adelante Facebook page had a total of 34,318 clicks, 473 comments, 9080 likes or reactions, and 617 shares. Post content categories that were statistically significantly associated with post engagement were Adelante program updates (P<.001); youth achievement showcases (P=.001); news links (P<.001); social marketing campaign posts (P<.001); and prevention topics, including substance abuse (P<.001), safe sex (P=.02), sexually transmitted disease prevention (P<.001), and violence or fighting (P=.047). Post features that were significantly associated with post engagement comprised the inclusion of photos (P<.001); Spanish (P<.001) or bilingual (P=.001) posts; and portrayal of youth of both sexes (P<.001) portrayed in groups (P<.001) that were facilitated by adults (P<.001).

CONCLUSIONS

Social media outreach is a promising strategy that youth programs can use to complement in-person programming for augmented engagement. The Latino immigrant youth audience in this study had a tendency toward more passive social media consumption, having implications for outreach strategies and engagement measurement in future studies. While study findings confirmed the utility of social marketing campaigns for increasing user engagement, findings also highlighted a high level of engagement among youth with posts that covered casual, day-to-day program activity participation. This finding identifies an underexplored area that should be considered for health messaging, and also supports interventions that use peer-to-peer and user-generated health promotion approaches.

Adapting a Behavioral Weight Loss Intervention for Delivery via Facebook: A Pilot Series Among Low-Income Postpartum Women

Background

Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss interventions.

Objective

The objective of this study was to adapt a DPP-based weight loss intervention (Fresh Start) for Facebook delivery and to evaluate its feasibility among low-income postpartum women.

Methods

This study comprised 3 single-group pilot studies where feasibility outcomes iteratively informed changes from one pilot to the next. We paralleled the in-person program for Facebook delivery by translating the protocol to a content library of Facebook posts with additional posts from lifestyle coaches. Low-income postpartum women were recruited from Women, Infants, and Children (WIC) clinics in Worcester, Massachusetts. Participants were enrolled into a 16-week weight loss intervention delivered via Facebook. During the first 8 weeks, Facebook intervention posts were delivered 2 times per day, with additional posts from coaches aiming to stimulate interaction among participants or respond to participants’ questions and challenges. For the following 8 weeks, posts were delivered once per day without additional coaching. Feasibility outcomes were engagement (defined by number of likes, comments, and posts measured throughout intervention delivery), acceptability, and retention (survey at follow-up and assessment completion rate, respectively). Changes in weight were also assessed at baseline and follow-up.

Results

Pilot 1 had a retention rate of 89% (24/27), and on average, 62% (17/27) of women actively engaged with the group each week during the 8-week coached phase. Mean weight loss was 2.6 (SD 8.64) pounds, and 79% (19/27) would recommend the program to a friend. Pilot 2 had a retention rate of 83% (20/24), and on average, 55% (13/24) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 2.5 (SD 9.23) pounds, and 80% (16/24) would recommend the program to a friend. Pilot 3 had a retention rate of 88% (14/16), and on average, 67% (11/16) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 7.0 (SD 11.6) pounds, and 100% (16/16) would recommend the program to a friend.

Conclusions

Our findings demonstrated that a Facebook-delivered intervention was acceptable and could be feasibly delivered to low-income postpartum women. Future research is needed to evaluate the efficacy of a Facebook-delivered weight loss intervention.

Social media use for nutrition outcomes in young adults: a mixed-methods systematic review

BACKGROUND

Social media has been widely adopted by young adults, consequently health researchers are looking for ways to leverage this engagement with social media for the delivery of interventions and health promotion campaigns. Weight gain and sub-optimal dietary choices are common in young adults, and social media may be a potential tool to facilitate and support healthier choices.

METHODS

We conducted a mixed-methods systematic review of studies examining social media use for nutrition-related outcomes in young adults. Seven databases [EBscohost, ERIC, ProQuest Central, PubMed, Ovid, Scopus, and Emerald] were systematically searched; 1225 abstracts were screened, and 47 full-text articles were assessed for eligibility. Study designs included both quantitative, such as experimental and observational studies, and qualitative, such as focus groups and interviews, approaches. Quality was assessed using the Mixed Methods Appraisal Tool. Quantitative and qualitative results were examined separately, and then synthesized.

RESULTS

Twenty-one studies were included although their use of social media was highly variable. The main purpose of social media was to provide information and social support to participants. In the nine randomized controlled trials, social media was used as one aspect of a multi-faceted intervention. Interventions had a positive statistically significant impact on nutritional outcomes in 1/9 trials. Engagement with the social media component of interventions varied, from 3 to 69%. Young adults appear to be open to receiving healthy eating and recipe tips through social media, however, they are reluctant to share personal weight-related information on their online social networks.

CONCLUSIONS

Information-dissemination is now an acceptable use of social media by young adults. Using social media effectively for social support, either via private groups or public pages, requires careful evaluation as its effectiveness is yet to be demonstrated in experimental designs. Concerns about public social media use may be a contributing factor to poor engagement with social media in research intervention studies aimed at influencing weight. Future research should consider how to best engage with young adults using social media, how to more effectively use social media to support young adults and to facilitate social and peer-to-peer support in making healthier choices.

What People "Like": Analysis of Social Media Strategies Used by Food Industry Brands, Lifestyle Brands, and Health Promotion Organizations on Facebook and Instagram

Background

Health campaigns have struggled to gain traction with young adults using social media, even though more than 80% of young adults are using social media at least once per day. Many food industry and lifestyle brands have been successful in achieving high levels of user engagement and promoting their messages; therefore, there may be lessons to be learned by examining the successful strategies commercial brands employ.

Objective

This study aims to identify and quantify social media strategies used by the food industry and lifestyle brands, and health promotion organizations across the social networking sites Facebook and Instagram.

Methods

The six most engaging posts from the 10 most popular food industry and lifestyle brands and six health promotion organizations were included in this study. A coding framework was developed to categorize social media strategies, and engagement metrics were collected. Exploratory linear regression models were used to examine associations between strategies used and interactions on Facebook and Instagram.

Results

Posts from Facebook (143/227, 63.0%) and Instagram (84/227, 37.0%) were included. Photos (64%) and videos (34%) were used to enhance most posts. Different strategies were most effective for Facebook and Instagram. Strategies associated with higher Facebook interactions included links to purchasable items (beta=0.81, 95% CI 0.50 to 1.13, P<.001) featuring body image messages compared with food content (beta=1.96, 95% CI 1.29 to 2.64, P<.001), and where the content induced positive emotions (beta=0.31, 95% CI 0.04 to 0.57, P=.02). Facebook interactions were negatively associated with using pop culture (beta=–0.67, 95% CI –0.99 to –0.34, P<.001), storytelling (beta=–0.86, 95% CI –1.29 to –0.43, P<.001) or visually appealing graphics (beta=–0.53, 95% CI –0.78 to –0.28, P<.001) in their posts compared with other strategies. Posting relatable content was negatively associated with interactions on Facebook (beta=–0.29, 95% CI –0.53 to –0.06, P=.01), but positively associated on Instagram (beta=0.50, 95% CI 0.05 to 0.95, P=.03). Instagram interactions were negatively associated with weight loss (beta=–1.45, 95% CI –2.69 to –0.21, P=.02) and other content (beta=–0.81, 95% CI –1.57 to –.06, P=.04) compared with food content.

Conclusions

Health promotion professionals and organizations can improve engagement using positive messaging and tailoring posts appropriate for different social media channels.

Weight Shame, Social Connection, and Depressive Symptoms in Late Adolescence

Child and adolescent obesity is increasingly the focus of interventions, because it predicts serious disease morbidity later in life. However, social environments that permit weight-related stigma and body shame may make weight control and loss more difficult. Rarely do youth obesity interventions address these complexities. Drawing on repeated measures in a large sample (N = 1443) of first-year (freshman), campus-resident university students across a nine-month period, we model how weight-related shame predicts depressive symptom levels, how being overweight (assessed by anthropometric measures) shapes that risk, and how social connection (openness to friendship) might mediate/moderate. Body shame directly, clearly, and repeatedly predicts depression symptom levels across the whole school year for all students, but overweight youth have significantly elevated risk. Social connections mediate earlier in the school year, and in all phases moderate, body shame effects on depression. Youth obesity interventions would be well-served recognizing and incorporating the influential roles of social-environmental factors like weight stigma and friendship in program design.

Social Media and Obesity in Adults: a Review of Recent Research and Future Directions

PURPOSE OF REVIEW

Social media is widely used and has potential to connect adults with obesity with information and social support for weight loss and to deliver lifestyle interventions. The purpose of this review is to summarize recent observational and intervention research on social media and obesity.

RECENT FINDINGS

Online patient communities for weight loss abound but may include misinformation. Systematic reviews and meta-analyses suggest that social media-delivered lifestyle interventions modestly impact weight, yet how social media was used and participant engagement varies widely. The rapidly changing social media landscape poses challenges for patients, clinicians, and researchers. Research is needed on how patients can establish supportive communities for weight loss and the role of clinicians in these communities. Emerging research on meaningful engagement in, and the efficacy and cost-effectiveness of, social media-delivered lifestyle interventions should provide insights into how to leverage social media to address the obesity epidemic.

Assessing the Feasibility of a Social Media to Promote Weight Management Engagement in Adolescents with Severe Obesity: Pilot Study

Background

Severe obesity in adolescents has deleterious physical and psychological complications necessitating frequent multi-disciplinary clinic visits. Greater treatment engagement has been equated with weight-loss. However, traditional medical weight-loss programs for adolescents have high attrition rates. Social media is widely used by adolescents and may enhance medical weight management engagement and success.

Objective

The first objective was to examine the acceptability and feasibility of using a private social media group as an adjunct to medical weight management in youth ages 14 to 20 years with severe obesity [body mass index (BMI) ≥ 35 kg/m2]. The second objective was to pilot test the use of social media to improve treatment engagement and decrease attrition rates.

Methods

In this single arm, 12 week pre-post study, participants attended individual clinic visits and participated in a moderated private social media group that received nutrition, exercise, and behavior change social media communications or “posts” 3 to 4 times/week. Youth commented and/or liked posts from the moderator and each other. Social media engagement was measured with the number of likes and comments on social media. Clinic attrition was compared, measuring clinic visit attendance 12 weeks prior, during, and after the intervention with mixed linear regression models. Correlations of social media engagement with changes from baseline for BMI, BMI-z score, and psychosocial measures were fit.

Results

All 13 enrolled youth completed the study and reported that the group was enjoyable, helpful, reinforced their weight management program, and would recommend using social media to support other youth. The pilot trial was acceptable and feasible. Youth mean weekly engagement (likes + comments) in social media was greater than once a day (8.6 ±3.6). Compared to 12 weeks prior to the intervention, there was no significant decrease in clinic visit attendance at the end of the intervention (M=.231, P=.69) or 12 weeks at the conclusion of the intervention (M=.589, P=.28). Increased social media comments correlated with weight change (r=–.633, P=.04).

Conclusions

This pilot trial demonstrated that the use of social media as an adjunct to medical weight management was feasible and acceptable to adolescents with severe obesity. Based upon these preliminary findings, social media may be an effective way to mitigate attrition from obesity treatment programs, and improve health outcomes in this high-risk population.

Facebook for Supporting a Lifestyle Intervention for People with Major Depressive Disorder, Bipolar Disorder, and Schizophrenia: an Exploratory Study

To examine whether Facebook could support a community-based group lifestyle intervention for adults with serious mental illness. Participants with serious mental illness and obesity enrolled in a 6-month group lifestyle program were invited to join a secret Facebook group to support their weight loss and physical activity goals. Two peer co-facilitators moderated the Facebook group. The proportion of participants who achieved ≥5% weight loss or improved fitness was measured at follow-up. The relationship between this outcome and participants' interactions in the Facebook group was examined. Interactions were defined as active contributions including posts, comments, or likes. Content of participants' Facebook posts was also explored. Participants (n = 25) had major depression (44%), bipolar disorder (36%), and schizophrenia (20%). Nineteen (76%) participants joined the Facebook group, and contributed 208 interactions (70 posts; 81 comments; 57 likes). Participants who achieved ≥5% weight loss or improved fitness contributed more interactions in the Facebook group (mean = 19.1; SD = 20.5) compared to participants who did not (mean = 3.9; SD = 6.7), though this relationship approached statistical significance (t = -2.1; Welch's df = 13.1; p = 0.06). Participants' posts containing personal sharing of successes or challenges to adopting healthy behaviors generated more interaction compared to posts containing program reminders (p < 0.01), motivational messages (p < 0.01), and healthy eating content (p < 0.01). Facebook appears promising for supporting health behavior change among people with serious mental illness. These findings can inform social media initiatives to scale up health promotion efforts targeting this at-risk group.

Peer-Based Social Media Features in Behavior Change Interventions: Systematic Review

Background

Incorporating social media features into digital behavior change interventions (DBCIs) has the potential to contribute positively to their success. However, the lack of clear design principles to describe and guide the use of these features in behavioral interventions limits cross-study comparisons of their uses and effects.

Objective

The aim of this study was to provide a systematic review of DBCIs targeting modifiable behavioral risk factors that have included social media features as part of their intervention infrastructure. A taxonomy of social media features is presented to inform the development, description, and evaluation of behavioral interventions.

Methods

Search terms were used in 8 databases to identify DBCIs that incorporated social media features and targeted tobacco smoking, diet and nutrition, physical activities, or alcohol consumption. The screening and review process was performed by 2 independent researchers.

Results

A total of 5264 articles were screened, and 143 articles describing a total of 134 studies were retained for full review. The majority of studies (70%) reported positive outcomes, followed by 28% finding no effects with regard to their respective objectives and hypothesis, and 2% of the studies found that their interventions had negative outcomes. Few studies reported on the association between the inclusion of social media features and intervention effect. A taxonomy of social media features used in behavioral interventions has been presented with 36 social media features organized under 7 high-level categories. The taxonomy has been used to guide the analysis of this review.

Conclusions

Although social media features are commonly included in DBCIs, there is an acute lack of information with respect to their effect on outcomes and a lack of clear guidance to inform the selection process based on the features’ suitability for the different behaviors. The proposed taxonomy along with the set of recommendations included in this review will support future research aimed at isolating and reporting the effects of social media features on DBCIs, cross-study comparisons, and evaluations.

Facebook Groups for the Management of Chronic Diseases

The use of Facebook groups by health care researchers and professionals for chronic disease management, namely type 2 diabetes mellitus and coronary heart disease, is in its early stages and challenges are emerging. While Facebook groups offer great potential to deliver health support, research of Facebook groups for chronic disease management remains in its infancy, with robust evidence not yet available. Designing Facebook groups that are acceptable to users, health care researchers as well as health care professionals is a challenge, and there is a poor fit with traditional research and evaluation methods. Key recommendations for future research of Facebook groups for chronic disease management include: (1) iterative content development with input from the target patient population; (2) further understanding of the potential role of group "champions"; (3) ensuring the social media policies of health care institutions allow for real time online communication; and (4) utilizing comprehensive evaluation strategies, including the use of process evaluations.

Feasibility and Acceptability of Delivering a Postpartum Weight Loss Intervention via Facebook: A Pilot Study

OBJECTIVE

To evaluate the feasibility and acceptability of a Facebook-delivered postpartum weight loss intervention.

METHODS

Overweight and obese postpartum women received a 12-week weight loss intervention via Facebook. Feasibility outcomes were recruitment, retention, engagement, and acceptability. Weight loss was an exploratory outcome.

RESULTS

Participants (n = 19) were 3.5 (SD 2.2) months postpartum with a baseline body mass index of 30.1 (SD 4.2) kg/m². Retention was 95%. Forty-two percent of participants visibly engaged on the last day of the intervention, and 100% in the last 4 weeks; 88% were likely or very likely to participate again and 82% were likely or very likely to recommend the program to a postpartum friend. Average 12-week weight loss was 4.8% (SD 4.2%); 58% lost ≥5%.

CONCLUSIONS AND IMPLICATIONS

Findings suggested that this Facebook-delivered intervention is feasible and acceptable and supports research to test efficacy for weight loss. Research is needed to determine how best to engage participants in social network-delivered weight loss interventions.

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.

Engagement of young adult cancer survivors within a Facebook-based physical activity intervention

Few studies have examined how young adult cancer survivors use online social media. The objective of this study was to characterize Facebook engagement by young adult cancer survivors in the context of a physical activity (PA) intervention program. Young adult cancer survivors participated in one of two Facebook groups as part of a 12-week randomized trial of a PA intervention (FITNET) compared to a self-help comparison (SC) condition. A moderator actively prompted group discussions in the FITNET Facebook group, while social interaction was unprompted in the SC group. We examined factors related to engagement, differences in engagement by group format and types of Facebook posts, and the relationship between Facebook engagement and PA outcomes. There were no group differences in the number of Facebook comments posted over 12 weeks (FITNET, 153 vs. SC, 188 p = 0.85) or the proportion of participants that reported engaging within Facebook group discussions at least 1-2 days/week. The proportion of participants that made any posts decreased over time in both groups. SC participants were more likely than FITNET participants to agree that group discussions caused them to become physically active (p = 0.040) and that group members were supportive (p = 0.028). Participant-initiated posts elicited significantly more comments and likes than moderator-initiated posts. Responses posted on Facebook were significantly associated with light PA at 12 weeks (β = 11.77, t(85) = 1.996, p = 0.049) across groups. Engagement within Facebook groups was variable and may be associated with PA among young adult cancer survivors. Future research should explore how to promote sustained engagement in online social networks. ClinicalTrials.gov identifier: NCT01349153.

College Freshmen Students' Perspectives on Weight Gain Prevention in the Digital Age: Web-Based Survey

BACKGROUND

College freshmen are highly vulnerable to experiencing weight gain, and this phenomenon is associated with an increased risk of chronic diseases and mortality in older adulthood. Technology offers an attractive and scalable way to deliver behavioral weight gain prevention interventions for this population. Weight gain prevention programs that harness the appeal and widespread reach of Web-based technologies (electronic health or eHealth) are increasingly being evaluated in college students. Yet, few of these interventions are informed by college students' perspectives on weight gain prevention and related lifestyle behaviors.

OBJECTIVE

The objective of this study was to assess college freshmen students' concern about weight gain and associated topics, as well as their interest in and delivery medium preferences for eHealth programs focused on these topics.

METHODS

Web-based surveys that addressed college freshmen students' (convenience sample of N=50) perspectives on weight gain prevention were administered at the beginning and end of the fall 2015 semester as part of a longitudinal investigation of health-related issues and experiences in first semester college freshmen. Data on weight gain prevention-related concerns and corresponding interest in eHealth programs targeting topics of potential concern, as well as preferred program delivery medium and current technology use were gathered and analyzed using descriptive statistics.

RESULTS

A considerable proportion of the freshmen sample expressed concern about weight gain (74%, 37/50) and both traditional (healthy diet: 86%, 43/50; physical activity: 64%, 32/50) and less frequently addressed (stress: 82%, 41/50; sleep: 74%, 37/50; anxiety and depression: 60%, 30/50) associated topics within the context of behavioral weight gain prevention. The proportion of students who reported interest in eHealth promotion programs targeting these topics was also generally high (ranging from 52% [26/50] for stress management to 70% [35/50] for eating a healthy diet and staying physically active). Email was the most frequently used electronic platform, with 96% (48/50) of students reporting current use of it. Email was also the most frequently cited preferred eHealth delivery platform, with 86% (43/50) of students selecting it. Facebook was preferred by the second greatest proportion of students (40%, 20/50).

CONCLUSIONS

Most college freshmen have concerns about an array of weight gain prevention topics and are generally open to the possibility of receiving eHealth interventions designed to address their concerns, preferably via email compared with popular social media platforms. These preliminary findings offer a foundation to build upon when it comes to future descriptive investigations focused on behavioral weight gain prevention among college freshmen in the digital age.

Trading pounds for points: Engagement and weight loss in a mobile health intervention

Objective

The objective of this study was to describe participant engagement and examine predictors of weight loss and points earned through the point-based incentive system of the Social Pounds Off Digitally (POD) app.

Materials and methods

Overweight and obese adults with Android smartphones/tablets (body mass index 25-49.9 kg/m²; N = 24) were recruited for a 3-month weight loss intervention. Participants completed a survey assessing demographics and personality and had their weight measured. Participants received the content of the intervention via podcasts and used the Social POD app to self-monitor diet, physical activity, and weight. The Social POD app contained: tracking features; in-app notifications to track; pre-set goals for tracking; newsfeed for updates on others' goal attainment; ability to earn and track points for usage (exchanged for study-provided prizes); and a message screen. Analyses examined relationships between percent weight loss, personality characteristics, and total points earned.

Results

A total of 4843 points were earned (mean = 202 ± 105 points/participant). Most participants earned all three prizes (62.5%), followed by two prizes (21%), no prizes (12.5%), and one prize (4%). Total points earned significantly predicted percent weight loss (B = -0.02, p = .01), and higher conscientiousness significantly predicted greater total points earned (B = 10.27, p = .01), but other personality characteristics assessed did not.

Conclusion

A mobile app yielded moderately high participant engagement, as demonstrated by points earned. Earning points was significantly associated with percent weight loss, and conscientiousness was significantly associated with total points earned. Future research should examine whether point systems impact health behavior and weight loss when rewards are discontinued.

Clinical trial registration number

NCT02344836.