Learning the Language of Social Media: A Comparison of Engagement Metrics and Social Media Strategies Used by Food and Nutrition-Related Social Media Accounts

The use of sentiment and emotion analysis and data science to assess the language of nutrition-, food- and cooking-related content on social media: a systematic scoping review

Social media data are rapidly evolving and accessible, which presents opportunities for research. Data science techniques, such as sentiment or emotion analysis which analyse textual emotion, provide an opportunity to gather insight from social media. This paper describes a systematic scoping review of interdisciplinary evidence to explore how sentiment or emotion analysis methods alongside other data science methods have been used to examine nutrition, food and cooking social media content. A PRISMA search strategy was used to search nine electronic databases in November 2020 and January 2022. Of 7325 studies identified, thirty-six studies were selected from seventeen countries, and content was analysed thematically and summarised in an evidence table. Studies were published between 2014 and 2022 and used data from seven different social media platforms (Twitter, YouTube, Instagram, Reddit, Pinterest, Sina Weibo and mixed platforms). Five themes of research were identified: dietary patterns, cooking and recipes, diet and health, public health and nutrition and food in general. Papers developed a sentiment or emotion analysis tool or used available open-source tools. Accuracy to predict sentiment ranged from 33·33% (open-source engine) to 98·53% (engine developed for the study). The average proportion of sentiment was 38·8% positive, 46·6% neutral and 28·0% negative. Additional data science techniques used included topic modelling and network analysis. Future research requires optimising data extraction processes from social media platforms, the use of interdisciplinary teams to develop suitable and accurate methods for the subject and the use of complementary methods to gather deeper insights into these complex data.

Growing up with allergies: Transitioning from adolescence to adulthood

Allergic disease management for adolescents and young adults requires consideration of unique psychosocial challenges and opportunities. Erik Erikson's model for the Stages of Psychosocial Development is a useful lens through which we can understand adolescent and young adult experiences with allergic and immunologic disease, particularly with regard to identity and relationship development. It is important to provide anticipatory guidance for patients who are transitioning environments (eg, home to college), with attention to the anxiety-provoking demands for increased responsibility on top of new stressors such as academic and vocational demands. It is critical that health care professionals use an empathetic, shared decision-making approach regarding the emotional impact of allergy on a patient's social engagement. A patient's ability to develop positive lifelong habits is also shaped by their environment's "culture of wellness," and clinicians can encourage habits to promote healthy choices and effective disease management. Social media provides opportunities and challenges as a conduit for both social connection and possible misinformation. Overall, allergic disease management in adolescents and young adults is a "high-risk, high-reward" period of time-and with awareness, anticipation, and proactive action, health care professionals can better serve patients by leveraging this transitional period to promote positive approaches to management of allergies and asthma, trusting relationships, and personal responsibility.

Using Natural Language Processing to Explore Social Media Opinions on Food Security: Sentiment Analysis and Topic Modeling Study

BACKGROUND

Social media has the potential to be of great value in understanding patterns in public health using large-scale analysis approaches (eg, data science and natural language processing [NLP]), 2 of which have been used in public health: sentiment analysis and topic modeling; however, their use in the area of food security and public health nutrition is limited.

OBJECTIVE

This study aims to explore the potential use of NLP tools to gather insights from real-world social media data on the public health issue of food security.

METHODS

A search strategy for obtaining tweets was developed using food security terms. Tweets were collected using the Twitter application programming interface from January 1, 2019, to December 31, 2021, filtered for Australia-based users only. Sentiment analysis of the tweets was performed using the Valence Aware Dictionary and Sentiment Reasoner. Topic modeling exploring the content of tweets was conducted using latent Dirichlet allocation with BigML (BigML, Inc). Sentiment, topic, and engagement (the sum of likes, retweets, quotations, and replies) were compared across years.

RESULTS

In total, 38,070 tweets were collected from 14,880 Twitter users. Overall, the sentiment when discussing food security was positive, although this varied across the 3 years. Positive sentiment remained higher during the COVID-19 lockdown periods in Australia. The topic model contained 10 topics (in order from highest to lowest probability in the data set): "Global production," "Food insecurity and health," "Use of food banks," "Giving to food banks," "Family poverty," "Food relief provision," "Global food insecurity," "Climate change," "Australian food insecurity," and "Human rights." The topic "Giving to food banks," which focused on support and donation, had the highest proportion of positive sentiment, and "Global food insecurity," which covered food insecurity prevalence worldwide, had the highest proportion of negative sentiment. When compared with news, there were some events, such as COVID-19 support payment introduction and bushfires across Australia, that were associated with high periods of positive or negative sentiment. Topics related to food insecurity prevalence, poverty, and food relief in Australia were not consistently more prominent during the COVID-19 pandemic than before the pandemic. Negative tweets received substantially higher engagement across 2019 and 2020. There was no clear relationship between topics that were more likely to be positive or negative and have higher or lower engagement, indicating that the identified topics are discrete issues.

CONCLUSIONS

In this study, we demonstrated the potential use of sentiment analysis and topic modeling to explore evolution in conversations on food security using social media data. Future use of NLP in food security requires the context of and interpretation by public health experts and the use of broader data sets, with the potential to track dimensions or events related to food security to inform evidence-based decision-making in this area.

Nutrition and Food Literacy: Framing the Challenges to Health Communication

Nutrition and food literacy are two important concepts that are often used interchangeably, but they are not synonymous. Nutrition refers to the study of how food affects the body, while food literacy refers to the knowledge, skills, and attitudes necessary to make informed decisions about food and its impact on health. Despite the growing awareness of the importance of food literacy, food illiteracy remains a global issue, affecting people of all ages, backgrounds, and socioeconomic status. Food illiteracy has serious health implications as it contributes to health inequities, particularly among vulnerable populations. In addition, food literacy is a complex and multidisciplinary field, and there are numerous challenges to health communication that must be addressed to effectively promote food literacy and improve health outcomes. Addressing food illiteracy and the challenges to health communication is essential to promote health equity and improve health outcomes for all populations.

Participant recruitment for paediatric research using social media: A practical 'how-to' guide for researchers

AIM

Social media platforms are being increasingly used to support participant recruitment into paediatric health-related research. This study aimed to develop a multi-phase approach for using social media as a recruitment strategy for paediatric research studies.

METHODS

The process was informed by the authors' prior experiences recruiting for paediatric obesity-related research studies, expertise in social media marketing and digital participant/ patient recruitment. Reflection on these experiences resulted in the iterative creation of a draft process which was further refined. A narrative literature review using a structured search was conducted to refine and augment the content and finalise the process.

RESULTS

A six-phase recruitment approach was developed that includes: (i) plan for social media use as a recruitment strategy, (ii) explore relevant ethical considerations to protect the wellbeing of potentially vulnerable groups and create an ethical management plan, (iii) identify and understand the different target audiences and develop the advertising strategy, (iv) develop and design campaign content, (v) implement, monitor and iteratively refine the recruitment campaign, (vi) evaluate the campaign success. Potential activities and key considerations relevant for paediatric research are presented within each phase.

CONCLUSION

Due to the widespread use and diverse characteristics of social media users, social media has the potential to disseminate details of research opportunities to community members who may otherwise not hear about, engage with, and potentially benefit from research participation. Researchers should collaborate with communication experts and target audiences to generate relevant and effective recruitment campaigns. Researchers should implement processes to protect vulnerable audiences' wellbeing at each stage of the process. Recruitment via social media may support wider community participation in research studies designed to improve young people's health.

A Scoping Review of Observational Studies on Food and Beverage Advertising on Social Media: A Public Health Perspective

Popular social media platforms have been actively used by ultra-processed food companies to promote their products. Being exposed to this type of advertising increases the consumption of unhealthy foods and the risk of developing obesity and other non-communicable diseases (NCDs). Thus, monitoring commercial content on social media is a core public health practice. We aimed to characterize the methods used for monitoring food advertising on social media and summarize the investigated advertising strategies via a scoping review of observational studies. This study is reported according to the MOOSE Statement, and its protocol was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration nº. CRD42020187740). Out of the 6093 citations retrieved, 26 met our eligibility criteria. The studies were published from 2014 to 2021, mostly after 2018. They focused on Australia, Facebook, strategies aimed at children and adolescents, and advertising practices of ultra-processed food companies. We grouped strategies in eight classes: post features (n = 18); connectivity and engagement (n = 18); economic advantages, gifts, or competitions (n = 14); claims (n = 14); promotional characters (n = 12); brand in evidence (n = 8); corporate social responsibility or philanthropy (n = 7); and COVID-19 (n = 3). We found similarities in the investigation of strategies regardless of the type of social media. Our findings can contribute to the designing of tools for monitoring studies and regulatory mechanisms to restrict the exposure of food advertising.

How to Avoid Lower Priority for Smoking Cessation Support Content on Facebook: An Analysis of Engagement Bait

Facebook demotes "engagement bait" content that makes people interact. As a result of this sanctioning, public health content can reach fewer Facebook users. This study aims to determine the negative effect of engagement bait and find alternative techniques. In a three-year period, 791 smoking cessation support content was included (n = 791). The Facebook posts were classified into "engagement bait", "alternative techniques" and control groups. Facebook metrics were compared between the study and control groups. The reach of Facebook page fans was significantly lower in the engagement bait group compared to the control group. On the other hand, the alternative techniques had a significantly lower rate of negative Facebook interactions, as well as significantly higher click rates compared to the control group. This is the first study to reveal the sanctioning of engagement bait on smoking cessation support Facebook posts. "Engagement bait" content has a lower ranking on the Facebook Fans' Newsfeed page. Nevertheless, alternative techniques can circumvent the restrictions on engagement bait. At the same time, alternative techniques can stimulate the click rate and inhibit the rate of negative interactions.

Impact of Fitness Influencers on the Level of Physical Activity Performed by Instagram Users in the United States of America: Analytical Cross-Sectional Study

BACKGROUND

Physical activity positively influences the general population's health. Social media networks may promote changes in physical activity habits. This study aimed to analyze the relation between being encouraged to perform physical activity by fitness influencers on Instagram and the level of physical activity performed.

METHODS

An analytical cross-sectional study was performed in 890 United States residents with an Instagram account. The sample was made up of 79.2% females and of 75.4% millennials (born between 1981-1996). Physical activity was measured with the International Physical Activity Questionnaire. Sociodemographic characteristics were registered.

RESULTS

The percentage of females (p = 0.001), millennials (p < 0.001), students (p < 0.001), participants with normal BMI (p = 0.001), and participants performing more than 150 min per week of moderate physical activity (p = 0.014) was significantly higher in the group that felt encouraged to perform physical activity by the information posted by fitness influencers. This group spent a median of 2 h per week on Instagram checking for nutrition or exercise (p < 0.001).

CONCLUSIONS

United States residents who felt encouraged to perform physical activity by fitness influencers on Instagram achieved more the World Health Organization recommendations for substantial health benefit for moderate physical activity. They were predominantly females and millennials with normal weight and spent more time on Instagram checking for nutrition or exercise.

Instabrand courtside: a content analysis of marketing strategies by food and beverage brands during the 2021 Australian Open tennis tournament

OBJECTIVE

To examine the marketing techniques food and beverage brands use on Instagram, as part of their sport sponsorship strategy.

METHODS

We conducted a qualitative content analysis of 31 Instagram accounts during the 2021 Australian Open tennis tournament. Branded food and beverage posts with tennis-linked content were coded based on an initial screening and previously published frameworks.

RESULTS

Of the 152 included posts, 92% were made by food and beverage companies that were official 'partners' of the Australian Open. Products in posts were mostly discretionary foods and alcohol. The most frequently used strategies were 'Engagement' (89%) and 'Branding' (80%) and nearly half (45%) of alcohol posts invited direct consumption of their product.

CONCLUSIONS

The powerful combination of sport and social media are utilised by brands to interact and build relationship with consumers while promoting the consumption of alcohol and discretionary foods - products which impede rather than promote health. The indirect marketing techniques favoured by brands make this form of advertising difficult to identify and control.

IMPLICATIONS FOR PUBLIC HEALTH

These results highlight the need for counter-marketing, policy and regulatory actions to remove unhealthy food and alcohol from sport and reorient sponsorship of sporting events towards products that promote health.

Communicating Health to Young Adults Using Social Media: How, Where, and When?

Communication with young adults about healthy lifestyle behaviours needs to result in improvements in dietary choices to impact the prevalence of diet-related diseases. This paper presents the health beliefs, behaviours, and communication practices in young Australian adults (n = 2019) by their pre-defined psycho-behavioural characteristics: Lifestyle Mavens, Health-Conscious, Aspirational Healthy Eaters, Balanced-All Rounders, Contemplating Another Day, or Blissfully Unconcerned. The Lifestyle Mavens and Health-Conscious groups were more likely to actively seek out health information on social media (p < 0.05). Lifestyle Mavens were the most likely to engage with health and food content on social media, whereas the Blissfully Unconcerned were the least likely to engage (p < 0.05). Lifestyle Mavens are more likely to report creating food and health-related content for social media, whereas Aspirational Healthy Eaters are more likely to report searching for food and health-related content online, but are less likely to share or create content. Contemplating Another Day are more likely to report interactions with commercial content. This paper defines how psycho-behavioural segments communicate about health, where they look for information, how they may prefer to receive health messages, and when they are most receptive to messages. By applying existing robust market segmentation techniques, this paper provides nuanced information that challenges the assumption that online social media health information is preferred by all young adults.

The Use of Social Media as a Persuasive Platform to Facilitate Nutrition and Health Behavior Change in Young Adults: Web-Based Conversation Study

Background

Globally, suboptimal dietary choices are a leading cause of noncommunicable diseases. Evidence for effective interventions to address these behaviors, particularly in young adults, is limited. Given the substantial time young adults spend in using social media, there is interest in understanding the current and potential role of these platforms in shaping dietary behavior.

Objective

This study aims to explore the influence of social media on young adults’ dietary behaviors.

Methods

We recruited 234 young adults aged 18-24 years and living in Australia, using market and social research panels. We applied a digital ethnography approach to collect data from web-based conversations in a series of forums, where participants responded to different health-themed questions related to health behavior change and persuasion on social media. We conducted a qualitative thematic analysis.

Results

Participants described how social media influenced their decisions to change their health behaviors. Access to social support and health information through web-based communities was juxtaposed with exposure to highly persuasive fast-food advertisements. Some participants expressed that exposure to web-based health-focused content induced feelings of guilt about their behavior, which was more prominent among women. Fast-food advertisements were discussed as a contributor to poor health behaviors and indicated as a major barrier to change.

Conclusions

Young adults reported that social media is highly persuasive toward dietary behavior through different pathways of social influence. This suggests that social norms on the web are an important aspect of changing young adults’ health behaviors. The commercialization of social media also encourages poor health behaviors, largely through fast-food advertisements. Future social media–delivered dietary interventions should acknowledge the social and environmental factors that challenge the ability of young adults to make individual health behavior improvements. Care should also be taken to ensure that future interventions do not further elicit guilt in a way that contributes to poor mental health within this community.

Online reach and engagement of a child nutrition peer-education program (PICNIC): insights from social media and web analytics

BACKGROUND

Parents frequently seek parental advice online and on social media; thus, these channels should be better utilized in child health interventions. The Parents in Child Nutrition Informing Community (PICNIC) program aims to facilitate peer-to-peer sharing of evidence-based child feeding information and support parents within their social networks. The present study aimed to explore web and social media analytics to evaluate reach and user engagement with the PICNIC online components.

METHODS

Online user activity data from the PICNIC Facebook closed group and public Page were collected through Facebook Insights, and program-specific website traffic data through Google Analytics. Analytics data from Nov-2019 to April-2021 was evaluated through visualisation and summary statistics to obtain insights into program growth and current reach in Australia, compare demographics of audience reached through the online channels, and explore parents' use and engagement in PICNIC content.

RESULTS

Results showed steady program growth in the 18 months of recruitment; participant numbers grew from 102 to 261 peer educators while the Facebook Page audience increased threefold, totalling 1615 followers. Intervention posts shared on Facebook (4-5 posts/week) typically reached only a portion of PICNIC Page followers each week, but also reached a wider audience through their friends. Throughout the evaluated period, Facebook users actively engaged in PICNIC posts, although the level of engagement varied considerably from post to post. Furthermore, results from this study suggest the strategy of directing potentially interested parents from social media to the website for program sign-up was successful. Finally, the explored data gave insights into users' availability, demographics and engagement, which will be used to inform refinement of the PICNIC website and social media strategies.

CONCLUSIONS

Our findings confirm the benefits of using a peer education approach and existing social network channels to disseminate evidence-based child feeding information to parents. This study also demonstrates the usefulness of web and social media analytics to be used as part of a continuous evaluation for gaining insight to inform further development and improvement of program strategies.

TRIAL REGISTRATION

The PICNIC project was retrospectively submitted for registration with the Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12622000230752 (09/02/2022).

Evaluating the effectiveness of Internet-based communication for public health: a systematic review (Preprint)

Background

Communicating strategically is a key issue for health organizations. Over the past decade, health care communication via social media and websites has generated a great deal of studies examining different realities of communication strategies. However, when it comes to systematic reviews, there is fragmentary evidence on this type of communication.

Objective

The aim of this systematic review was to summarize the evidence on web institutional health communication for public health authorities to evaluate possible aim-specific key points based on these existing studies.

Methods

Guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, we conducted a comprehensive review across 2 electronic databases (PubMed and Web of Science) from January 1, 2011, to October 7, 2021, searching for studies investigating institutional health communication. In total, 2 independent researchers (AN and SS) reviewed the articles for inclusion, and the assessment of methodological quality was based on the Kmet appraisal checklist.

Results

A total of 78 articles were selected. Most studies (35/78, 45%) targeted health promotion and disease prevention, followed by crisis communication (24/78, 31%), general health (13/78, 17%), and misinformation correction and health promotion (6/78, 8%). Engagement and message framing were the most analyzed aspects. Few studies (14/78, 18%) focused on campaign effectiveness. Only 23% (18/78) of the studies had an experimental design. The Kmet evaluation was used to distinguish studies presenting a solid structure from lacking studies. In particular, considering the 0.75-point threshold, 36% (28/78) of the studies were excluded. Studies above this threshold were used to identify a series of aim-specific and medium-specific suggestions as the communication strategies used differed greatly.

Conclusions

Overall, the findings suggest that no single strategy works best in the case of web-based health care communication. The extreme variability of outcomes and the lack of a unitary measure for assessing the end points of a specific campaign or study lead us to reconsider the tools we use to evaluate the efficacy of web-based health communication.

Young Adults' Use of Different Social Media Platforms for Health Information: Insights From Web-Based Conversations

Background

Social media–delivered health promotion has demonstrated limited uptake and effectiveness among young adults. Understanding how young adults interact with existing social media platforms for health might provide insight for future health promotion interventions.

Objective

The aim of this study is to describe how young adults interact with different social media platforms for health and health information.

Methods

We used a web-based conversation methodology to collect data from 165 young adults aged 18 to 24 years. Participants participated in an extended conversation with moderators and other participants about health and social media. They were prompted to discuss how they find health information, how they use different social media platforms, and how they evaluate the trustworthiness of information. A thematic qualitative analysis was applied to the data.

Results

Young adults spent a lot of time scrolling through Facebook newsfeeds, which often resulted in seeing health-related content either from their friends, news sources, or advertisements. Some actively sought out information about specific health areas by joining groups or following relevant pages. YouTube was considered a useful source for learning about everything and was often the go-to when searching for information or advice (after Google). Young adults found the video format easy to learn from. They stated that they could identify accurate YouTube health content by cross-checking multiple videos, by feeling that the presenter was real and relatable, or just through instinctively judging a video’s credibility. Instagram was a source of inspiration for health and wellness from those whose lives were dedicated to healthy lifestyles and fitness. Twitter, Tumblr, and Snapchat were rarely used for health information.

Conclusions

Most young adults obtain health information from social media, both actively and through passive exposure. Participants indicated looking to social media influencers for health and lifestyle inspiration and judged the credibility of sources by appearance and instinct. Health experts should try to use the channels in the way that young adults already use them; use relatable role models on Instagram and YouTube, eye-catching headlines and support groups on Facebook, and easy to follow instruction videos via YouTube.

International Registered Report Identifier (IRRID)

RR2-10.1111/1747-0080.12448

Communication of Nutrition Information by Influencers on Social Media: A Scoping Review

ISSUE ADDRESSED

Although government promoted public health, social media and media campaigns have communicated nutrition information, the Australian population remain chronic under-consumers of fruit and vegetables and over-consumers of ultra-processed foods. This scoping review aimed to determine how social media influencers (SMI) communicate nutrition information and the factors that influence the popularity of messages. Identified factors could inform how governments may utilise social media to impact positively on food choices.

METHODS

Nine databases were searched in the past 5 years (2016-2021). After relevant sources were identified, entire texts of the grey literature and the 'Results' sections of the academic literature were coded. Using Microsoft Word, each key feature of the relevant text was highlighted, and the relevant code was recorded. Inductive coding was utilised where codes were created based on the text itself. These codes were then sorted iteratively into relevant themes and subthemes.

RESULTS

Eleven studies were included. From these sources, five themes were identified. These were, 1) Promoting Dietary Change, 2) Certain Modes/Styles of Content Delivery, 3) An Attractive Individual, 4) Language Features and 5) Appearing Connected to the Audience.

CONCLUSION

SMI are selective in their content and communication techniques to ensure their nutrition messages are popular with social media users. These methods exhibited by SMI could inform strategies to build trust in government messages about food and nutrition. SO WHAT?: SMI are able to nurture trust and exert influence on followers. It may be possible to leverage existing SMI to deliver specific nutrition messages to their audiences.

Where Do Online Games Fit into the Health Behaviour Ecology of Emerging Adults: A Scoping Review

Online video games are a common pastime for emerging adults (EAs). EAs are an age group that is of interest in health communication because habits formed during this life stage can cause or prevent disease later in life. Guided by three research questions, this scoping review identifies the current state of research into socio-ecological influences on physical activity and diet behaviours of EAs. The review also examines the role that online video games play within this behavioural ecology. In total, 112 articles were found that focused on behavioural ecological influences for physical activity and diet behaviour among EAs. Seven of these articles focused on the impact of online video games, although only in conjunction with their influence on physical activity, identifying a gap in understanding the influence of online games on diet. Results show that online video games are currently under-researched in terms of impacts on physical activity and diet despite the prevalence of the use of these games within the EA cohort.

A Teaching Kitchen Medical Groups Visit with an eHealth Platform for Hypertension and Cardiac Risk Factors: A Qualitative Feasibility Study

Introduction: Our Whole Lives-Hypertension (OWL-H) is an eHealth toolkit for hypertension and cardiac risks factors. It is a hybrid online self-management platform that teaches blood pressure (BP) self-monitoring and evidence-based lifestyle modifications combined with in-person teaching kitchen medical group visit. Qualitative feedback from participants regarding the facilitators and barriers of using OWL-H has been discussed in this article. Methods: The OWL-H platform was pilot tested in a pre-post trial with two cohorts of participants with hypertension (N = 24). The online intervention utilized OWL-H for teaching mindfulness meditation, the Dietary Approaches to Stop Hypertension nutrition plan, and evidence-based strategies for lifestyle modifications. Three in-person teaching kitchen medical group visits were held to demonstrate cooking skills to reinforce the online platform. Semi-structured focus group discussions (FGDs) were held after the intervention. Results: Fourteen of the 24 participants in the trial participated in the FGDs, and 1 participant provided feedback in a solo interview. Major themes that emerged included: (1) participants' request to tailor OWL-H's recipes and meal planning to suit their own dietary needs or preferences, to personalize the Home Practices (e.g., meditation) according to individual preferences (e.g., addition of nature sounds or guided visual imagery); (2) the strengths and weaknesses of OWL-H as a BP self-monitoring tool; (3) the need for community support in managing BP; and (4) participants noted lack of time, work and commute, Internet connectivity, stress, and sickness as obstacles in using OWL-H. Participants described feeling outpaced by the growth of technology and raised concerns of poor Internet connectivity hampering their use of OWL-H. Conclusion: OWL-H and the accompanying teaching kitchen medical group visit are potential tools to help reduce hypertension and cardiac risk factors. The intervention was found to have acceptability among people with lower income. Clinical Trials Registration#: NCT03974334.

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