Brar P, Awuah W, Mensah M, Amaka S. Embracing social media as a modern means of health promotion: can we “like” and “share” our way towards better population health? HPHR. 2021;40. 10.54111/0001/MM7
Over the past year, the world has been drastically impacted by the COVID-19 pandemic. While some sectors have successfully embraced the accelerated way in which societies were forced to digitize, it could be said that the public health sector has not fully taken advantage of the opportunities presented by social media. This article explores some of the benefits of using social media as a means of health communication, particularly with regards to faster dissemination of information and benefits to mental health during the COVID-19 pandemic. Concerns surrounding social media misinformation and the “digital divide” are also addressed and recommendations are made on how they can be tackled. Furthermore, real-life case studies from the Pacific Islands region and Finland are explored so as to identify ways in which similar frameworks and strategies can be applied in other similar communities across the world.
The COVID-19 pandemic has taken the world by storm since early 2020, forcing societies around the world into sudden lockdowns, and the implementation of physical distancing measures. Almost overnight, businesses and services were forced to move online in an attempt to survive this once-in-a-lifetime occurrence. Due to the coronavirus pandemic, modern society was forced to digitize at a much faster rate than previously expected, with organizations embracing work-from-home and e-meetings (Caldwell & Krishna, 2020). While the education and business sectors seemingly embraced this virtual “new normal”, it could be said that the public health sector has not taken advantage of the benefits of social media, particularly in relation to health communication and promotion.
Social media sites including WhatsApp, Twitter, Facebook, Instagram, and YouTube have become an intrinsic part of our lives, revolutionizing the way in which we communicate. According to the Digital 2021: Global Digital Report there are 4.2 billion (approximately 54% of the global population) social media users across the world (Kemp, 2021). Nearly 60% of the global population is already online, and these statistics are only expected to grow by the end of this year (Kemp, 2021). The report also found that typical social media users spend approximately 2 hours and 25 minutes online every day (Kemp, 2021). Facebook emerges as the most popular social media site, with over 2.27 billion active monthly users, closely followed by YouTube which has just over 2 billion active monthly users (Dean, 2021). Social media appears to be a large part of daily life which remains untapped by the public health sector, and could hold the ability to revolutionize population health across the world.
Despite the known popularity of social media, many authorities and public health organizations were initially hesitant in sharing information on these sites. While some organizations, such as the World Health Organization (WHO), have actively shared important updates and other information using their social media platforms, there could have been better frameworks and strategies in place to fully capitalize on the reach and potential of this newer method of communication. Using social media as a means of public health messaging and communication has the potential to bring a new and innovative dimension to modern healthcare, and even the opportunity to better connect with the next generation of patients.
A survey of young people in Summer 2020 found that 80% of respondents agreed that the COVID-19 pandemic had made their mental health worse (YoungMinds, 2020). Factors such as financial strain caused by the pandemic increased the likelihood of respondents experiencing worse mental health (Ford et al., 2021). In addition, feelings of social isolation and loneliness as a result of physical distancing measures can also exacerbate stress, anxiety, and depression (Ford et al., 2021). Poor mental health is known to be a trigger for eating disorders and self-harm (Ford et al., 2021); as evidenced in data showing the number of urgent referrals for young people with eating disorders in England doubled during 2020 (NHS England, 2021).
During the COVID-19 pandemic, social media proved to be a lifesaver in helping maintain some social contact. Friends and families were able to use social media sites such as Facebook and Zoom to video chat, while platforms such as Twitter and Instagram allowed users to connect with others going through similar experiences, and rally together to provide social support (Owens, 2020). Research has also shown that social media data could be used to detect mental health issues amongst the population (Gao et al., 2020, Li et al., 2020). TikTok has also been linked to helping improve mental health during lockdowns. Research shows TikTok challenges and activities helped keep users entertained during the lockdown, allowing them to use the creative outlet to connect with other people and feel good about themselves (Mallinson, 2020).
Not only has social helped been beneficial for mental health during COVID-19, it has also helped to tackle the spread of false information. Throughout the COVID-19 pandemic, rural, remote, and isolated communities have been at greater risk of misinformation or lack of information (Ranscombe, 2020) due to geographical isolation, lack of resources, or simply lack of up-to-date and accurate information. Across the Pacific Islands, numerous communities have taken the initiative to use social media as a method of communication and to share the latest information regarding COVID-19. There are a variety of factors, including language, education level, and access to the Internet or other news sources, which influence health literacy rates (Gonzalez et al., 2020). Many across the region still live in intergenerational housing, and older people are heavily reliant on younger family members for news and information.
After assessing the needs of their community, the Native Hawaiian and Pacific Islander (NHPI) COVID-19 Response Team, in collaboration with Papa Ola Lokahi (the Native Hawaiian health board) and the University of Hawaii Office of Public Health Studies, launched “Next Gen Hawaii”. Next Gen Hawaii identified the opportunity to educate young people across the Pacific Islands using TikTok and Instagram, recruiting young ambassadors fluent in native languages from across the region (University of Hawai’i at Manoa Office of Public Health Studies, 2020). The initiative helped communities feel included and seen, as resources had been tailored to their language and needs, and helped to improve health literacy of COVID-19 among all age groups. In addition to educational initiatives, some Pacific Islander communities have also used social media to provide aid. Residents of Lautoka, Fiji set up a Facebook group which has delivered over $15,000US worth of groceries to people in need in their local area (Lal & Nandini, 2020). Another Fijian initiative is the “Barter for Better Fiji ” (BFBF) page set up on Facebook. BFBF allows members to barter and make trades with a strict no-cash-for-trade policy (Lal & Nandini, 2020). The success of this initiative has even led to similar groups being set up on other Islands, including Tonga, Vanuatu, Papua New Guinea, Solomon Islands, Samoa, and even New Zealand (Lal & Nandini, 2020).
While social media proved useful in the Pacific Islands region, there are still endless possibilities for similar strategies to be implemented in other rural, isolated, and remote areas across the globe. More than three-quarters of sub-Saharan Africans who are active online (Silver & Johnson, 2020) use social media, and with a median age of 19 in the region, there is a need to recruit and educate younger authority figures in order to spread public health messaging (Ranscombe, 2020). Communities in rural America have also faced similar problems with COVID-19 information reaching them slowly and infrequently (Rayes, 2020). Residents in these areas have relied on social media for information but have faced issues with misleading or false information, and vulgar or argumentative comments (Rayes, 2020). In such cases, had there been concrete frameworks in place from public health authorities, communities would have been better informed and more-equipped to respond to the challenges of the COVID-19 pandemic.
Social media can also play a key role in public health messaging in high-income, more developed communities. For example, the Finnish authorities collaborated with a Helsinki media consultancy to recruit social media influencers (for free, without any monetary remuneration) who could share information quickly, clearly and accurately with its citizens (Henley, 2020). Finland is the only country which has identified social media as a “critical operator”, alongside other key workers such as doctors and supermarket workers (Henley, 2020). The initiative allows influencers access to a range of information and images which can then be shared on multiple social media platforms, ensuring reliable information is shared and reducing the risk of false or misinformation (Heikkilä, 2020). As well as being innovative this initiative was successful due to its almost immediate mobilization. The use of social media influencers has been part of Finland’s emergency contingency plans for nearly two years, meaning there was already a pool of individuals ready to share information on social media in case of a national emergency (Heikkilä, 2020).
While the Finnish media remains one of the most trusted news media (Newman et al., 2019), 57.1% of Gen Z and Millennials around the world feel their government and media are not giving the full picture on the pandemic (Hess et al., 2021). It is therefore no surprise that an increasing amount of people are turning to social media during the pandemic. In the United States around seven-in-ten (approximately 72%) adults report using some form of social media (Auxier & Anderson, 2021). While some might argue that social media is used more commonly by younger people, data from the United States shows 81% of 30-49 year olds and 73% of 50- 64 year olds use social media, compared to 84% of 18- 29 year olds (Auxier & Anderson, 2021).
Social media is becoming an increasingly important part of daily life for many people around the world. The average amount of time a typical user spends on social media is approximately 2 hours and 25 minutes, although this number can be as high as 4 hours and 15 minutes in the Philippines (the world’s biggest consumers of social media), (Kemp, 2021). The State of Mobile 2021 report revealed that the average American spends more than 4 hours per day using their mobile phone, compared to approximately 3 hours and 45 minutes each day watching live TV (State of Mobile 2021, 2021). If public health authorities across the world could harness even a small proportion of the immense possibilities of social media as a tool for health promotion and education, population health in every corner of the globe could be drastically improved.
Social media allows for rapid dissemination of information. Thus, the use of social media to share educational public health content could be transformative. Chan et al (2020) developed and shared an infographic on the “principles of airway management in COVID-19” on social media sites including Twitter and WeChat. After just a few days, the team had received requests to translate the infographic into more than ten languages including context-specific modifications (Chan et al., 2020). They successfully demonstrated the power of social media as a means of educating people across the world. Similarly, a study of young people’s social media use in Summer 2020 showed 43.9% of young people would likely share “scientific” content on their social media accounts (Hess et al., 2021). It was also reported that 41.9% used social media content shared as their first source of information on the COVID-19 vaccine (Hess et al., 2021).
In addition, social media is a more cost-effective medium for the public health sector to reach its audiences (Gatewood et al., 2020). There are little to no advertising fees or cost of printing leaflets etc. Instead, existing health professionals can work with a graphic designer to produce infographics, short videos, and other content to be shared on social media. This strategy has been implemented in Latin America, where the Mexican Center for Nutrition and Health Research (CINyS) proved that even with little resources this new medium allowed for greater dissemination and higher user engagement than previously used methods of health promotion and education (Mendoza-Herrera et al., 2020).
As the first global health emergency during which social media and technology have been widely available as a means to keep people well-informed and connected, social media served as not only a great benefit but also as an unexpected hurdle. In fact, at the beginning of the pandemic the WHO Director-General, Dr Tedros Adhanom Ghebreyesus (2020) stated “we’re not fighting just a pandemic; we’re fighting an infodemic”. Social media allows for rapid dissemination of information, and while this can be a great benefit, it actually became an unexpected hurdle during the pandemic. There have been many reports of misinformation and “fake news” being shared online, which have sometimes resulted in the evolution of coronavirus conspiracy theories, doubts and hesitations about the COVID-19 vaccine, and in some cases, preventable deaths (Guardian News and Media, 2020; Fleming, 2020; Lee, 2021).
A commonly discussed disadvantage of social media is the spreading of fake news or misinformation. Research from the WHO shows 59.1% of Gen Z and Millennials are “very aware” of “fake news” surrounding COVID-19 (Hess et al., 2021). In a bid to combat any misconceptions surrounding the pandemic or vaccines, some scientists and health workers have turned to video-sharing app TikTok (Marchant, 2021). During the first quarter of 2020, TikTok was downloaded 315 million times (Singh, 2020). Some widely shared videos include a PhD scientist clearing up misconceptions above the COVID-19 vaccine, and a nurse answering commonly asked questions related to the virus (Marchant, 2021). Similar initiatives can be used by health authorities to educate people who may otherwise be hesitant to approach health professionals.
In addition, social companies such as Facebook, Twitter and YouTube have begun to better regulate any information shared on their sites. Facebook has clarified that it relies on third-party fact checkers and health authorities to flag misinformation that the organization will then block or remove from its site (Chakravorti, 2020; Rosen, 2020). Instagram, owned by Facebook, has also vowed to block or restrict hashtags that spread misinformation (Chakravorti, 2020). While it may be harder to patrol information shared on YouTube due to the sheer scale of content production, the company removes videos claiming to prevent the spread of Sars-CoV-2 infections (Chakravorti, 2020). As well as monitoring content for false information, Facebook, Twitter, and Google have all banned ads profiting from COVID-19, such as the sale of medical face masks (Chakravorti, 2020). These three companies have also given free ad space to public health and non-profit organizations to promote coronavirus related health information (Chin, 2020; Chakravorti, 2020). As well as social media companies, the WHO and UK government have teamed up to launch multiple initiatives in a bid to combat the spread of false news and misinformation (WHO, 2021).
While using social media as a tool for health promotion and education has a wide range of benefits, the success of initiative and strategies can be limited by the “digital divide”. The digital divide refers to the gap between people who have access to digital technologies and those who do not, whether it is due to lack of physical access to digital devices or lack of skills and training to use such technologies (Baker et al, 2020). As highlighted by the Digital 2021: Global Digital Report, nearly 60% of the global population is online (Kemp, 2021). While this can be seen as a great success, it still remains that almost 40% of the world’s population are offline and cannot reap the benefits of digitalization and digital technologies (Kemp, 2021). The digital divide exists between developing and developed countries, between men and women, between young people and older persons. In 2019, only 15% of women in Least Developed Countries (LDCs) used the Internet, compared to 86% in developed countries (Bridging the gender divide, 2021).
While the digital divide is still heavily present in communities around the world, there are strategies and initiatives in place to help improve access to digital technology and provide the necessary skills and training to help all population groups enjoy the benefits of digital technology. In the UK, following the closure of schools due to COVID-19 related restrictions, children who did not have access to technological devices or internet connections were provided laptops, tablets, and 4G routers by the Department for Education (Baker et al, 2020). In addition to physical access to devices, the government also launched ‘Skills Toolkit’, a free online learning platform for people to improve their digital skills, in addition to £8 million of funding for similar digital skills ‘boot camps’ (Baker et al, 2021). In Uganda, Digital Literacy Initiative (DLI), a non-profit organization, is running workshops and programs to help people develop their digital skills (DLI, 2020). DLI has a special focus on helping provide training and opportunities to people with disabilities, specialized courses for young girls, and even provide a tailored course on embracing social media in the health sector (DLI, 2020).
Embracing social media as a tool for health communication and education could help revolutionize public health post-COVID. Similar to Finland, health authorities around the world need to incorporate social media into existing and future health communication and education strategies and frameworks. Authorities must recognize and identify newer methods of disseminating information to the masses and keep up with the times. Ensuring constant social media presence can help combat the spread of misinformation, and reduce the chances of any further ‘infodemics’, as health authorities and medical professionals can be more accessible for users to ask questions and clarify misleading notions.
While countries with centralized health systems will rely more on government departments (e.g. Ministry of Health, Ministry of Digitalization, and/or other relevant departments) for national public health initiatives, countries with decentralized health systems could begin more localized campaigns. For example, once national lockdowns forced schools in the rural Indian state of Rajasthan to close, teachers quickly began WhatsApp groups to help parents and families with the transition to at-home learning (Windlass, 2020). More than 20,000 WhatsApp groups allowed 95% coverage of schools and students, ensuring better sharing of learning resources and increased learning opportunities for children who would otherwise have been unable to access laptops, computers and other resources (Windlass, 2020). Similarly, rural communities could begin using WhatsApp, and other social media groups to help educate locals on the health needs of their community. Using social media could allow health information to be shared in more languages and in more culturally specific/appropriate ways, reaching a greater proportion of the global population.
Aside from governments, social media companies also have to take greater responsibility in regulating health information shared on their platforms. It could be useful for social media companies to establish specific health teams who can monitor, identify, and resolve issues of misinformation and false news. It is no longer acceptable for these companies to be passive; they must ensure their platforms share accurate and up-to-date health information not just during the COVID-19 pandemic but in the future as well.
In order for social media to be a successful means of health promotion, a majority of the population should be able to access the platforms. Governments must prioritize and ensure that all population groups have access to Internet connections and physical digital technologies. Life-long learning approaches should be encouraged to help people of all ages and abilities develop necessary digital skills.
In conclusion, social media holds the power to transform modern healthcare. Collaboration between the public health sector and social media companies could drastically help improve population health literacy. Embracing social media as a tool for health communication and education could lead to people feeling more confident in their respective health systems, but also allow communities to be better prepared in case of future global health emergencies. Lessons can be learned from the Pacific Islands’ and Finland’s use of social media during the COVID-19 pandemic, and concrete strategies can be proposed and implemented across other countries/regions. While some flaws, such as spreading of misinformation may currently exist, it is possible to overcome these with increased monitoring and tangible frameworks. The COVID-19 pandemic has highlighted the need for all sectors to continuously adapt and stay current with changing trends, and it is imperative that the public health sector adopts new tools to educate and reach the population.
The author(s) have no relevant financial disclosures or conflicts of interest.
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Pavi Brar is a MSc Global Health and Social Justice student at King’s College London. She is currently interested in researching the impacts of the COVID-19 pandemic, particularly on young people, and lessons to be learnt in building forward better and fairer.
Wireko Andrew Awuah is a fifth-year medical student at Sumy State University, Ukraine. He also serves as an Editorial Board Member at the Harvard Public Health Review, and 4 other reputable journals in the UK, Canada and India.
Martina Mensah is a BS Chemical Engineering student at the University of Maryland. Her research interests include public health, protein engineering, and biopharmaceutical manufacturing.
Shekinah Obinna Amaka is a sixth-year medical student at Sumy State University, Ukraine. She also serves as a Reviewer at the Harvard Public Health Review. Her research interests include public health, and obstetrics and gynecology.