Optimizing the Presentation of Mental Health Information in Social Media: The Effects of Health Testimonials and Platform on Source Perceptions,Message Processing,and Health Outcomes

Using social media for the purpose of disseminating mental health information is a critical area of scientific inquiry for health communication professionals. The purpose of this study was to investigate whether the presence of a first-person testimonial in educational mental health information placed in Facebook and Twitter messages influenced college students’ (N = 257) source perceptions, information processing, cognitive elaboration, health information recall, beliefs, and behavioral intentions. Results show that exposure to social media messages that featured mental health information embedded with a testimonial predicted less source homophily and more critical thoughts about the social media source, less systematic message processing, and less cognitive elaboration. Health information recall was significantly impacted by both the social media platform and message content such that participants in the testimonial condition on Facebook were more likely to recall the health facts in those messages whereas participants who viewed the testimonial in Twitter were less likely to recall the facts in those tweets. Compared to those who read Facebook messages, participants who read Twitter messages reported higher levels of systematic message processing. These findings suggest that the integration of health testimonials into social media messages might inadvertently provoke psychological resistance to mental health information, thereby reducing the persuasive impact of those messages.     

Psychological effects of belonging to a Facebook weight management group in overweight and obese adults: Results of a randomised controlled trial

This study was conducted to test whether the weight outcomes in an online social networking group were mediated by changes to psychological outcome measures in overweight and obese individuals, following a weight management programme delivered via Facebook. The data analysed in this study were collected during a three‐armed, randomised, controlled clinical weight management trial conducted with overweight and obese adults over 24 weeks. Two intervention groups were given the same weight management programme: one within a Facebook group, along with peer support from other group members (the Facebook Group); the other group received the same programme in a pamphlet (the Pamphlet Group). A Control Group was given standard care. The primary outcome was weight; secondary outcomes included the following domains from self‐reported questionnaires: energy intake and expenditure; psychological health, social relationships, physical health, quality of life, depression, anxiety, stress, health anxiety, happiness, as well as Facebook Group participants’ opinion of this group. The Facebook Group experienced a reduction in their baseline weight measurement by week 24, significantly compared to the Control Group (p = .016). The Facebook Group recorded a significant increase in the psychological health domain during the trial (at week 12) relative to their baseline measurement, and significant compared to the Control Group (p = .022). Mediation analysis indicated a statistical trend, but not statistical significance, for psychological health as a mediator to weight loss in the Facebook Group. While both intervention groups showed significant changes in psychological outcome measures, the Facebook Group was the only group to experience statistically significant weight loss by the end of the 24 weeks. Therefore, an examination of other psychological and/or behavioural outcome measures undertaken in larger studies in the future may help to identify significant mediators to improved weight loss outcomes in online social networking groups.     

Project HOPE: Online Social Network Changes in an HIV Prevention Randomized Controlled Trial for African American and Latino Men Who Have Sex With Men

Objectives. We examined whether and how an HIV prevention diffusion-based intervention spread throughout participants’ online social networks and whether changes in social network ties were associated with increased HIV prevention and testing behaviors.Methods. We randomly assigned 112 primarily racial/ethnic minority men who have sex with men (MSM) to receive peer-delivered HIV (intervention) or general health (control) information over 12 weeks through closed Facebook groups. We recorded participants’ public Facebook friend networks at baseline (September 2010) and follow-up (February 2011), and assessed whether changes in network growth were associated with changes in health engagement and HIV testing.Results. Within-group ties increased in both conditions from baseline to follow-up. Among the intervention group, we found a significant positive relation between increased network ties and using social media to discuss sexual behaviors. We found a positive trending relationship between increased network ties and likelihood of HIV testing, follow-up for test results, and participation in online community discussions. No significant differences were seen within control groups.Conclusions. Among high-risk MSM, peer-led social media HIV prevention interventions can increase community cohesion. These changes appear to be associated with increased HIV prevention and testing behaviors.African American and Latino individuals are at high risk for contracting HIV.1 In Los Angeles County, California, most of these cases are attributable to men who have sex with men (MSM), who currently account for more than 75% of all HIV cases.2,3 Researchers, and MSM themselves, have suggested use of novel approaches to increase HIV prevention and testing among at-risk populations.4,5Peer leader interventions, based on diffusion theories, are community-based interventions that train community peers to spread HIV prevention information and change HIV prevention-related social norms.6–9 Successful peer-led interventions have resulted in decreasing anal intercourse up to 25% and increasing condom use up to 16%, with sustained behavior change up to 3 years later.10–12 Peer-delivered interventions have been found to be acceptable among MSM populations.13 Social network interventions have shown that information can rapidly diffuse throughout social networks to change health behaviors,14,15 suggesting that peer-delivered HIV interventions also might diffuse throughout social networks.Growth in social media allows these technologies to be used for peer-led HIV testing interventions,4 and research supports that peer-led interventions delivered via social media can increase HIV testing.16 Social networking technologies, such as Facebook, allow users to connect and communicate with other network users by sharing pictures, messages, Web site links, and other multimedia information.17 High rates of online social networking, especially among groups disproportionately affected by HIV (e.g., MSM),18 make it important to evaluate whether and how interventions might diffuse throughout online social networks. Although social media can be used to increase HIV prevention,16,19,20a and health behaviors of (offline) social ties influence our own health behaviors20b, no known research has studied changes in social network ties during the course of an online social media community HIV intervention or whether and how HIV prevention information and behaviors might spread among group participants in a social media–based HIV testing intervention that is designed for network diffusion.The Harnessing Online Peer Education (HOPE) intervention was a 12-week randomized controlled HIV prevention intervention designed to use peer-led Facebook groups to diffuse HIV information to increase testing among African American and Latino MSM. The study found that participants in the HIV intervention groups were more likely to request an HIV test than were those in the control groups,16 but whether changes in social network ties (i.e., participants within each group becoming Facebook friends with one another) played a role in these effects among intervention group participants is unknown. The current study used data from the HOPE study and was designed to evaluate the association between changes in online social network structure and HIV prevention and testing among HOPE network participants. Specifically, we have (1) described the change from baseline to follow-up in network ties among HOPE participants as a result of the intervention, (2) presented network visualizations to illustrate changes in network connections among intervention and control group participants, and (3) determined whether changes in social network ties from baseline to follow-up were associated with online community engagement, discussions about HIV prevention, and rates of HIV testing.     

Public Meetings About Suspected Cancer Clusters: The Impact of Voice,Interactional Justice,and Risk Perception on Attendees' Attitudes in Six Communities

Holding a public meeting is a frequent method of communicating with community residents during official investigations into possible cancer clusters; however, there has been little formal research into the effectiveness of this method of health communication. This article presents research examining the influence of public meetings held during ongoing cancer cluster investigations in six U.S. communities. Drawing on social psychological theories of organizational justice, it examines the degree to which three specific elements of justice, including having a voice in the process, receiving fair interactional treatment, and facing equal risk of loss (i.e., cancer), influenced five outcome variables: meeting satisfaction, community connectedness, willingness to accept meeting outcomes or recommendations, willingness to attend future public meetings, and concern about the potential cancer cluster. The analysis of data collected from meeting attendees who responded to the mailed survey (N = 165) confirms a strong role for justice concerns in public meeting evaluations. In particular, perceptions of voice and interactional treatment had consistently large effects on the outcome variables, suggesting that managing a fair public engagement process can contribute to positive civic outcomes even during periods of heightened community concern about area cancer rates.     

Physicians,patients, and Facebook: Could you? Would you? Should you?

ABSTRACT

This article investigates the opinions of physicians and patients regarding the use of Facebook to communicate with one another about health-related issues. We analyzed 290 comments posted on online discussion boards and found that most (51.7%) were opposed to physicians being Facebook “friends” with patients and many (42%) were opposed to physicians having any kind of Facebook presence. Some believed that health care organizations should have a social media policy and provide social media training. We conclude with suggestions for how health care administrators can provide assistance to physicians and effectively manage their social media presence.     

Advancing health equity through social care interventions

Objective

To use evidence on addressing racism in social care intervention research to create a framework for advancing health equity for all populations with marginalized social identities (e.g., race, gender, and sexual orientation). Such groups have disproportionate social needs (e.g., food insecurity) and negative social determinants of health (SDOH; e.g., poverty). We recommend how the Agency for Healthcare Research and Quality (AHRQ) could advance health equity for marginalized populations through social care research and care delivery.

Data Sources and Study Setting

This commentary is informed by a literature review of social care interventions that were affiliated with healthcare systems; input from health equity researchers, policymakers, and community leaders attending the AHRQ Health Equity Summit; and consensus of the authors.

Principal Findings

We recommend that AHRQ: (1) create an ecosystem that values research on SDOH and the effectiveness and implementation of social care interventions in the healthcare sector; (2) work with other federal agencies to (a) develop position statements with actionable recommendations about racism and other systems that perpetuate marginalization based on social identity and (b) develop aligned, complementary approaches to research and care delivery that address social marginalization; (3) advance both inclusive care delivery and inclusive research teams; (4) advance understanding of racism as a social determinant of health and effective strategies to mitigate its adverse impact on health; (5) advance the creation and scaling of effective strategies for addressing SDOH in healthcare systems, particularly in co-creation with community partners; and (6) require social care intervention researchers to use methods that advance our understanding of social health equity.

Conclusions

AHRQ, as a federal agency, could help advance health equity using a range of strategies, including using the agency's levers to ensure AHRQ stakeholders examine and address the unique experiences of socially marginalized populations in SDOH and social care intervention research.     

Location, location, location: contextual and compositional health effects of social capital in British Columbia, Canada

After decades of epidemiological exploration into individual-level risk factors for ill health, a recent surge of interest in the health effects of socially patterned attributes of geographically defined 'places' has given the structural side of the agency-structure debate new prominence in population health research. Utilizing two original data sets, one pertaining to features of communities in British Columbia, Canada and the other to characteristics of individuals living in them, this article distinguishes the health effects of socially patterned attributes of communities, including the social capital of communities, from the health effects of characteristics of residents that contribute to social capital, e.g., trust and participation in voluntary associations. Results from multilevel analysis demonstrated that, of three different individual-level measures of health and well-being (and including measures of long-term limiting illness and self-rated health), only a measure of depressive symptoms had variability that could be reasonably attributed to the level of the community. The social capital of communities in the form of the availability of public spaces explained some of this variability, but in the direction contrary to expectations. Overall, location (community of residence) did little to explicate health inequalities in this context. The strongest predictors of health in multivariate and multilevel models were characteristics of individual survey respondents, namely, income, trust in politicians and governments, and trust in other members of the community. Breadth of participation in networks of voluntary association was not significantly related to health in multivariate models.     

Can Parental Engagement in Social Media Enhance Outcomes of an Online Healthy Lifestyle Program for Preschool-Aged Children?

ABSTRACT

This study explored parental engagement, child BMI and secondary outcomes from the social media component of an online healthy lifestyle program for parents of preschool-aged children. Intervention group participants received access to an online program and Facebook group. Data were collected at baseline and 3- and 6-months follow-up. Facebook usage data on comments and posts were used to determine total active engagement. There was a high level of Facebook group membership and most parents actively engaged at least once. Although there were varying levels of engagement between modules and cohorts, it was modest overall. User acceptability of the Facebook group was lower than expected. Children of parents in the intervention who engaged more in the Facebook group (by posting and commenting) demonstrated greater sleep duration over time (estimate 1.79, 95% CI 0.42 to 3.17, p = .01) Children of parents who engaged more in the Facebook group also participated in less moderate- to vigorous-intensity physical activity (estimate ?0.14, 95% CI ?0.26 to ?0.01, p = .03). This study is one of the first parent-focussed healthy lifestyle interventions to include a social media component. Further research is recommended with larger sample sizes and longer duration to further explore the potential of social media in childhood obesity interventions.     

Social Network Recruitment for <Emphasis Type="Italic">Yo Puedo</Emphasis>: An Innovative Sexual Health Intervention in an Underserved Urban Neighborhood—Sample and Design Implications

Most existing evidence-based sexual health interventions focus on individual-level behavior, even though there is substantial evidence that highlights the influential role of social environments in shaping adolescents’ behaviors and reproductive health outcomes. We developed Yo Puedo, a combined conditional cash transfer and life skills intervention for youth to promote educational attainment, job training, and reproductive health wellness that we then evaluated for feasibility among 162 youth aged 16–21 years in a predominantly Latino community in San Francisco, CA. The intervention targeted youth’s social networks and involved recruitment and randomization of small social network clusters. In this paper we describe the design of the feasibility study and report participants’ baseline characteristics. Furthermore, we examined the sample and design implications of recruiting social network clusters as the unit of randomization. Baseline data provide evidence that we successfully enrolled high risk youth using a social network recruitment approach in community and school-based settings. Nearly all participants (95 %) were high risk for adverse educational and reproductive health outcomes based on multiple measures of low socioeconomic status (81 %) and/or reported high risk behaviors (e.g., gang affiliation, past pregnancy, recent unprotected sex, frequent substance use; 62 %). We achieved variability in the study sample through heterogeneity in recruitment of the index participants, whereas the individuals within the small social networks of close friends demonstrated substantial homogeneity across sociodemographic and risk profile characteristics. Social networks recruitment was feasible and yielded a sample of high risk youth willing to enroll in a randomized study to evaluate a novel sexual health intervention.     

Community-Initiated Urban Development: An Ecological Intervention

Neglected urban environments have been linked to social isolation, depression, and other health problems. In Portland, OR in 2003, an intervention was implemented and evaluated in three neighborhoods with the objective of promoting community participation in urban renewal and engaging residents in the construction of attractive urban places. Municipal officials approved and permitted community-designed street murals, public benches, planter boxes, information kiosks with bulletin boards, trellises for hanging gardens, all positioned in the public right-of-way. Residents within a two-block radius of the three sites were systematically sampled and interviewed before (N = 325) and after (N = 349) the intervention, of which, 265 individuals completed both surveys of the panel study. After the intervention, multivariate results revealed improvements in mental health (p = 0.03), increased sense of community (p < 0.01), and an overall expansion of social capital (p = 0.04). Through community empowerment, participation, and collective action, the strategy successfully engaged residents in restoring neighborhoods, with direct benefits to community well-being.     

Socially responsible medical education: innovations and challenges in a minority setting

Medical Education 2010: 44 : 263–271 Context Distributed medical education sites help train, recruit and retain doctors, notably in rural and isolated areas, by providing education and training in these areas and adapting their curriculum to meet the host community’s health needs. Objectives The Centre de Formation Médicale du Nouveau Brunswick (CFMNB; New Brunswick Medical Education Centre) was established by a partnership between two academic institutions, the Université de Sherbrooke (University of Sherbrooke), situated in the province of Quebec, and the Université de Moncton (University of Moncton), situated in the province of New Brunswick, in Canada. The CFMNB is specifically targeting a minority community (Acadians). Working to establish a high‐quality medical education programme, the CFMNB has also set community objectives to meet not only the health needs of this population, but also its social and economic needs. Methods This paper describes the overall objectives of this project, which are: to reduce the gap between community needs and academic institutional needs; to address ethno‐cultural and language differences in a defined minority population, and to develop collaboration between the partners involved, including government and community entities which are often perceived as operating in isolation from one another. We also describe why and how the CFMNB developed community‐focused objectives and the challenges that came with these innovations, and present lessons from the experience that may be relevant to other sites interested in the social responsibility of medical schools. Conclusions The CFMNB has produced interesting work and innovations in the field of social responsibility and has encountered many challenges. Continuing interaction between medical education, health research and health services to better address the needs of the population has been established. The information obtained by this process has been used to build a strategic plan for the CFMNB in order to ensure that it is socially responsive and has significant generalisable features.     

The role of organizations in community participation--prevention of accidental injuries in a rural Swedish municipality

Accidental injuries are a major public health problem in most of the industrialized world. It is no longer justifiable to accept accidents as unfortunate but unavoidable occurrences. Their prevention is important and appears increasingly possible. The health care sector is uniquely knowledgeable about health hazards and must be more involved in social planning. An intervention programme towards the prevention of accidental injuries based on local epidemiological data has since 1980 been conducted in a geographically defined population in Skaraborg County in western Sweden. This article describes a community intervention approach. The programme has been implemented in a local community with the application of a community oriented and organization oriented perspective. This has above all constituted a starting point for initiating the programme. The programme includes as well active as passive strategies and consists of information, education, supervision and changes in the physical environment. Intersectorial cooperation and community involvement are emphasized.     

Health as situational adaption: a social psychological perspective

A model to encompass the complex relationship between the individual and his social, physical and cultural environments and to provide strategies for intervention has not yet been developed. While professionals acknowledge the importance of an ecological and holistic conception of man-environment interaction, various biases and ideologies prevent them from adequately taking this interaction into account. To overcome this inadequacy this paper explores a relational conception of health, the central importance of the socially defined situation for health and adaption, the limits of medicine and holism in intervening in problems of adaption and suggests a situational approach to the study of health and adaption. By stressing the socially defined situation and the social psychological actor it may be possible to sensitize the actor to socially situated man-environment transactions, to preserve the actor's confidence in his own health, to encourage individual responsibility for maintaining health and to promote an awareness of signs and symptoms that require medical attention. Within a larger framework, however, it is not effective to intervene in the individual's social situations if we do not also attempt to alter the macro economic, political, cultural and structural elements in society which encourage, produce and support unhealthy environmental conditions.     

Factors related to screening for problem gambling among healthcare and social service providers in Ontario,Canada: A concept mapping study

Problem gambling is a major public health concern, especially among persons who are precariously housed, living in poverty or have complex health and social needs. Problem gambling has been connected to negative health and social outcomes; however, current healthcare services rarely screen for problem gambling. With support from community partners, the purpose of this study was to understand factors related to screening for problem gambling. Concept mapping, a mixed‐method approach driven by participatory involvement, was conducted with healthcare and social service providers from Ontario, Canada in 2019. Three phases were conducted with participants either in‐person or online: Brainstorming, Sorting/Rating and Mapping. Brainstorming sessions were conducted to generate statements, guided by the focal prompt: “If you were directed to routinely screen for problem gambling, what would help you do this in your daily practice?” Participants sorted statements into categories and rated them based on their importance and feasibility. A mapping session was conducted with participants to co‐create visual representations of the data. Thirty participants took part in the in‐person or online concept mapping sessions. During the brainstorming sessions, participants generated 213 statements, which the research team condensed into a final list of 45 statements. Participants decided that the five‐cluster map best represented these 45 statements and labelled the five clusters: (a) top level (macro), (b) screening tool, (c) staff skills and training, (d) screening, and (e) team resources and support. Staff skills and training was rated as the most important and the most realistic cluster to implement, while screening was rated relatively as the least important when compared to the other clusters. Team resources and support was rated relatively as the least realistic cluster. By identifying the needs of healthcare and social service providers, this study co‐developed actionable suggestions that will assist providers in routinely screening for problem gambling.     

A scoping review to understand the effectiveness of linking schemes from healthcare providers to community resources to improve the health and well‐being of people with long‐term conditions

The prevalence of people living with long‐term conditions is increasing, accompanied by an increased expectation that patients will become more involved in self‐management. Long‐term conditions are associated with increased social isolation and poor physical and mental health. But there remains a gap in health provision between providing medical treatment and effectively addressing psychosocial well‐being. One potential way of addressing this gap is by utilising social interventions which link patients from health services to community‐based sources of support. However, the mechanisms involved in the delivery of interventions providing that link and their effectiveness remain unclear. This review adopted the methodological framework for conducting scoping studies, searching for both academic and grey literature on social interventions which link people from healthcare settings to a range of community and voluntary sector organisations. A literature search between May and June 2013, involving five electronic databases, hand searching of two journals and the use of Google search engine, identified seven studies relevant to the review question. In terms of key characteristics and mechanisms of the interventions, mental health conditions and social isolation were the most common reasons for referral to the interventions, and referrals were usually made through general practices. Almost all the interventions were facilitator‐led, whereby the facilitator worked to identify and link participants to appropriate community‐based resources. In regard to health and social outcomes and their cost‐effectiveness, studies reported improvement to participants' psychological and social well‐being as well as their decreased use of health services, although there were limited measures of participants' physical health outcomes. Interventions for linking patients from healthcare setting to community‐based resources target and address psychosocial needs of participants. The review identified involvement of health professionals in aiding the referral of patients to the intervention and the role of the intervention facilitators as key components of the interventions.     

Using Geographic Information Systems to Promote Community Involvement in Comprehensive Cancer Control

Geographic information systems (GIS) for cancer control present an innovative approach to health communication for comprehensive cancer control (CCC) planning. The ability to spatially depict multivariate views of cancer incidence, treatment site locations, transportation routes, and even environmental exposures within a map represents opportunities to involve communities in novel ways with cancer control. Communities may be involved strategically and/or as a goal in planning efforts. The experiences and perceptions of a near census of U.S. CCC program managers (N = 49) were examined to gain their insights about the compatibility of GIS mapping for CCC, the target audiences to be reached with maps as a CCC message, and relative advantages of this technology in its diffusion. Analysis includes a quantitative assessment of interviews and qualitative statements to illustrate these issues. Results suggest that GIS use for cancer control has the potential to build community capacity and social capital for communities as a way to reduce the cancer burden.     

Social Capital,Participation and the Perpetuation of Health Inequalities: Obstacles to African‐Caribbean Participation in ‘Partnerships’ to Improve Mental Health

Objectives. There has recently been much emphasis on the role of ‘partnerships’ between local community ‘stakeholders’ in strategies to redress health inequalities. This paper examines obstacles to participation in such partnerships by African‐Caribbean lay people in local initiatives to improve mental health in a town in southern England. We present a ‘social psychology of participation’ which we use to interpret our data. Our work seeks to illustrate some of the micro‐social mechanisms through which social inequalities are perpetuated, using Bourdieu's conceptualisation of the role played by various forms of capital (economic, social, cultural and symbolic) in perpetuating social inequalities.

Design. Our empirical research consists of a qualitative case study of attitudes to participation in mental‐health‐related partnerships in a deprived community. In‐depth interviews and focus groups were conducted with 30 local community ‘stakeholders’, drawn from the statutory, voluntary, user and lay sectors.

Results. While interviewees expressed enthusiasm about the principles of participation, severe obstacles to its effective implementation were evident. These included severe distrust between statutory and community sectors, and reported disillusionment and disempowerment within the African‐Caribbean community, as well as low levels of community capacity. Moreover, divergent understandings of the meaning of ‘partnership’ suggested that it would be difficult to satisfy both community and statutory sectors at once.

Conclusions. We suggest that disadvantaged and socially excluded communities are often deprived of the social resources which would provide a solid basis for their participation in partnerships with state health services. In the absence of efforts to remove such obstacles, and to generate the necessary resources for participation, partnerships may be ‘set up to fail’, leaving social inequalities to prevail.