Diabetes on the social media: health promotion intervention and behaviour analysis

From the last two Delphi studies carried out with 5 experts in diabetes and health education, we have concluded that: - Experts strongly agree that it is necessary to provide more information to people affected with diabetes and also to their family members through social media. They think this information should be provided by patient organizations and their collaborating healthcare personnel. They also think that the public health service should allocate resources to this and involve people with diverse competences like communication experts, general practitioners, and diabetes specialists like nutritionists, diabetes nurses and endocrinologists. - Experts agree that social media could be good environments to provide health promotion contents to people affected with diabetes. The most important issue highlighted by the experts is that social media channels have the benefit that they might reach out to very many people (different groups; people in all ages use these channels every day). They are easy to access. The information is available when you need it (always at hand). Experts are also worried about the validity and reliability of posted content. - Experts would recommend healthcare authorities the use of social media for diabetes-related health promotion. They think healthcare authorities could have their own social media for sharing information and answering questions By monitoring of all social media posts published in Diabetesforbundet channels (Facebook, Twitter and Instagram) during 3-years period (2017-2019, we have found that: - Regarding engagement with social media posts: A total of 1449 messages were posted. Posts of interviews and personal stories received 111% more likes, 106% more comments, and 112% more shares than miscellaneous posts (all P<.001). Messages posted about awareness days and other celebrations were 41% more likely to receive likes than miscellaneous posts (P<.001). Conversely, posts on research and innovation received 31% less likes (P<.001), 35% less comments (P=.02), and 25% less shares (P=.03) than miscellaneous posts. Health education posts received 38% less comments (P=.003) but were shared 39% more than miscellaneous posts (P=.007). With regard to social media channel, Facebook and Instagram posts were both 35 times more likely than Twitter posts to receive likes, and 60 times and almost 10 times more likely to receive comments, respectively (P<.001). Compared to text-only posts, those with videos had 3 times greater chance of receiving likes, almost 4 times greater chance of receiving comments, and 2.5 times greater chance of being shared (all P<.001). Including both videos and emoji in posts increased the chances of receiving likes by almost 7 times (P<.001). Adding an emoji to posts increased their chances of receiving likes and being shared by 71% and 144%, respectively (P<.001). - Social support & posts dealing with health education and physical activity promotion analysis: A total of 260 posts specifically dealing with health education (n=200) and physical activity promotion (n=60) were published along 3 years. Posts promoting physical activity received 54% more likes than posts on health education (p<0.05), but they were also 69% less likely to receive comments and be shared (both p<0.01). Posts that expressed two or more types of social support were the most engaging (received 3 times more likes, 2 times more comments, and over 6 times more shares, all p<0.001). Furthermore, posts that expressed tangible assistance received 6 times more likes (p<0.001), and the ones expressing network support almost 11 times more shares (p<0.05). The project had 2 additional media publications: - In Forskning.no: Article available at http://shorturl.at/dtuvI - In Science Nordic: Article available at http://shorturl.at/jszVX The use of social media to provide health education and health promotion to people with diabetes and their family members should be regarded as a supplementary health service: - Through 3 Delphi studies carried out in this project, health professionals, experts in diabetes and health education from Norway agree that it is necessary to provide more information to people affected with diabetes and also to their family members. They think that social media could be good environments to provide health promotion contents to people with diabetes. And they would recommend healthcare authorities the use of social media for diabetes-related health promotion. - Patient associations and patient groups from around the world are increasingly more present on social media. Being both ubiquitous and freely accessible, social media channels allow patient associations to share content and connect with individuals interested in their health condition while providing social support. This project has been carried out in collaboration with Diabetesforbundet, the main diabetes association in Norway. By January 2021, the association had almost 36,000 followers on Facebook, almost 8000 followers on Instagram, and more than 3000 followers on Twitter. - Users of the diabetes social media groups responded in a survey they are interested in health promotion contents delivered through social media. They say they are especially interested in knowing more about research and innovations in diabetes, in receiving contents in text format, and in finding the contents on Facebook. - A total of 260 posts specifically dealing with health education and physical activity promotion were published during the 3-years period in the three channels from the patient association (Facebook, Twitter and Instagram). - By monitoring social media posts from the patient association during a 3-years period we have found that diabetes social media users seem to be least engaged in posts with content topics that a priori could be linked to greater empowerment (i.e., research and innovation on diabetes, and health education). According to our findings we can recommend to diabetes social media groups, public health authorities, and other stakeholders interested in sharing research and innovation content and promoting health education on social media to consider including videos and emoji in their posts, and to publish on popular and visual-based social media channels, such as Facebook and Instagram, to increase user engagement. Our findings also suggest that the engagement on health education and physical activity promotion contents can be increased by expressing two or more types of social support within social media posts, by providing tangible assistance and network support, and by posting contents on Facebook and Instagram.