Abstract: This paper discusses the success and evolving nature of technology and online platforms and how they can influence and inform modern lives, particularly in relation to health information, or misinformation, and health impacting behaviours. It touches on traditional methods of health promotion practice and explores how the advancement of the internet, social media platforms and online communities provides an opportunity for health promotion programs, based on the five action areas of the Ottawa Charter, to extend their reach and effectiveness and dispel health misinformation.
Thesis statement: Evidence informed online health promotion programs, aimed at creating supportive environments, strengthening community action and developing personal skills, have the power to refute misinformation found online and improve the health of individuals and communities overall
Social media platforms are accessed by over three billion users worldwide and have become a regular daily source of entertainment, information and companionship for people across the globe (Stellefson et al., 2020). The success of these platforms is a consequence of their ability to adapt and evolve with their users and with ever changing technology, resulting in new social institutions that influence and inform modern lives (Stellefson et al., 2020). Whilst there is much debate about the impacts of social media on traditional communities, Hampton and Wellman (2018) argue that communities have continued to evolve overtime and throughout history, and the emergence of online communities brings with it new and exciting opportunities, particularly in the area of Health Promotion. The World Health Organization (2019) recognizes the particular role of social media in spreading of health information and misinformation, and similar to Hampton and Wellman (2018) acknowledge that social media is here to stay. As a major source of information, social media platforms will influence decision making for generations to come (WHO, 2019). We have seen this in relation to vaccine uptake during the COVID-19 pandemic, the discouragement of risky behaviours, such as tobacco use to prevent chronic disease, and the encouragement of healthy behaviours, such as physical activity, to improve mental health outcomes. The influence of social media is not limited to individual behaviours, its reach extends to influence government and policy as well. The overall health of communities can be affected either positively or negatively as a consequence of online information and misinformation. Health promotion practice can use social media platforms as an instrument for effective evidence-informed health education and the promotion of health-giving behaviours (Gabarron et al., 2021). It, like social media platforms, must also adapt and evolve to ensure online interventions continue to be effective, equitable and just. Evidence informed online health promotion programs, aimed at creating supportive environments, strengthening community action and developing personal skills, have the power to refute misinformation found online and improve the health of individuals and communities overall.
The five action areas of health promotion, as determined in the Ottawa Charter, are to build health public policy, create supportive environments, strengthen community action, develop personal skills and reorient health services (World Health Organization, 1986b). These action areas are as applicable today as they were in 1986, as are the strategies used to implement them; to enable, mediate and advocate. The advancement of internet, smart phones, social media platforms and online communities offer an opportunity for health promotion programs, based on the 5 action areas, to extend their reach and effectiveness (Abroms et al., 2019). Social media platforms can enhance the sense of community, with no limits to distance, no necessity to conform, no control of traditional hierarchy and an increased awareness and diversity (Hampton & Wellman, 2018). In fact, global connectivity is at an unprecedented level due to the ongoing advancements in technology and social media use (Conrad et al., 2020). Leveraging these advancements has positive implications for health promotion practice with a purpose of enabling and empowering individuals, communities and whole populations to increase control over and improve their health (Conrad et al., 2020; WHO, 1986a). However, despite the growing evidence that supports the potential of digital communication, there is limited discussion and integration about how this potential can be capitalized on to improve public health (Abroms et al., 2019). By embracing digital health communication methods, both the private and public health sectors can integrate traditional methods of health promotion practice with social media and technology to obtain maximum reach, improve cross-sector co-ordination, create solutions for what are complicated health issues, and to challenge misinformation found online (Abroms et al., 2019; Conrad et al., 2020). Analysis of social media platforms and online communities in relation to the COVID-19 pandemic and infodemic provide some insight as to how health promotion practice can evolve and improve through the use of technology.
The internet and online social media platforms are regularly the first sources accessed by the public to find health information or answer health-related questions, however the health disinformation found online is prolific and a possible detriment to public health overall (Abroms et al., 2019; Stellefson et al., 2020). Considering the billions of people who use social media, it’s broad reach, and the pace of which information can spread, is it not surprising that these platforms were a major source of COVID-19 information. More than a quarter, equating to over 62 million views, of the most watched COVID-19 related videos on YouTube, consisted of misinformation and were misleading (Cuello-Garcia et al., 2020). Unconfirmed sources and incorrect posts on social media platforms included information about case numbers, lockdowns, untested treatments or remedies, and vaccine risk, all of which had significant impacts on public anxiety and health outcomes (Mheidly & Fares, 2020). The response to health misinformation needs to be rapid and wide to be effective and involve disseminating evidence informed and reliable information (Mheidly & Fares, 2020). Evidence informed interventions are not new to health promotion and in fact form a solid foundation to its practice. Used in conjunction with social media and other online platforms, health promotion practice can make a substantial contribution to improving health awareness and literacy, influencing healthy behaviours and disputing misinformation (Mheidly & Fares, 2020). This was particularly the case when designing health promotion programs, aimed towards at risk groups, during COVID-19.
Impacts on health during the COVID-19 pandemic also extended to other health conditions, such as poor mental health, as a result of lockdowns and social isolation (Tsai et al., 2021). People with an at-risk mental state are more prone to mental health issues, making them more vulnerable during the COVID-19 pandemic where normal support channels were not readily available, and lack of contact with family and friends had enormous impacts (Tsai et al., 2021). Health misinformation, easily found and rapidly spread, on social media throughout the pandemic was also a contributing factor to poor mental health (Cuello-Garcia et al., 2020). Health promotion has long been recognised as an effective strategy for mental health improvement and symptom management, however, as the essential nature of community evolves and new online networks open up, there is a need for successful health promotion programs to adapt suitability to an online format (Tsai et al., 2021). Previous studies that have effectively prevented or treated depression, anxiety and social phobia were explored by Tsai et al. (2021) who then implemented their own similar study to evaluate their effectiveness during the COVID-19 pandemic. The online methods used included videos, social media interaction, including online counselling, and wearable fitness trackers (Tsai et al., 2021). They found that the online version of the original program was equally effective in increasing physical and mental health in at-risk young people and, in addition to that, converting the program to an online format increased accessibility, which is particularly important when barriers such as the COVID-19 pandemic exist (Tsai et al., 2021). The program provided an alternative online supportive environment and promoted the development of particular personal skills shown to be effective in the prevention of poor mental health outcomes. This includes encouraging and enabling physical activity which is shown to play an important role in prevention of not only poor mental health outcomes but many other chronic health conditions, including the prevention and treatment of diabetes.
Diabetes is a serious and chronic disease, the prevalence of which is increasing significantly around the world, that can lead to severe health difficulties and premature death (Gabarron et al., 2018). Risk factors include tobacco use, an unhealthy diet, too much alcohol consumption and as previously mentioned physical inactivity (Gabarron et al., 2018). By addressing these risk factors, through effective prevention actions and health promotion programs, the quality of life of individuals can be stabilized and the risk of premature death reduced (Gabarron et al., 2018). This then has a flow on effect for families, communities and whole populations and is where health promotion programs can have a significant impact by addressing the social determinants of health, help to develop personal skills and create supportive environments. Where in the past information may be collected via focus groups, community meetings, surveys or interviews, in a recent study Gabarron et al.(2018) established preferences and interests of diabetic social media users using an online questionnaire posted to Facebook, Twitter and Instagram. This method enabled them to reach and engage with participants quickly and suggests there is potential for increased patient engagement and satisfaction with health promotion interventions (Gabarron et al., 2018). A follow up study enabled them to determine that social media platforms, and specific health dedicated social media communities, are effective channels for health education and the promotion of physical activity amongst people with diabetes. They also displayed the importance of having a thorough understanding of the best options for online engagement and communication, to ensure that the important health and lifestyle related behaviour messaging is reaching the relevant communities (Gabarron et al., 2021). This is particularly important and relevant for health promotion practice to provide the relevant care and support, dispute misinformation, and subsequently lead to successful interventions and healthier and more supportive online communities. An online community with evidence-informed knowledge, enhanced health literacy and an understanding of the social determinants of health can increase control over, and improve their health.
The Cancer Council is a health promoting organisation successfully using online social media platforms and online communities to create supportive environments, address misinformation and advocate for changes in policy that impact health. Evidence shows that the rapidly increasing consumption of processed foods is a factor that can lead to an increased risk of non-communicable diseases, including cancer (Fiolet et al., 2018). It is well known that a healthy childhood is the basis for a healthy future overall and that the opposite is also true. Research completed by the Cancer Council of Victoria (2022) show that children are exposed to at least 25 food and drink advertisements daily and that 62% of food advertisements located around schools in Melbourne indorse unhealthy food and drink. It is based on this evidence that they have launched the Food Fight campaign. The campaign is shared on multiple social media platforms encouraging people to upload images of advertising in their local areas, directing them to the Cancer Council website and encouraging them to sign a partition; all to encourage local governments to implement restrictions on unprocessed food advertising, as has already occurred in cities like New York and London. Health promotion strategies that garnish the support of online communities can increase their effectiveness and address the social determinants of health that are so instrumental to better health outcomes.
The amount of health misinformation found on social media platforms and within online communities is not surprisingly of great concern and can have a negative impact on health outcomes for some communities. However, these platforms also provide health promotion practice with great opportunities to dispel the misinformation and spread alternative evidence informed information, gaining increased reach compared to some traditional health promotion methods. The five action areas of health promotion are all easily adaptable for use on online platforms and with online communities. Evidence shows their effectiveness does not reduce, and in actual fact the additional benefits of accessibility can improve their success overall. The positive and promising outcomes discussed in this paper can provide health promotion practitioners with motivation and incentive to further explore the use of social media and online communities in improving population health overall and to continue to evolve with technology.
Social media and online communities provide opportunities for health promotion practice
References
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Hey Gen, what a great read! This was so informative and well-written; I found myself nodding in agreeance with every point. It’s a bit of a double-edged sword in that paradoxically, the same features of social media that give it the potential to be impactful in a positive way (accessibility, reach etc.), are also the key weapons for serious damage when used in the wrong way. Whilst I think that in a world that has been dominated for so long by the privileged (wealthy, white, cisgender, able-bodied etc.), it’s amazing that social media is so inclusive and has given a voice to more marginalised groups and those who wouldn’t usually be heard; everyone has a platform. Unfortunately, I think this is also the very issue that everyone has a platform, whether they deserve one or not. In a digital world where anyone can speak on quite literally anything, I wonder if you think that there is more misinformation circulating than there is regulated and genuine facts; it definitely feels that way at times. If this is the case, do you think we’ll ever get to a point where there are enough real experts online to drown out the fake? And how are we to decipher between the two and combat those who do spread misinformation? Misinformation in terms of fashion recommendations and gaming tactics are harmless but in this context when it comes to the physical and mental health of users, do you think there should be legal ramifications for those not abiding by the moral guidelines of social media?
Thank you Amber! I’m glad you enjoyed it. Will one profession, or even the board area of public health overall, ever be able to balance out all the health misinformation found online? No, I personally don’t think so. But I think part of the challenge is that social media is not a comfortable or familiar space for a lot of medical and health professionals to operate or communicate in. And understandably they already have a lot on their plate! But this is where I hope we’ll see some change and growth in the future. The convenience, accessibility and reach can’t be ignored and as we see younger health professionals, who have grown up using social media platforms, graduate into the field, I think/hope we’ll see a lot more evidence informed information online that is easily accessible to the masses.
This unit is not an optional unit offered as part of my BSc Health Promotion degree. However, I decided to seek it out as I thought I could really benefit from it. I wonder if we’ll see it become part of the core units for Health Sciences degrees in future. In the context of our discussion, I think it’s probably really important that it is. What do you think?
Great questions Amber! I think the integration of medical professionals into some of these online support groups as either a mediator or an advocate could help dispel misinformation from some platforms. In my paper I discuss this proposition, I’d love to hear your thoughts! https://networkconference.netstudies.org/2022/csm/1430/unrealistic-views-and-expectations-of-motherhood-are-being-portrayed-by-motherhood-bloggers-on-instagram/#comment-1652
Hi Gen, I really enjoyed reading your paper. I can’t help but agree with all the points you put forward. I agree that social media is a vital platform to help minorities gain recognition. I also believe that social media was critical for staying connected during pandemic induced isolation. But I also believe that it has a negative side. Although social media was helpful for younger generations to cope with isolation, I believe that it left out older generations, as they don’t have access or don’t understand how the online space works. However, it may be a good thing, like online scams, older generations are more likely to be influenced and targeted by misinformation. But I do agree that social media gives the wrong people a platform. Would a law-bound code of online conduct help prevent the spread of misinformation? maybe a stronger system needs to be put in place to censor non-credited information rather than just a fact-checked tag, as people still believe false information even when it has a fact-checked tag.
Hi Sienna
You are absolutely correct, and I didn’t touch on the negative aspects of misinformation too much in my paper as my focus was more on health promotion practice in general. But technology has advanced so much in recent years that it must be very hard for older generations to catch up or keep up – I know my mum refuses to get a smart phone! But keeping her offline does protect her to a certain extent, and she can be ruthless with the landline phone scammers! 😉
As I mentioned in my response to Diana I think Governments, while we need their intervention, can’t do it alone, the technology is moving too fast for them to keep up. Another challenge is once things become social norms then it is harder to take steps back, as we saw recently with the Australian Government wanting to charge media outlets for posting on social media platforms where they had been freely operating for many years previously.
And now we have Elon Musk owning Twitter, whilst I respect and admire what he’s achieved, I’m concerned as he is a know advocate for free speech, regardless of the content or truth… And he is a very clever man too.
Hi Gen
This was a really enjoyable read, well-researched and well-written – thank you! It was interesting to note your mention of YouTube and the spread of misinformation regarding unsafe health practices. My paper also dealt with misinformation on YouTube, specifically anti-progressive political views. It never ceases to amaze me that YouTube doesn’t consistently remove this kind of content, when it can actually result in harm. I firmly believe that YouTube and other social media platforms need to do more to prune this type of content off their site. As Sienna suggested, governments can do more to legislate against the spread of misinformation and penalise platforms who don’t conform to the rules.
As a Type 1 diabetic, I completely agree with your statements regarding how online forums have assisted diabetics to live with their disease more successfully, both by providing information and a sense of community. It can be a lonely disease, and the help and camaraderie I’ve found online has got me through some tough times. Thanks for bringing it up, and well done!
Hi Diana
Thank you so much for sharing your personal experience. I’m so glad that what I wrote resonated with you. From the papers I have read in this conference so far, TikTok, like YouTube, also seems to be a law unto itself when it comes to allowing misinformation to be posted and shared on its platform. And now the news of Elon Musk purchasing Twitter! He is a well-known advocate for free speech so it will be interesting if we will see more changes there too – reversing some of the restrictions and guidelines that were in place, and maybe the return of Donald Trump to the platform….
Yes, I agree it needs a combined push from governments and the social media platforms themselves to police misinformation. The issue I see with government intervention is that they are consistently a step (or two, or three) behind the technology. If we consider social media platforms as the modern day newspapers, where it was the newspaper editorial teams who were responsible for the content in their publication, is it too simple to say the same should apply of social media platforms???
Ps; I’ll have a look for your paper too, it sounds interesting!
Hi Diana,
I related a lot with your comment, I found that online communities were the only place I could find a sense of belonging and educate myself on my condition. The online support groups I’ve been a part of have improved my treatments, and understanding of the condition, and absolutely helped me through hard times.
I do hope you give my paper a read, as I’d love to hear what someone who can relate to the experience: https://networkconference.netstudies.org/2022/csm/843/a-challenge-of-knowledge-power-and-gender-equality-endometriosis-online-support-communities/#comment-1601
Hello Gen,
Interesting paper thank you, it covered a lot of important topics and was well researched. I do find as your paper states a tremendous amount of information regarding health advice on my social medias. It becomes difficult to dispel misinformation at times and we really must be diligent and cautious with what information we absorb into are lives. What are your thoughts on the prevention of misinformation, through your research were there any effected methods found to do this?
Hi Harry
Thanks for reading and I appreciate the feedback. My paper was written from quite a different perspective from most in the conference, in that Health Promotion generally focuses on a community, or target group, rather than an individual, in order to change attitudes and behaviours within that group, to improve health outcomes. I think this approach overall helps to dispute misinformation as it’s a more controlled environment (even online) with program moderators able to answer questions, dispute misinformation and provide supporting evidence to the target group. Obviously it doesn’t have a huge impact in a short period of time, but evidence does show that if attitudes and behaviours can be changed, through education, communication and support services, then changes are more likely to be long-term. As opposed to an approach that targets individuals in a less focused way.
It has been interesting during Covid, that some have become armchair epidemiologists – thinking they understand and know best, whilst for others there is a new appreciation for science and a heightened awareness of the need for evidence to inform decisions and actions. Hopefully this desire and need for evidence is what will help to dispute health misinformation. What do you think? Could it make the difference, or is it causing an even greater divide?
Look forward to hearing your thoughts too. Gen
Hi Gen,
I thoroughly enjoyed your paper! I totally agree that online communities improve health outcomes, and in my paper I advocate for the integration of medical professionals into these platforms. Both for dispelling medical misinformation, but also as a tool for medical professionals to gain a greater understanding of how the conditions can affect patients both physically and emotionally, and how their treatments and their side effects interact with patients on an everyday basis.
I’d love to hear your thoughts on my paper, I investigate Endometriosis support groups on Facebook, and their significant impact on people’s health and overall wellbeing: https://networkconference.netstudies.org/2022/csm/843/a-challenge-of-knowledge-power-and-gender-equality-endometriosis-online-support-communities/#comment-1601
Hi Taylah
Thanks for your considerable contributions and yes, the more we can encourage trained and experienced health professionals onto online platforms the better! I believe social media platforms are now a vital tool to both inform and implement future health promotion programs, particularly those targeting youth. Combined with other media campaigns to build awareness and increase health literacy I really believe we can make a difference, whether it be one community at a time, or in some instances for whole populations. I’m happy to hear that you found a positive and supportive online space when faced with your own health challenges and I hope that continues to be the case.
I’ll definitely give your paper a read.
Best, Gen
Hi Genevieve,
I really enjoyed reading your paper and I think it flowed well. You showed some good examples and it makes the pessimist in me feel a bit less stressed about the abundance of health misinformation online. I’ve never heard of the Ottawa Charter before. If they haven’t done already, they should remodel that charter to make a version that is specific to social media. As you’ve mentioned, the internet and social media platforms are often the first source of information for people so there is opportunity to do more about health messaging in the social media space. In your opinion, how can health authorities most effectively use social media to reach their intended audiences? I believe that health information should only come from confirmed government or health authorities and everything else blocked or flagged that it is not confirmed health information. What do you think?
Cheers
Chantal
Hi Chantal
Thanks for reading and I’m glad I was able to help you feel a little more positively about health information online. You can find some history regarding the Ottawa Charter here https://www.who.int/publications/i/item/ottawa-charter-for-health-promotion
It really is still extremely relevant today and forms the foundation for health promotion practice. It acts as a guide and is open to interpretation and adaptions to suit the particular space (online or not) or community the program is focused on. Health promotion strategies include education, communication, policy & legislation, advocacy, environmental and technological – so you can see how all of these can be adapted for online use. Implementing a mixture of strategies is important to get the best outcomes.
In answer to your question, I think a targeted approach requires thorough research and needs to be evidence informed. It’s important to identify a target group (intended audience) and gain an understanding of their attitudes and values, along with any barriers that prevent healthy behaviours or encourage risky behaviours. Only then can goals and objectives be decided and focused strategies be implemented. In terms of putting outright blocks on who can and can’t provide health information online, I don’t think it’s as simple as that. Take for example Donald Trump and the health advice he gave regarding covid during his presidency – that’s not government advice any reputable health authority would have wanted spread. It’s very complex, who would we determine as “health authorities” and what would we determine as “health related advice”. For example a local sporting club promoting physical activity is a great advocate for healthy and active lifestyles, but a corporation promoting a diet powder, maybe not so much. How would we differentiate from the two in terms of health information if we were to take a black and white approach?
So complex!
Best, Gen
Hi Gen,
Thanks for the link! I’ll check it out. Yes I agree that an evidence informed approach is the best way to go ahead. As much as I would prefer to silence the misinformation spreaders straight up, I also understand that it is a grey area and that’s why the battle against misinformation is difficult. I guess moving forward, different approaches to combatting misinformation and also increasing health promotion are a bit of trial and error.
Cheers
Chantal
Hi Genevieve,
I enjoyed reading your paper. I agree that social media platforms have given minority groups a floor to voice and share their problems. We have seen how crucial the role of social media was in assisting people in communicating and staying up-to-date with news during the lockdown caused by the covid-19 pandemic. But on the other hand, it does have its negative side; on these platforms, It is difficult sometimes to decipher what is true or not. Especially when it comes to fake news, we have seen and heard how fake news is easily spread on social media, especially during the pandemic, giving fake news on prevention or the nature of the virus itself.
You can read my paper below on how social media helped in creating terror and panic duriong the covid-19 pandemic:
https://networkconference.netstudies.org/2022/csm/374/social-media-helped-in-creating-terror-and-panic-during-the-covid-19-pandemic-in-mauritius/
Thank you.
Hi Nadarajan
Thank you for reading. There was so much misinformation about Covid-19, conspiracy theories and vaccinations online, I agree. The implementation of fact check tags on some social media platforms, like Twitter and Facebook, during this time certainly helped to address some of this. I think we should be optimistic, particularly here in Australia, that in the end the majority of people did understand the true nature of covid, the risks it presented to our individual health as well as the health of our communities, and the need to get vaccinated. We are one of the most vaccinated countries in the world now and can live relatively freely, which shows the misinformation did not win! We should be very proud of ourselves.
Best, Gen
Hi Gen,
Great paper. Very thought-provoking. I never put much thought into how social media can work in unison with health promotion processes. Another point that you made that I liked was the power that minorities have on social media nowadays. Very true and great paper.
Thanks Luke – happy to hear your feedback and glad my paper resonated with you. I hope you’ve enjoyed the conference.
Best, Gen