Using Facebook for health promotion : understanding women's use of Facebook for health-related information, support and motivation

Background: Health promotion interventions can improve health and quality of life. With the ever-increasing presence of social media in people's lives, platforms such as Facebook may be harnessed to disseminate health promotion in a cost-effective and accessible manner. Facebook is well-placed to address socially contagious‚ÄövÑvp health behaviours such as physical activity. However, it is generally assumed that health-related Facebook use is infrequent, even among women, who typically engage more with health information than men. Research is lacking on how to improve engagement with Facebook-based health content. In this thesis we aimed to identify what drives women's health-related use of Facebook. The first two empirical chapters investigated factors predicting female Facebook users' intentions and behaviour of health-related support- or information-seeking on Facebook. The third empirical chapter provides a reflexive thematic analysis of interviews conducted with a separate sample of female Facebook users. Based on these findings, we created the autonomy, relevance, and others (ARO) model and the guidance, microenvironment, autonomy, relevance, and others (G-MARO) framework to describe the process of engaging in health-related Facebook use, its effect on health behaviour, and how health promotion can encourage health-related Facebook use. Study 1 Aim: This study aimed to identify what drives women's health-related Facebook use by applying the theory of planned behaviour (TPB) in predicting intentions to use Facebook to seek either health-related emotional support or health-related information. Methods: A cross-sectional correlational design was used with 159 women (mean age = 27 years). Two hierarchical regressions predicted either intentions to use Facebook to perform health-related support-seeking or information-seeking. Predictors included health concern, health locus of control, and TPB variables. Results: The TPB significantly predicted intentions to use Facebook to seek health-related support or information, explaining variance over and above the other variables in both models. For information-seeking on Facebook, past behaviour, attitudes, and subjective norms were significant predictors. For support-seeking intentions, past behaviour, attitudes, and powerful others locus of control contributed significantly. Discussion: It was concluded that improving attitudes towards health-related Facebook use and increasing perceptions of subjective norms or the role of others, may increase intentions to use Facebook for health-related purposes. Study 2 Aim: Extending on Study 1, Study 2 used a longitudinal design to consider women's selfreported health-seeking on Facebook, rather than their intentions. The study investigated whether health self-efficacy significantly predicted future engagement with Facebook to seek health-related emotional support or information. It also examined how pre-existing depressive symptoms influenced these relationships. Methods: In this longitudinal study, 129 adult female participants (mean age = 26 years) completed online survey measures approximately two weeks apart. Survey measures included health self-efficacy and depressive symptoms (Time 1) and seeking of health-related emotional support and information on Facebook (Time 2). Moderation analyses were conducted with health self-efficacy as the predictor and depressive symptoms as the moderator for both health-related information-seeking and support-seeking. Results: A moderation effect was not identified for health-related emotional support-seeking on Facebook, although a significant negative main effect of health self-efficacy was found. Moderation was indicated for health-related information-seeking on Facebook. The conditional effects showed a significant positive relationship occurred between health selfefficacy and health-related information-seeking on Facebook for individuals with higher levels of depressive symptoms. Discussion: Depressive symptoms and health self-efficacy may be valuable factors to consider when designing Facebook-based health promotion. To encourage informationseeking in those with higher depressive symptoms, health self-efficacy may need to be increased to facilitate engagement. For people lacking health self-efficacy, support-seeking on Facebook is more likely, perhaps due to their greater need. Thus, it may be effective to direct Facebook-based emotional support to persons low in health self-efficacy. Study 3 Aim: This study aimed to examine women's experiences and beliefs about using Facebook for health purposes, especially for increasing their physical activity. Participants were asked to identify the features that encouraged or discouraged their use of Facebook for healthrelated content and how they thought such content could improve their health outcomes. Methods: Semi-structured face-to-face interviews were conducted with 10 women (mean age = 23 years) who self-identified as Facebook users who wanted to increase their physical activity. Reflexive thematic analysis was applied to the data to develop an understanding of these women's use of Facebook to increase physical activity. Results: Several themes were created that describe how use of Facebook may promote physical activity (or health) behaviour, and what features may further encourage use and improve the effectiveness of engagement in changing health behaviour. Discussion: Health-related Facebook use was viewed as influencing physical activity through its ability to facilitate access to information, motivation, and support. Also, Facebook can raise awareness of health topics not already considered or remind people to perform health behaviour. According to our themes, use of Facebook for health may be encouraged, and its effects enhanced, by providing guidance on how to use the platform for health-related purposes, supporting autonomy, ensuring relevance of content is evident, and enabling the role of others. These themes informed the creation of the ARO model and G-MARO framework which describe the process of engaging in health-related Facebook use, its effect on health behaviour, and how use can be encouraged by health promotion materials. Conclusion: Given Facebook is user-directed, understanding what drives health-related use of this platform is important for designing successful health promotion. Based on the synthesised results of our quantitative and qualitative studies we revised our ARO model and G-MARO framework, which demonstrate the process of using Facebook for health, its effect on behaviour, and how health promotion materials can encourage health-related Facebook use and increase its effectiveness in influencing health outcomes. Several factors (e.g., self-efficacy, autonomy) should be considered when trying to increase people's engagement in Facebook-based health promotion initiatives. Future research should assess whether manipulating these factors increases engagement and changes health-related behaviour. This research highlights the need for public guidance on how to engage with Facebook-based health content, perhaps via education campaigns from government or health organisations. Such guidance would be beneficial in normalising online health-seeking behaviour, and in ensuring that benefits are maximised, and risks minimised.