Key messages
Programmes on social media (such as Facebook or Twitter) that aim to increase physical activity may help people to become more physically active and may improve people's well-being.
Future studies are needed to find out if there are any unwanted effects associated with taking part in interactive social media programmes.
What is social media?
Social media are computer-based technologies that help people to share ideas, thoughts and information by building virtual networks and communities on the Internet; examples include, Facebook, Twitter or WhatsApp. Social media networks are 'interactive': the user communicates directly with a computer, or other device, to share and receive information.
What did we want to find out?
People who use social media can exchange ideas and share updates about their behaviours, such as becoming more active or eating more healthily. We wanted to find out if health programmes using interactive social media could change people's behaviours and improve their health.
What did we do?
We searched for studies that tested the effects of interactive social media programmes on people's health. We were interested in how the programmes might affect people's:
- health behaviours (such as smoking, drinking alcohol, breastfeeding, dieting, physical activity; seeking and using health services);
- health (such as physical fitness, lung function, asthma episodes);
- mental health (such as measures of depression, stress, coping);
- well-being; and
- whether people reported any unwanted effects related to interactive social media programmes.
How up to date is this review?
We included evidence published up to 1 June 2020.
What did we find?
We found 88 studies involving 871,378 adults (aged 18 years and older). Most studies (49) took place in the USA; all studies took place in either high-income countries or upper middle-income countries. Facebook was the most commonly used social media platform; others included WeChat, Twitter, WhatsApp and Google Hangouts.
In most studies the effects of interactive social media programmes were compared against non-interactive programmes, including paper-based or in-person programmes, or no programme. Ten studies compared two social media programmes against each another; for these studies we chose the more interactive of the two programmes as the 'interactive social media programme'.
What are the main results of our review?
Compared with non-interactive programmes, social media programmes:
- may improve some health behaviours, such as increasing the number of daily steps taken, or taking part in screening tests, but may show little to no effect on other health behaviours, such as better diet or reducing tobacco use (evidence from 54 studies in 20,139 people).
- may cause small improvements in health, such as a small increase in amount of weight lost, and a small reduction in resting heart rate (evidence from 30 studies in 4521 people).
- may improve people's well-being (evidence from 16 studies in 3792 people).
- may have little to no effect on people's mental health, such as depression (evidence from 12 studies in 2070 people).
No studies reported any unwanted effects related to using social media.
What are the limitations of the evidence?
Overall, our confidence in the evidence is low. Many studies did not report clearly how they were conducted. In most studies, people knew whether they were taking part in an interactive programme, and this may have affected the results of the study. Some of the studies did not report all their results, and there were wide variations in the results of some studies. Further research is likely to increase our confidence in the evidence.
This review combined data for a variety of outcomes and found that social media interventions that aim to increase physical activity may be effective and social media interventions may improve well-being. While we assessed many other outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of our included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase our understanding of the potential effect of these interventions on reducing health inequities.
Social networking platforms offer a wide reach for public health interventions allowing communication with broad audiences using tools that are generally free and straightforward to use and may be combined with other components, such as public health policies. We define interactive social media as activities, practices, or behaviours among communities of people who have gathered online to interactively share information, knowledge, and opinions.
We aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects.
Our secondary objective was to assess the effects of these interventions on the health of populations who experience health inequity as defined by PROGRESS-Plus. We assessed whether there is evidence about PROGRESS-Plus populations being included in studies and whether results are analysed across any of these characteristics.
We searched CENTRAL, CINAHL, Embase, MEDLINE (including trial registries) and PsycINFO. We used Google, Web of Science, and relevant web sites to identify additional studies and searched reference lists of included studies. We searched for published and unpublished studies from 2001 until June 1, 2020. We did not limit results by language.
We included randomised controlled trials (RCTs), controlled before-and-after (CBAs) and interrupted time series studies (ITSs). We included studies in which the intervention website, app, or social media platform described a goal of changing a health behaviour, or included a behaviour change technique. The social media intervention had to be delivered to adults via a commonly-used social media platform or one that mimicked a commonly-used platform. We included studies comparing an interactive social media intervention alone or as a component of a multi-component intervention with either a non-interactive social media control or an active but less-interactive social media comparator (e.g. a moderated versus an unmoderated discussion group).
Our main outcomes were health behaviours (e.g. physical activity), body function outcomes (e.g. blood glucose), psychological health outcomes (e.g. depression), well-being, and adverse events. Our secondary outcomes were process outcomes important for behaviour change and included knowledge, attitudes, intention and motivation, perceived susceptibility, self-efficacy, and social support.
We used a pre-tested data extraction form and collected data independently, in duplicate. Because we aimed to assess broad outcomes, we extracted only one outcome per main and secondary outcome categories prioritised by those that were the primary outcome as reported by the study authors, used in a sample size calculation, and patient-important.
We included 88 studies (871,378 participants), of which 84 were RCTs, three were CBAs and one was an ITS. The majority of the studies were conducted in the USA (54%). In total, 86% were conducted in high-income countries and the remaining 14% in upper middle-income countries. The most commonly used social media platform was Facebook (39%) with few studies utilising other platforms such as WeChat, Twitter, WhatsApp, and Google Hangouts. Many studies (48%) used web-based communities or apps that mimic functions of these well-known social media platforms.
We compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. We only reported the RCT results in our 'Summary of findings' table. We found a range of effects on health behaviours, such as breastfeeding, condom use, diet quality, medication adherence, medical screening and testing, physical activity, tobacco use, and vaccination. For example, these interventions may increase physical activity and medical screening tests but there was little to no effect for other health behaviours, such as improved diet or reduced tobacco use (20,139 participants in 54 RCTs). For body function outcomes, interactive social media interventions may result in small but important positive effects, such as a small but important positive effect on weight loss and a small but important reduction in resting heart rate (4521 participants in 30 RCTs). Interactive social media may improve overall well-being (standardised mean difference (SMD) 0.46, 95% confidence interval (CI) 0.14 to 0.79, moderate effect, low-certainty evidence) demonstrated by an increase of 3.77 points on a general well-being scale (from 1.15 to 6.48 points higher) where scores range from 14 to 70 (3792 participants in 16 studies). We found no difference in effect on psychological outcomes (depression and distress) representing a difference of 0.1 points on a standard scale in which scores range from 0 to 63 points (SMD -0.01, 95% CI -0.14 to 0.12, low-certainty evidence, 2070 participants in 12 RCTs).
We also compared studies assessing interactive social media interventions with those with an active but less interactive social media control (11 studies). Four RCTs (1523 participants) that reported on physical activity found an improvement demonstrated by an increase of 28 minutes of moderate-to-vigorous physical activity per week (from 10 to 47 minutes more, SMD 0.35, 95% CI 0.12 to 0.59, small effect, very low-certainty evidence). Two studies found little to no difference in well-being for those in the intervention and control groups (SMD 0.02, 95% CI -0.08 to 0.13, small effect, low-certainty evidence), demonstrated by a mean change of 0.4 points on a scale with a range of 0 to 100.
Adverse events related to the social media component of the interventions, such as privacy issues, were not reported in any of our included studies.
We were unable to conduct planned subgroup analyses related to health equity as only four studies reported relevant data.