Background: Behavior change is essential in adopting healthy behaviors. Although several social media (SM) platforms such as Facebook, Myspace, Twitter, etc., are available to share information and to promote health behaviors, how are they used in and health promotion? What specific online platform is used in supporting the health promotion of adopting health behaviors in general? By this, it can be understood what SM platform can be used to change the behavior of some African American mothers’ infant safe sleep practices to prevent the risk of Sleep Related Infant Death. Objective: To explore the literature for the identification of specific social media platform(s) that is/are helpful in changing the behavior of the general population. Methods: PubMed, EBSCOhost, and Google Scholar search engines were utilized to find articles that supported changes in health behavior following social media use, were published between 2010 to 2021, had free access, outlined interventions, and reported media marketing impacts, health promotion, as well as documented improvements in health behaviors. Findings: The findings of this literature review revealed that among all social media platforms such as Facebook, Twitter, YouTube, LinkedIn, and Myspace were utilized to obtain health information on various health topics including breastfeeding vaccinations, drug/alcohol use, physical activity, and more, Facebook was found to be the most utilized social media platform. Overall, women were the primary participants. However, no study has been done on changing the behavior of the African American mothers via social media platforms for adopting infant safe sleep practices. Conclusion and Recommendations: Although the literature has shown that Facebook was most utilized to improved behavioral health outcomes of various health topics, it did not describe how interventions led to improved behavioral health outcomes. Further research can be performed to identify how social media platforms influence health behaviors by measuring behavioral outcomes qualitatively and quantitatively. This result can be utilized to change the behavior of the African American mothers’ for adopting infant safe sleep practices.
Sleep-Related Infant Deaths (SRID) are the leading cause of death of infants between 1 month and 12 months of life. In 2017, SUID deaths among infants (1-year-old) accounted for about 3,600 deaths annually in the United States, where 1,400 deaths were due to SIDS, 1,300 deaths were due to unknown cause, and 900 deaths due to accidental suffocation and strangulation in bed 1. Literature shows that if the safe sleep practices recommended by the American Academy of Pediatrics (AAP) are followed, SRID can be reduced. Although a review of infant safe sleep interventions reported that while various interventions including education in various forms are valuable and effective in reducing SUID death rates 2, some African American (AA) mothers remain reluctant to adopt infant safe sleep recommendations. Adopting safe sleep recommendations by mothers and caretakers is challenging, since doing so requires acquiring a new set of intentional behaviors.
In this COVID-19 Pandemic, educating mothers in-person on infant safe sleep practices is a big challenge. To help reduce the number of sleep related death among infants, there is the question of how AAP messages can be disseminated on a large scale to all mothers and caretakers. As COVID pandemic stress impacts human behavior, fostering practice changes with respect to SRID under the guidance of public health experts and through use of social media is timely and indicated.
Social media online platforms, such as Facebook and Twitter, are promising instruments that could improve population health 3. In 2012, the World Health Organization (WHO) launched the global eHealth strategy to encourage the promotion, development, and evaluation of actions that involve these platforms 4, 5. Social media can bolster user participation, optimize health systems, be an interactive space for science dissemination, support health policies, and promote healthy behaviors 3.
Interestingly, more than 263 million people in developed countries use the internet, with more than one billion computers estimated worldwide by 2008 5. With the advancement of cell phones, smartphones are nearly as capable as a computer. According to Pew Internet and American Life Project (2006), 75% of Americans use the internet, and 57% have home access 6, 7. Because of the broad reach of the internet, researchers have been designing online interventions to promote changes in health behavior 7, 8. Online interventions have demonstrated positive health outcomes for behaviors such as physical activity and tobacco cessation 9, 10, 11, 12, 13, 14. As Social media use continues to grow daily and more platforms (i.e., Facebook, Twitter, Tik Tok) are developed, social media has become easier for its users to find health information and obtain beneficial education. Among all social media platforms, Auxier and Anderson from Pew Research Center (2021) quoted YouTube and Facebook, as these platforms continue to dominate the online landscape, with 81% and 69%, respectively. As a comparison, about half of Hispanic (52%) and Black Americans (49%) report using Instagram, compared to smaller percentages of White Americans (35%) who report the same. Hispanic Americans (46%) are far more likely to report using WhatsApp than African American (23%), with White Americans (16%) 15, 16.
Although reports of positive behavior change have been noted after users visited one to several named social media platforms, unreported is which specific platform bears evidence of best influencing mothers who have infants for their adoption of safe sleep practices to reduce the risk of SRID. As there is no such scholarly reporting to date, this study aimed to search for evidence from the peer-reviewed pool of literature on specific social media platforms that will be effective among AA mothers of infants, such that they would learn and commit to safe sleep they would learn and commit to safe sleep practices for their infants.
In furthering this discussion, social media platforms can also reach large audiences. For example: one individual can share a message or provide a link to resources that reach millions of people internationally. This mechanism of dissemination can be implemented to increase caretakers’ understanding of infant safe sleep recommendations, allowing them to become more intentional and goal-directed in adopting safe sleep practices. Simeon et al. (2020) revealed that social media features influenced the positive behavior change. The American Academy of Pediatrics (AAP) acknowledged the powerful influence of media and advertisements on safe sleep which can shape people's beliefs, attitudes, and behaviors in the 2016 update to safe sleep recommendations and called for media and advertising to adhere to safe sleep guidelines 18.
A literature search was conducted using EBSCOhost, Google Scholar, ScienceDirect and ResearchGate search engines to find articles related to documented changes in SRID safe-sleep behavioral practices after users visited social media platforms. Search terms included combinations of social media, social media marketing, health communication, health campaign, health behavior change, parents, sleep-related infant death, SIDS, and intervention. These terms yielded a total of 23,300 articles from all search engines. Articles were included as they met the following criteria: published between 2010 to 2021, had free access, described its’ online intervention, reported social media usage, included its’ health promotion, and reported changes in health behaviors. Given this, 23,200 articles were excluded for not having met the inclusion criteria. Initial screening of titles and abstracts of articles were completed by the research team to determine eligibility. This resulted in 29 articles remaining. Seventeen articles were included in this review after removing the duplicates. Figure 1 provides a breakdown of the initial search strategy to the final selection of articles included in this review. Table 1 provides the demographic information for each article included in this review.
Table 2 describes what social media platform was used and its measured behavior change.
3.1. Study CharacteristicsMost of the included studies collected data within the United States. Five studies did not specify a location 19, 20, 23, 33, 34. The states specifically mentioned where data was collected were California 22, 26, Florida 21, Indiana 30, Massachusetts 33, Pennsylvania 35, Rhode Island 28, Washington 23, Washington, DC 35, and Texas 25. Some studies specified regions in the United States 29 including the Midwest 27, and a southern state 31.
When identified, participants were primarily female. In general, mothers and female participants were studied most. When examining race, Swindle reported on the most racially diverse sample (2014). Other studies focused primarily on one race specifically. Participants ranged in age from 16-74. The most studied group was “low-income”. Education levels reported that most participants had at least a high school education.
There were seven different types of research designs identified. All studies reviewed social media usage. Three studies utilized social media-based interventions 21, 22, 24, three used descriptive cross-sectional 23, 26, 32, one used exploratory 31, four used surveys 22, 31, 34, 35, four used qualitative 26, 27, 28, 33 designs, and four conducted post-content analyses 19, 20, 25, 35 to investigate health behavior and social media.
3.2. OutcomesThree studies had statistically significant data related to social media usage and behavior.
Evaluations by Fernandez et al. (2019) found that social media campaigns are helpful in improving awareness of HIV prevention services for college students. Nabi and colleagues (2019) found that when looking at emotion at p<.05 hope, rp(369) = 0.13, p=.01, and inspired, rp(365) = 0.12, p=.02. were statistically significant regarding a video about skin cancer prevention on social media. Participants who saw the video that featured sad personal stories (M = 0.37, SD = 0.48) F(1, 364) = 4.85, p = .028, η2 = 0.013, were more likely to share the video. Fiks and colleagues (2017) found that a Facebook peer group had a positive impact on feeding behaviors for infants in families at high risk for obesity.
The average number of Facebook posts according to the state health department (SHD) was 76.4 (median = 72.5), ranging from 34 (South Carolina) to 133 (Delaware) 33. The average number of categories (of health messages) covered per SHD was 30 (median = 31), with a range from 12 (Massachusetts) to 42 (North Dakota) 33. The SHD covered topics such as adolescent health, cancer prevention, chronic diseases, communicable diseases, drugs (including prescription) and alcohol emergency preparedness and response, environmental health, geriatric health, health insurance, healthy living, infant and child health, injury, and violence, mental health, miscellaneous, pet health advisory, reproductive health, smoking and tobacco use, vaccines and immunization, and women’s health 33.
The platform most reported was Facebook with 14 studies 20, 25, 28, 35. Twitter followed Facebook with 3 studies 28, 31, 35, and YouTube - 2 studies 28, 32. LinkedIn and Myspace were mentioned in one study 35.
Social media research included a variety of health behaviors. They included adult nutrition, pregnancy nutrition, baby development, breastfeeding, swaddling, gas relief for babies, physical activity, vaccination, smoking, road traffic accidents, drugs, and alcohol use, and care for a baby (i.e. change diaper, holding, and soothing a fussy baby) 28, 33.
Studies that involved social media and health behavior investigated topics concerning parents’ concerns and needs regarding their child’s health 34, 35, parental support systems 34, 35, identification of demographic differences in technology use and interest in receiving health information 28, 32, as well as use of social media 31.
Many parents sought social media to get information. About 81% of parents in Mitchell (2014) used social media, primarily Facebook, to get information concerning their child’s health. Facebook’s parenting groups and pages were also utilized for information 31. Participants used social media to get information on health issues, recommendations on health-related issues, and care for a baby 28. Regarding the perspective of fathers, Kim (2016) identified reasons why fathers used social media. Fathers used social media to seek information, express paternal concerns, help with emotional management, identify what makes a strong father figure, and gather a locus of control.
In addition to an educational resource, social media was used to obtain social and emotional support. Participants reported using Facebook to follow maternal and child health organizations and to connect with family and friends for social and emotional support 28.
Despite that social media can provide reliable health-related education, there are parents that do not trust Facebook for pregnancy and child health information 32. These parents only trust the information from their healthcare provider (e.g., doctor, nurse, WIC nutritionist) 32. Additionally, female participants mentioned the need to use other resources such as family members and the internet as another source of credible information versus social media.
Sleep-related infant deaths are the leading cause of death in infants less than twelve months of age. Literature shows that if the safe sleep practices recommended by the American Academy of Pediatrics (AAP) are followed, SRID can be reduced. Although a review on infant safe sleep interventions reported that while various interventions, including education, of various formats are valuable and effective in reducing SUID death rates 2, some African American mothers remain reluctant to adopt infant safe sleep recommendations. Adopting safe sleep recommendations by mothers and caretakers can be a challenge, since doing so requires being intentional about following prescribed behaviors.
Use of social media could have a favorable impact on increasing adopting prescribed infant safety behaviors, since its use continues to grow daily. Online interventions reported positive health outcomes for behaviors such as physical activity and tobacco cessation [9-14] 9.
However, SRID-related findings from our review of literature revealed that social media has not brought about behavioral changes relative to safe-sleep practices in infants. The only successful platforms that have been investigated to assess the relationship between social media use and SRID is Facebook. However, SRID behavior-related benefits were not clear or convincing.
Current research reports, however, that online health interventions can lead to improved behavioral health outcomes 9, 13 and social media platforms have been found to be a cost-effective way to disseminate health-related information 21.
Accordingly, Facebook was found to be the most utilized social media platform, being referenced in 14 of the 17 of the articles reviewed. The majority of the individuals connecting with social media platforms to access health information were female, which supports the ongoing conversation about males (men) who are reportedly not as personally engaged in their healthcare and general well-being.
Results also show that the behaviors most closely associated with social media research include adult - and pregnancy nutrition, general infant care/child development, breastfeeding, vaccinations, physical activity, smoking, drug/alcohol use, and road/traffic accidents.
Parents were found to be major stakeholders in accessing social media platforms, specifically Facebook, to research topics relating to health information 28, 30, 31, 32, 33, 35 and information pertaining to parental concerns and needs with respect to child health. Parents were also found to join Facebook parenting support groups, seek social and emotional support 28, 29, 31, 33, 35, and use the platform to stay connected with family and friends. In contrast to these findings, there were 47 pregnant Hispanic women in 32 that did not trust Facebook for pregnancy or child health information.
It is suggested that the results of this study be regarded within the context of review-based limitations. This study maximized the literature review search to four databases. Based on the inclusion criteria, articles utilized were obtained by free access, leaving only 17 articles to be reviewed. Additionally, articles included were published between 2010 to 2021, limiting the authors’ ability to provide the reader with a mental image of how social media’s impact on health behavior change has transitioned from the year 2000 to this present day. Different social media platforms existed in the earlier 2000s and exploring their impact on health behavior changes, if any, are worth further research and reviews.
Social media has become an integral part of the public health community. The use of social media instruments to disseminate health messages and health research has significantly grown over the past decade, specifically with Facebook, Twitter, and YouTube 36. Increasingly, social media platforms have become effective tools to promote engagement, disseminate key health messages to various populations and increase access to reliable sources of health research and respected health authorities.
Social media platforms have given rise to commercial applications that offer new and sometimes radical approaches and strategies for using social media for improved health 37.
The findings of this literature review revealed that people utilized social media platforms such as Facebook, Twitter, YouTube, LinkedIn, and Myspace to obtain health information and advice, seek emotional support, engage in discussion around different health topics, and daily living practices.
Although several social media (SM) platforms such as Facebook, Myspace, Twitter, etc., are available to share information related to health promotional ideas, Facebook is used mostly in general, but how effectively it is used, is still a question? Also, this literature review did not illustrate or describe how online health interventions implemented lead to improved SRID behavioral health outcomes or changes Future study can be performed to determine the effectiveness of Facebook usage and adoption of infant safe sleep practices among AA mothers in prevention of Sleep Related Infant Death.
Funding: Maryland Department of Health by BPO/PO: M00B9400330.
Many thanks to Ms. Colleen Wilburn, MPA; Director of MCH Division of MDOH for past and present support of Morgan State's SRID Research Team. Many thanks to Aundrea Collins1, MPH and Uzma Binte Haidary1 for their review and edits of the manuscript.
The authors have no competing interests.
AA - African American
AAP - American Academy of Pediatrics
SIDS - Sudden Infant Death Syndrome
SRID - Sleep-Related Infant Deaths
SUID - Sudden Unexpected Infant Death
SM - Social Media
WIC - Women, Infants, And Children
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Published with license by Science and Education Publishing, Copyright © 2022 David Thomas, Margaret Alston, Malliga Jambulingam, Ariel Hunt and Yvonne Bronner
This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit
https://creativecommons.org/licenses/by/4.0/
| [1] | Centers for Disease Control and Prevention, “Sudden unexpected infant death and sudden infant death syndrome”, Data and statistics, 2020. https://www.cdc.gov/sids/data.htm [Accessed August 2, 2020]. | ||
| In article | |||
| [2] | Jambulingam, M., Hunt, A., Alston, M., Thomas, D. and Bronner, Y., “Infant safe sleep interventions in African American communities”, American Journal of Public Health Research, 8(5). 2020. | ||
| In article | View Article | ||
| [3] | Centers for Disease Control and Prevention, “An overview of social media use in the field of public health nutrition: Benefits, scope, limitations, and a latin american experience”, Preventing Chronic Disease, 17, August 2020. [Online] Available: https://www.cdc.gov/pcd/issues/2020/20_0047.htm. [Accessed August 2, 2020]. | ||
| In article | View Article PubMed | ||
| [4] | World Health Organization [WHO]. “Health promotion”, n.d. [Online] Available: https://www.who.int/westernpacific/about/how-we-work/programmes/health-promotion. [Accessed August 12, 2020]. | ||
| In article | |||
| [5] | Organization for Economic Co-Operation and Development [OECD], “OECD communications outlook 2007”, 2007. [Online]. Available: https://213.253.134.43/oecd/pdfs/browseit/9307021E.pdf. [Accessed July 12, 2020]. | ||
| In article | |||
| [6] | Pew Internet and American Life Project, “Internet penetration and impact”, 2006. [Online] Available: https://www.pewinternet.org/pdfs/PIP_Internet_Impact.pdf [Accessed June 27, 2020]. | ||
| In article | |||
| [7] | Internet World Stats, “Internet growth statistics”, 2021. [Online] Available: https://www.internetworldstats.com/emarketing.htm. [Accessed July 12, 2020]. | ||
| In article | |||
| [8] | Murray, E., Khadjesari, Z., White, I.R., Kalaitzaki, E., Godfrey, C., McCambridge, J., et al., “Methodological challenges in online trials”, J Med Internet Res, 11(2). E9. April 2009. | ||
| In article | View Article PubMed | ||
| [9] | Portnoy, D.B., Scott-Sheldon, L.A.J., Johnson, B.T., and Carey, M.P., “Computer-delivered interventions for health promotion and behavioral risk reduction: A meta-analysis of 75 randomized controlled trials, 1988-2007”, Preventive Medicine, 47(1). 3-16. 2008. | ||
| In article | View Article PubMed | ||
| [10] | Shahab, L., and McEwen, A., “Online support for smoking cessation: a systematic review of the literature”, Addiction, 104(11). 1792-1804. 2009. | ||
| In article | View Article PubMed | ||
| [11] | Vandelanotte, C., Spathonis, K.M., Eakin, E.G., and Owen, N., “Website-delivered physical activity interventions a review of the literature”, Am J Prev Med, 33(1). 54-64. 2007. | ||
| In article | View Article PubMed | ||
| [12] | Walters, S.T., Wright, J.A., and Shegog, R., “A review of computer and Internet-based interventions for smoking behavior”, Addict Behav, 31(2). 264-277. 2006. | ||
| In article | View Article PubMed | ||
| [13] | Webb, T.L., Joseph, J., Yardley, L., and Michie, S., “Using the internet to promote health behavior change: a systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy”, Journal of Medical Internet Research, 12(1). e4. 2010. | ||
| In article | View Article PubMed | ||
| [14] | Wantland, D.J., Portillo, C.J., Holzemer, W.L., Slaughter, R., and McGhee, E.M., “The effectiveness of web-based vs. non-web-based interventions: a meta-analysis of behavioral change outcomes”, J Med Internet Res, 6(4). e40. 2004. | ||
| In article | View Article PubMed | ||
| [15] | Auxier, B., and Anderson, M., “Social media use in 2021”, Pew Research Center, 1-19. April 2021. | ||
| In article | |||
| [16] | Pretorius, K., Johnson, K.E., and Rew, L., “An integrative review: Understanding parental use of social media to influence infant and child health”, Maternal and Child Health Journal, 23(10). 1360-1370. 2019. | ||
| In article | View Article PubMed | ||
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