Yousef Albalawi, Health Promotion Research Centre, National University of Ireland Galway, University Road, Galway, , Ireland, Phone: 353 83 1232203, Fax: 353 91 494577, Email: moc.liamg@iwalabla.y .
1 Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
2 Public Health Administration, Ministry of Health, Medina, Saudi Arabia
Find articles by Yousef Albalawi1 Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
Find articles by Jane Sixsmith Corresponding author. # Contributed equally. Corresponding Author: Yousef Albalawi moc.liamg@iwalabla.y Received 2015 Aug 10; Revisions requested 2015 Sep 2; Revised 2015 Sep 20; Accepted 2015 Oct 17.Copyright ©Yousef Albalawi, Jane Sixsmith. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 25.11.2015.
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Examples of intervention tweets and tweets by other users that mention the keywords road traffic accident (Arabic texts).
The foundation of best practice in health promotion is a robust theoretical base that informs design, implementation, and evaluation of interventions that promote the public’s health. This study provides a novel contribution to health promotion through the adaptation of the agenda-setting approach in response to the contribution of social media. This exploration and proposed adaptation is derived from a study that examined the effectiveness of Twitter in influencing agenda setting among users in relation to road traffic accidents in Saudi Arabia.
The proposed adaptations to the agenda-setting model to be explored reflect two levels of engagement: agenda setting within the social media sphere and the position of social media within classic agenda setting. This exploratory research aims to assess the veracity of the proposed adaptations on the basis of the hypotheses developed to test these two levels of engagement.
To validate the hypotheses, we collected and analyzed data from two primary sources: Twitter activities and Saudi national newspapers. Keyword mentions served as indicators of agenda promotion; for Twitter, interactions were used to measure the process of agenda setting within the platform. The Twitter final dataset comprised 59,046 tweets and 38,066 users who contributed by tweeting, replying, or retweeting. Variables were collected for each tweet and user. In addition, 518 keyword mentions were recorded from six popular Saudi national newspapers.
The results showed significant ratification of the study hypotheses at both levels of engagement that framed the proposed adaptions. The results indicate that social media facilitates the contribution of individuals in influencing agendas (individual users accounted for 76.29%, 67.79%, and 96.16% of retweet impressions, total impressions, and amplification multipliers, respectively), a component missing from traditional constructions of agenda-setting models. The influence of organizations on agenda setting is also highlighted (in the data of user interactions, organizational accounts registered 17% and 14.74% as source and target of interactions, respectively). In addition, 13 striking similarities showed the relationship between newspapers and Twitter on the mentions trends line.
The effective use of social media platforms in health promotion intervention programs requires new strategies that consider the limitations of traditional communication channels. Conducting research is vital to establishing a strong basis for modifying, designing, and developing new health promotion strategies and approaches.
Keywords: agenda setting, health promotion, social media, Twitter, health communication, Saudi Arabia, road traffic accidents
Communication is a core component of many effective health promotion interventions and change processes at individual and community levels [1]. In the social media age, the emergence of eHealth communication is expected to significantly enhance the efficacy of health promotion programs. The evolution of social media stimulated a shift of the communication equation from a top-down, expert-to-consumer approach to a nonhierarchical, dialog-based strategy. Consequently, communication has become an individual and community enabler in terms of achieving development goals, including health development [2]. Korda [3] indicated that an important characteristic of Web-based interventions is the sense of empowerment that it endows people and groups as they make decisions related to health; this feature is a positive influence on communities and individuals who are actively aiming for healthy behaviors and lifestyle changes. With these considerations in mind, we investigated the use of the agenda-setting function of health promotion interventions in the social media era. Specifically, we examined the effectiveness of Twitter as a social media platform in influencing agenda setting among users in relation to road traffic accidents in Saudi Arabia.
Globally, road traffic accidents result in 1.24 million deaths and 20 to 50 million injuries per year, many of which cause permanent disabilities [4]. In Saudi Arabia, the 544,000 yearly accidents cause 7153 fatalities and more than 39,000 injuries [5]. Eighty-one percent of deaths in Ministry of Health hospitals are the result of road traffic accidents [6]. The World Health Organization recommendations emphasize the consideration of road safety as a public health issue [7], with a focus on persuading policy and decision makers to place road traffic accidents on their agendas as a major problem and implement measures for improving related interventions.
Maximizing the effectiveness of social media for the promotion and protection of health necessitates intervention programs based on a thorough scientific understanding of how communication and media action theories and models are prioritized [8,9]. Agenda-setting theory has been examined within the sphere of social media and shows promise for the promotion of effective health practices [10,11,12].
According to Kaplan and Haenlein, social media is “a group of Internet-based applications that build on the ideological and technological foundations of Web 2.0, and that allow the creation and exchange of User Generated Content” [13]. This definition covers many types of social media including Twitter, Facebook, and Instagram. These platforms have powerful characteristics which make them effective channels for communication-based activities. An interesting development in recent years is the significant increase in the availability of social media; this growth is expected to continue [14].
The development of social media has been recognized as an opportunity for the promotion of the public’s health demonstrated through the concept of infodemiology, a term coined by Eysenbach [15]. Infodemiology is the melding of health informatics and epidemiology and has been defined as “the science of distribution and determinants of information in an electronic medium, specifically the Internet, or in a population, with the ultimate aim to inform public health and public policy” [16,17].
Infodemiology is based on the idea that the vast quantities of communication data generated by social media can be used for public health [16]. We live in a digital world where people communicate using Internet channels supported by highly advanced technologies. These communication channels are characterized by an ability to track activities and collect information and data about them. For example, social media platforms generate data that reflect people’s behaviors and record, in real time, large parts of their daily life, including their health status [16,18]. When suitable metrics and measures are applied, these data can provide valuable information that can inform policies, strategies, and decisions for public health at the level of policy makers and of the population [17].
These data provide a new level of information that was not measurable before this era [17]. Currently, only a small proportion will be analyzed (in 2013, only 5% of these data were analyzed [19]) due to a lack of methods and measures for collecting, analyzing, and interpreting such data [16,17,20]. Nevertheless, infodemiology advances our understanding and provides methods that can move public health to a new level of practice and research [16,17]. Applications of infodemiology can harmonize the research and practice of public health through the analysis of so-called “big data” in the era of social media [16,17]. Examples of infodemiology applications include tracking user activities on microblogging platforms such as Twitter [16]. This study explores user activities on Twitter in relation to public health and as such can be positioned in the context of infodemiology.
Twitter is “an information network made up of 140-character messages called Tweets” [21]. It is a social and microblogging service that enables participants to post messages and follow others’ posts. Outside China, 53% of the Internet population has Twitter accounts, and 69% of online adults browse Twitter [22]. The 2015 statistics for Saudi Arabia show that in a population of 28 million, more than 18 million are Internet users [23], 60% of whom have Twitter accounts and 33% of Internet users are active Twitter users [22]. Apart from being among the top-ranked countries in terms of registered users, Saudi Arabia is number one globally in terms of visitation rates (logged-out users) [22].
Lippman [24] first expressed the idea of agenda setting, which was subsequently developed by Lasswell [25] and Cohen [26], culminating in agenda-setting theory through the work of McCombs and Shaw [27]. The core concept of agenda setting assumes that media stimulates the awareness of people regarding certain issues. This assumption is grounded on two main principles: (1) media shapes and filters reality before presenting it to people and (2) these channels determine the priority with which individuals regard salient issues [28]. Rogers and Dearing [29] proposed an agenda-setting model that comprises three components: media agenda, public agenda, and policy agenda. Each of these agendas represents issues that are the chief concerns of a particular stakeholder. The interrelationship among these components forms the core of agenda-setting theory [30]. Figure 1 shows the process of agenda setting among the three main components according to Rogers and Dearing’s model [29].