Can social media be used to create sustainable changes in health behavior?
A UCLA study published Sept. 3 in the peer-reviewed journal Annals of Internal Medicine demonstrates that an approach that combines behavioral science with social media and online communities can lead to improved health behaviors among men at risk of HIV infection.
The evidence-based approach not only led to increased HIV testing and encouraged significant behavioral change among high-risk groups but also proved to be one of the best HIV-prevention and testing approaches on the Internet, according to the study's lead investigator, Sean D. Young, an assistant professor of family medicine and director of innovation at the Center for Behavior and Addiction Medicine at the David Geffen School of Medicine at UCLA.
And it's not only applicable to HIV prevention efforts, he noted.
"We found similar effects for general health and well-being," said Young, who is also a member of the UCLA AIDS Institute. "Because our approach combines behavioral psychology with social technologies, these methods might be used to change health behaviors across a variety of diseases."
In an earlier study, published in February and also led by Young, researchers found that social media could be useful in HIV- and STD-prevention efforts by increasing conversations about HIV prevention.
For the current study, the researchers recruited 112 men who have sex with men through banner ads placed on social networking sites like Facebook, through a Facebook fan page with study information, through banner ads and posts on Craigslist, and from venues such as bars, schools, gyms and community organizations in Los Angeles. Of the participants, 60 percent were African-American, 28 percent were Latino, 11 percent were white and 2 percent were Asian-American.
The men were randomly assigned to one of two Facebook discussion groups — an HIV intervention group or a general health group (with the latter serving as a control in the study). Each participant was then randomly assigned to two "peer leaders" within their group. The peer leaders communicated with participants by sending messages, chats and wall posts.
In addition to general conversation, peer leaders for the HIV group discussed HIV prevention and testing, while those in the control group communicated about the importance of exercising, eating right and maintaining a low-stress lifestyle.
While the men were under no obligation to engage with the peer leaders or other participants or to even remain members of their respective Facebook groups, the authors found that the participants were highly engaged and maintained active participation during the 12-week study.
Throughout the study, the men were able to request and receive home-based HIV self-testing kits. At baseline and again after 12 weeks, participants completed a 92-item survey that included questions about their Internet and social media use (including whether they discussed health and sexual risk behaviors), their general health behaviors (including exercise and nutrition), and their sex and sexual health behaviors (including HIV testing and treatment).
Among other things, the researchers looked for evidence of behavioral change — such as reductions in the number of sexual partners — and requests for home-based HIV test kits, along with follow-ups to obtain test results.
Among the findings:
- 95 percent of the intervention group participants voluntarily communicated on Facebook, as did 73 percent of the controls.
- 44 percent (25 of 57) of the members of the intervention group requested the testing kits, compared with 20 percent (11 of 55) of the controls.
- Nine of the 57 intervention group participants took the test and mailed back the test kits to receive their results, compared with two of the 55 control group members, suggesting a greater likelihood that the approach can successfully lead one to take an HIV test.
- The intervention group members chatted and sent personal messages with much higher frequency than did the control group members.
- African-American and Latino men who have sex with men, who are at higher risk for becoming infected with HIV compared with the rest of the population, find social networks to be an acceptable platform for HIV prevention.
- African-Americans and Latinos also find home-based tests to be an acceptable HIV testing method.
In addition, the authors found that retention at follow-up was more than 93 percent, in contrast to the high dropout rates from other Internet-based HIV-prevention interventions.
"Internet HIV-prevention interventions and mobile health applications have had very high dropout rates and problems getting people engaged, and this effect is even more pronounced among high-risk groups such as minority populations and men who have sex with men," Young said. "However, our approach appeared to overcome these issues and led to changed behavior."
The researchers noted some limitations to the study, among them the fact that they used only two Facebook communities per condition; these methods should be tested with more people before implementing them, they said. In addition, no best practices regarding the use of social networking for HIV communication have been established.
The next step will be to assess how this method might generalize to other populations, diseases, and prevention efforts, Young said.
"We have created a potential paradigm for health behavior change using new social technologies," he said. "We are beginning to explore this approach in other areas."
Study co-authors were William G. Cumberland, Sung-Jae Lee, Devan Jaganath, Greg Szekeres and Thomas Coates, all of UCLA.The UCLA Department of Family Medicine provides comprehensive primary care to entire families from newborns to seniors. It provides low risk obstetrical services and prenatal and inpatient care at UCLA Medical Center Santa Monica, and outpatient care at the UCLA Family Health Center in Santa Monica and the Mid-Valley Family Health Center, which is located in a Los Angeles County Health Center in Van Nuys, Calif. The department is also a leader in family medicine education, for both medical students and residents, and houses a significant research unit focusing on health care disparities among immigrant families and minority communities and other underserved populations in Los Angeles and California.
Grants from the National Institute of Mental Health (K01 MH090884), the UCLA Center for HIV Identification, Prevention and Treatment Services (CHIPTS) and the UCLA AIDS Institute funded this study.
The Center for HIV Identification, Prevention, and Treatment Services (CHIPTS) is a collaboration involving researchers from UCLA, Charles Drew University of Medicine and Science, the Friends Research Institute, the RAND Corp. and the broader Los Angeles community. It aims to enhance the collective understanding of HIV research and to promote early detection, effective prevention and treatment programs for HIV. Funded by the National Institute of Mental Health, CHIPTS serves as a bridge among researchers, the government, service providers and people with HIV in responding to changes in the HIV epidemic and in shaping sound public policy. This is accomplished through a range of services, including consultation on the development of new research projects and assistance with obtaining funds for these initiatives. CHIPTS provides technical assistance in HIV program development and evaluation and sponsors an annual conference for researchers to present their work. In addition, the center hosts an annual policy forum for researchers, government officials and the HIV community to discuss emerging HIV policy issues and hosts a research colloquia series.
The UCLA AIDS Institute and Center for AIDS Research is a multidisciplinary group of top-flight researchers united in the worldwide fight against HIV/AIDS, the first cases of which were reported in 1981 by UCLA physicians. Institute members include researchers in virology and immunology, genetics, cancer, neurology, ophthalmology, epidemiology, social science, public health, nursing and disease prevention. Their findings have led to advances in preventing and treating HIV as well as other diseases such as hepatitis B and C, influenza, TB and cancer. To find out about ways to support these efforts, please contact Laura Pescatore ([email protected]).