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Recent studies suggest social media may be an attractive strategy to promote mental health and wellness. There remains a need to examine the utility for individually tailored wellness messages posted to social media sites such as Facebook to facilitate positive psychological outcomes.
Our aim was to extend the growing body of evidence supporting the potential for social media to enhance mental health. We evaluated the influence of an 8-week social media intervention on anxiety in college students and examined the impact of dynamic (active) versus static (passive) Facebook content on physical activity behaviors.
Participants in the static group (n=21) accessed a Facebook page featuring 96 statuses. Statuses were intended to engage cognitive processes followed by behavioral processes of change per the transtheoretical model of behavior change. Content posted on the static Facebook page was identical to the dynamic page; however, the static group viewed all 96 statuses on the first day of the study, while the dynamic group received only 1 to 2 of these status updates per day throughout the intervention. Anxiety was measured using the Overall Anxiety Severity and Impairment Scale (OASIS). Time spent engaging in physical activity was assessed using the International Physical Activity Questionnaire (IPAQ).
The OASIS change score for the dynamic Facebook group was statistically significant (
We observed a decrease in anxiety and increase in total physical activity for the dynamic group only. Dynamic social networking sites, featuring regularly updated content, may be more advantageous than websites that retain static content over time.
ClinicalTrials.gov NCT03363737; https://clinicaltrials.gov/ct2/show/NCT03363737 (Archived by WebCite at http://www.webcitation.org/6vXzNbOWJ)
Verduyn and colleagues [
Although mHealth is less investigated than traditional, face-to-face therapeutic interventions, emerging work has begun to evaluate the effectiveness of online-based mHealth interventions [
Collectively, recent studies have demonstrated social media may be an attractive strategy to promote mental health and wellness. Social media champions a robust individual social presence, as well as mass interactivity, which may contribute to user satisfaction and subjective well-being [
Firth et al [
Undergraduate and graduate students (N=39; n=21 for static arm and n=18 for dynamic arm; see
Study design schematic.
This pilot study was approved by the institutional review board at the University of Mississippi. Participants randomly allocated to join the static Facebook page (n=21) were exposed to a page that already contained 96 status updates targeting the precontemplation, contemplation, preparation, action, and maintenance phases of the transtheoretical model. The statuses progressed through general information tailored to participants’ community and university resources for healthy eating, stress and time management, physical activity benefits, and tips to implement positive lifestyle changes. Statuses were intended to offer participants awareness and specific tools necessary to engage cognitive processes of change (ie, consciousness raising, dramatic relief, self-evaluation, environmental evaluation, and social liberation) followed by behavioral processes of change (helping relationships, self-liberation, reinforcement, stimulus control, and counterconditioning) throughout the 8-week intervention period. Posts on the static Facebook page consisted of identical content as the dynamic group. The only distinction was that the static group received access to all 96 statuses on the first day of the study, while the dynamic group was exposed to 1 to 2 of these status updates per day across the 8-week intervention period.
Participants randomly allocated to join the dynamic Facebook page (n=18) were exposed to 2 status updates per weekday and 1 status update per weekend day for 7 weeks (96 status updates). During the final week, participants did not receive daily notifications to read status updates but were encouraged to complete online follow-up surveys. No incentives were provided to participants upon completion of this study.
The primary outcomes assessed were changes in physical activity behavior and anxiety, measured via self-report. After meeting inclusionary criteria, which included having an active Facebook account, daily access to a mobile phone, and a current University of Mississippi email account, eligible participants were sent a Facebook invitation to join either the static or dynamic Facebook group. Time spent engaging in vigorous, moderate, and walking physical activity habits was assessed using the International Physical Activity Questionnaire (IPAQ), which has demonstrated adequate reliability and validity [
Anxiety was measured using the Overall Anxiety Severity and Impairment Scale (OASIS), a 5-item psychometric instrument completed via self-reported response on a 5-point Likert scale. A sample question from the OASIS is “How much does anxiety or fear interfere with your social life and relationships?” Higher ratings indicate greater anxiety inference. This scale has been used as a valid and reliable assessment of degree of anxiety impairment in various clinical and subclinical populations [
Stata SE version 12 (StataCorp LLC) was used to conduct paired sample
Demographic information is displayed in
Demographic information.
Variable | Entire sample |
Dynamic group |
Static group |
GPAa, baseline | 3.26 (0.63) | 3.31 (3.01 to 3.62) | 3.05 (2.79 to 3.31) |
GPA, postintervention | 3.55 (0.46) | 3.52 (3.17 to 3.87) | 3.47 (3.14 to 3.81) |
Age, years | 22.65 (3.16) | 21.9 (20.42 to 23.46) | 22.2 (21.22 to 23.18) |
Gender (% female) | 68 | 75 | 81 |
Race (% white) | 66 | 75 | 57 |
Years active on Facebook | 7.97 (2.99) | 7.56 (6.55 to 8.58) | 8.62 (6.98 to 10.25) |
Number of Facebook friends | 1256 (949.92) | 939.93 (558.47 to 1321.4) | 1390.57 (1050.1 to 1731.04) |
Number of logins per day, baseline | 7.72 (6.2) | 6.31 (4.92 to 7.71) | 6.57 (4.32 to 8.82) |
Number of logins per day, postintervention | 4.35 (3.98) | 3.73 (2.36 to 5.09) | 4 (1.7 to 6.3) |
Number of intervention-page logins per day | 1.38 (0.58) | 1.45 (1.12 to 1.79) | 1.43 (0.8 to 2.06) |
Total ambulatory physical activity, minutes per week | 762.8 (1375.54) | (mean change score) 1378.25 |
(mean change score) 59.44 |
aGPA: grade point average.
We used
The dearth of research examining the link between modern media consumption and anxiety is equivocal [
Regarding the main outcomes, we observed a statistically significant decrease in anxiety for the dynamic group only. This finding may be influenced by our adherence to the transtheoretical model of behavior change. All status updates followed a theoretically driven sequence of messages in alignment with the cognitive and behavioral processes of change. Participants in the dynamic group received daily status updates containing accurate and credible health information. A total of 96 wellness messages were posted over 7 weeks with content first focusing on cognitive processes of change (ie, consciousness raising, dramatic relief, self-evaluation, environmental evaluation, and social liberation) followed by behavioral processes of change (helping relationships, self-liberation, reinforcement, stimulus control, and counterconditioning). Participants randomized into the static, or passive, Facebook page received access to all 96 messages on the first day of the intervention with no daily updates occurring thereafter. We hypothesize the potency of the cognitive and behavioral messages was diluted in the static group, providing rationale for the observed reduction in anxiety in the dynamic group alone. We also found a statistically significant inverse correlation between mean total physical activity change and mean change in anxiety. We feel this finding underscores the importance of daily, dynamic exposure to Facebook wellness messages. Physical activity behavior changes are difficult to sustain over time, so perhaps consistent social media notifications were advantageous reminders for participants in the dynamic group to increase total ambulatory movement throughout the 8-week intervention period. Thus, our findings suggest that dynamic social networking sites featuring regularly updated content may be more advantageous than websites that retain static content over time.
Despite the plausibility for social media to be used effectively in physical and mental health research, there are numerous concerns that must be addressed when implementing social networking site interventions. Social media is user-centered, meaning individuals consume and produce content relevant to their unique goals and interests. Thus, efficacious social networking site research must be individually tailored. Lack of tailored content is a possible limitation of this pilot study. Although we observed increased changes in physical activity in the dynamic group, the majority of our recruited participants were exercise science or health promotion students already engaging in physical activity. Such extensive exposure to information specifically targeting initiation of positive health behaviors may have been less impactful in this sample. Cognitive and behavioral processes of change may be more appropriately tailored to individuals contemplating behavior change. Further, the risk of psychological disorders such as depression and anxiety is highest among young adults [
The results of this pilot study suggest reduced anxiety among college students may be associated with exposure to dynamic, or active, Facebook wellness interventions. We propose mHealth interventions be used as self-monitoring aids rather than for mental health diagnoses. That is, mobile phone technologies should not replace face-to-face therapeutic interventions but may be complementary to clinical services. Awareness and management of psychological health status may be improved through social media, which has been suggested to enhance self-efficacy and decrease the functional impairment associated with anxiety, depression, stress, and psychological disturbances [
International Physical Activity Questionnaire
Overall Anxiety Severity and Impairment Scale
None declared.