title: Click "like" to change your behavior: a mixed methods study of college students' exposure to and engagement with Facebook content designed for weight loss.
abstract: BACKGROUND
  Overweight or obesity is prevalent among college students and many gain weight during this time. Traditional face-to-face weight loss interventions have not worked well in this population. Facebook is an attractive tool for delivering weight loss interventions for college students because of its popularity, potential to deliver strategies found in successful weight loss interventions, and ability to support ongoing adaptation of intervention content.
  
  
  OBJECTIVE
  The objective of this study was to describe participant exposure to a Facebook page designed to deliver content to overweight/obese college students in a weight loss randomized controlled trial (N=404) and examine participant engagement with behavior change campaigns for weight loss delivered via Facebook.
  
  
  METHODS
  The basis of the intervention campaign model were 5 self-regulatory techniques: intention formation, action planning, feedback, goal review, and self-monitoring. Participants were encouraged to engage their existing social network to meet their weight loss goals. A health coach moderated the page and modified content based on usage patterns and user feedback. Quantitative analyses were conducted at the Facebook post- and participant-level of analysis. Participant engagement was quantified by Facebook post type (eg, status update) and interaction (eg, like) and stratified by weight loss campaign (sequenced vs nonsequenced). A subset of participants were interviewed to evaluate the presence of passive online engagement or "lurking."
  
  
  RESULTS
  The health coach posted 1816 unique messages to the study's Facebook page over 21 months, averaging 3.45 posts per day (SD 1.96, range 1-13). In all, 72.96% (1325/1816) of the posts were interacted with at least once (eg, liked). Of these, approximately 24.75% (328/1325) had 1-2 interactions, 23.39% (310/1325) had 3-5 interactions, 25.13% (333/1325) had 6-8 interactions, and 41 posts had 20 or more interactions (3.09%, 41/1325). There was significant variability among quantifiable (ie, visible) engagement. Of 199 participants in the final intervention sample, 32 (16.1%) were highly active users and 62 (31.2%) never visibly engaged with the intervention on Facebook. Polls were the most popular type of post followed by photos, with 97.5% (79/81) and 80.3% (386/481) interacted with at least once. Participants visibly engaged less with posts over time (partial r=-.33; P<.001). Approximately 40% of the participants interviewed (12/29, 41%) reported passively engaging with the Facebook posts by reading but not visibly interacting with them.
  
  
  CONCLUSIONS
  Facebook can be used to remotely deliver weight loss intervention content to college students with the help of a health coach who can iteratively tailor content and interact with participants. However, visible engagement with the study's Facebook page was highly variable and declined over time. Whether the level of observed engagement is meaningful in terms of influencing changes in weight behaviors and outcomes will be evaluated at the completion of the overall study.
authors: Center for Wireless and Population Health Systems, The Qualcomm Institute/Calit2, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, United States. gmerchant@ucsd.edu.
authors: Gina
authors: G
authors: Merchant
authors: Nadir
authors: N
authors: Weibel
authors: Kevin
authors: K
authors: Patrick
authors: James H
authors: JH
authors: Fowler
authors: Greg J
authors: GJ
authors: Norman
authors: Anjali
authors: A
authors: Gupta
authors: Christina
authors: C
authors: Servetas
authors: Karen
authors: K
authors: Calfas
authors: Ketaki
authors: K
authors: Raste
authors: Laura
authors: L
authors: Pina
authors: Mike
authors: M
authors: Donohue
authors: William G
authors: WG
authors: Griswold
authors: Simon
authors: S
authors: Marshall
mesh_terms: D000293:Adolescent; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D009765:Obesity / Q000628:therapy; D050177:Overweight / Q000628:therapy*; D061108:Social Media; D060756:Social Networking; D013334:Students; D017216:Telemedicine; D015431:Weight Loss; D055815:Young Adult
keywords: behavior; obesity; overweight; social behavior; social networking; students