title: Representation of health conditions on Facebook: content analysis and evaluation of user engagement.
abstract: BACKGROUND
  A sizable majority of adult Internet users report looking for health information online. Social networking sites (SNS) like Facebook represent a common place to seek information, but very little is known about the representation and use of health content on SNS.
  
  
  OBJECTIVE
  Our goal in this study was to understand the role of SNS in health information seeking. More specifically, we aimed to describe how health conditions are represented on Facebook Pages and how users interact with these different conditions.
  
  
  METHODS
  We used Google Insights to identify the 20 most searched for health conditions on Google and then searched each of the resulting terms on Facebook. We compiled a list of the first 50 Facebook "Pages" results for each health condition. After filtering results to identify pages relevant to our research, we categorized pages into one of seven categories based on the page's primary purpose. We then measured user engagement by evaluating the number of "Likes" for different conditions and types of pages.
  
  
  RESULTS
  The search returned 50 pages for 18 of the health conditions, but only 48 pages were found for "anemia" and 5 pages were found for "flu symptoms", yielding a total of 953 pages. A large number of pages (29.4%, 280/953) were irrelevant to the health condition searched. Of the 673 relevant pages, 151 were not in English or originated outside the United States, leaving 522 pages to be coded for content. The most common type of page was marketing/promotion (32.2%, 168/522) followed by information/awareness (20.7%, 108/522), Wikipedia-type pages (15.5%, 81/522), patient support (9.4%, 49/522), and general support (3.6%, 19/522). Health conditions varied greatly by the primary page type. All health conditions had some marketing/promotion pages and this made up 76% (29/38) of pages on acquired immunodeficiency syndrome (AIDS). The largest percentage of general support pages were cancer (19%, 6/32) and stomach (16%, 4/25). For patient support, stroke (67%, 4/6), lupus (33%, 10/30), breast cancer (19%, 6/31), arthritis (16%, 6/36), and diabetes (16%, 6/37) ranked the highest. Six health conditions were not represented by any type of support pages (ie, human papillomavirus, diarrhea, flu symptoms, pneumonia, spine, human immunodeficiency virus). Marketing/promotion pages accounted for 46.73% (10,371,169/22,191,633) of all Likes, followed by support pages (40.66%, 9,023,234/22,191,633). Cancer and breast cancer accounted for 86.90% (19,284,066/22,191,633) of all page Likes.
  
  
  CONCLUSIONS
  This research represents the first attempts to comprehensively describe publicly available health content and user engagement with health conditions on Facebook pages. Public health interventions using Facebook will need to be designed to ensure relevant information is easy to find and with an understanding that stigma associated with some health conditions may limit the users' engagement with Facebook pages. This line of research merits further investigation as Facebook and other SNS continue to evolve over the coming years.
authors.affiliation: Center for Connected Health, Partners HealthCare, Inc, Harvard Medical School, Boston, MA, United States. tmhale@mgh.harvard.edu.
authors.forename: Timothy M
authors.identifier: http://orcid.org/0000-0002-4228-465X
authors.initials: TM
authors.lastname: Hale
authors.forename: Akhilesh S
authors.identifier: http://orcid.org/0000-0003-2367-4174
authors.initials: AS
authors.lastname: Pathipati
authors.forename: Shiyi
authors.identifier: http://orcid.org/0000-0002-6496-8534
authors.initials: S
authors.lastname: Zan
authors.forename: Kamal
authors.identifier: http://orcid.org/0000-0002-0122-8002
authors.initials: K
authors.lastname: Jethwani
mesh_terms: D000328:Adult; D000329:Advertising / Q000706:statistics & numerical data; D015706:Bibliometrics; D054626:Consumer Health Information / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D057226:Information Seeking Behavior; D061108:Social Media / Q000706:statistics & numerical data*; D060756:Social Networking
keywords: Facebook; Internet; health communication; information seeking behavior; social media; social networking sites; social support
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