title: The Role of Social Network Technologies in Online Health Promotion: A Narrative Review of Theoretical and Empirical Factors Influencing Intervention Effectiveness.
abstract: BACKGROUND
  Social network technologies have become part of health education and wider health promotion—either by design or happenstance. Social support, peer pressure, and information sharing in online communities may affect health behaviors. If there are positive and sustained effects, then social network technologies could increase the effectiveness and efficiency of many public health campaigns. Social media alone, however, may be insufficient to promote health. Furthermore, there may be unintended and potentially harmful consequences of inaccurate or misleading health information. Given these uncertainties, there is a need to understand and synthesize the evidence base for the use of online social networking as part of health promoting interventions to inform future research and practice.
  
  
  OBJECTIVE
  Our aim was to review the research on the integration of expert-led health promotion interventions with online social networking in order to determine the extent to which the complementary benefits of each are understood and used. We asked, in particular, (1) How is effectiveness being measured and what are the specific problems in effecting health behavior change?, and (2) To what extent is the designated role of social networking grounded in theory?
  
  
  METHODS
  The narrative synthesis approach to literature review was used to analyze the existing evidence. We searched the indexed scientific literature using keywords associated with health promotion and social networking. The papers included were only those making substantial study of both social networking and health promotion—either reporting the results of the intervention or detailing evidence-based plans. General papers about social networking and health were not included.
  
  
  RESULTS
  The search identified 162 potentially relevant documents after review of titles and abstracts. Of these, 42 satisfied the inclusion criteria after full-text review. Six studies described randomized controlled trials (RCTs) evaluating the effectiveness of online social networking within health promotion interventions. Most of the trials investigated the value of a "social networking condition" in general and did not identify specific features that might play a role in effectiveness. Issues about the usability and level of uptake of interventions were more common among pilot studies, while observational studies showed positive evidence about the role of social support. A total of 20 papers showed the use of theory in the design of interventions, but authors evaluated effectiveness in only 10 papers.
  
  
  CONCLUSIONS
  More research is needed in this area to understand the actual effect of social network technologies on health promotion. More RCTs of greater length need to be conducted taking into account contextual factors such as patient characteristics and types of a social network technology. Also, more evidence is needed regarding the actual usability of online social networking and how different interface design elements may help or hinder behavior change and engagement. Moreover, it is crucial to investigate further the effect of theory on the effectiveness of this type of technology for health promotion. Research is needed linking theoretical grounding with observation and analysis of health promotion in online networks.
authors.affiliation: Institute of Population Health, Centre for Health Informatics, University of Manchester, Manchester, United Kingdom. panagiotis.balatsoukas@manchester.ac.uk.
authors.forename: Panos
authors.identifier: http://orcid.org/0000-0002-2454-0816
authors.initials: P
authors.lastname: Balatsoukas
authors.forename: Catriona M
authors.identifier: http://orcid.org/0000-0002-1699-9328
authors.initials: CM
authors.lastname: Kennedy
authors.forename: Iain
authors.identifier: http://orcid.org/0000-0003-3392-1650
authors.initials: I
authors.lastname: Buchan
authors.forename: John
authors.identifier: http://orcid.org/0000-0002-1456-4857
authors.initials: J
authors.lastname: Powell
authors.forename: John
authors.identifier: http://orcid.org/0000-0002-2187-9195
authors.initials: J
authors.lastname: Ainsworth
mesh_terms: D015438:Health Behavior; D006266:Health Education / Q000379:methods; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D033181:Information Dissemination; D020407:Internet; D010379:Peer Group; D061108:Social Media; D060756:Social Networking; D012944:Social Support; D012984:Software; D013672:Technology
keywords: content analysis; health behavior change; health behaviors; health education; health promotion; social media; social networking; social technology; theoretical grounding