title: Agenda Setting for Health Promotion: Exploring an Adapted Model for the Social Media Era.
abstract: BACKGROUND
  The foundation of best practice in health promotion is a robust theoretical base that informs design, implementation, and evaluation of interventions that promote the public's health. This study provides a novel contribution to health promotion through the adaptation of the agenda-setting approach in response to the contribution of social media. This exploration and proposed adaptation is derived from a study that examined the effectiveness of Twitter in influencing agenda setting among users in relation to road traffic accidents in Saudi Arabia.
  
  
  OBJECTIVE
  The proposed adaptations to the agenda-setting model to be explored reflect two levels of engagement: agenda setting within the social media sphere and the position of social media within classic agenda setting. This exploratory research aims to assess the veracity of the proposed adaptations on the basis of the hypotheses developed to test these two levels of engagement.
  
  
  METHODS
  To validate the hypotheses, we collected and analyzed data from two primary sources: Twitter activities and Saudi national newspapers. Keyword mentions served as indicators of agenda promotion; for Twitter, interactions were used to measure the process of agenda setting within the platform. The Twitter final dataset comprised 59,046 tweets and 38,066 users who contributed by tweeting, replying, or retweeting. Variables were collected for each tweet and user. In addition, 518 keyword mentions were recorded from six popular Saudi national newspapers.
  
  
  RESULTS
  The results showed significant ratification of the study hypotheses at both levels of engagement that framed the proposed adaptions. The results indicate that social media facilitates the contribution of individuals in influencing agendas (individual users accounted for 76.29%, 67.79%, and 96.16% of retweet impressions, total impressions, and amplification multipliers, respectively), a component missing from traditional constructions of agenda-setting models. The influence of organizations on agenda setting is also highlighted (in the data of user interactions, organizational accounts registered 17% and 14.74% as source and target of interactions, respectively). In addition, 13 striking similarities showed the relationship between newspapers and Twitter on the mentions trends line.
  
  
  CONCLUSIONS
  The effective use of social media platforms in health promotion intervention programs requires new strategies that consider the limitations of traditional communication channels. Conducting research is vital to establishing a strong basis for modifying, designing, and developing new health promotion strategies and approaches.
authors.affiliation: Health Promotion Research CentreNational University of Ireland GalwayGalwayIreland.|Public Health AdministrationMinistry of HealthMedinaSaudi Arabia.
authors.forename: Yousef
authors.identifier: 0000-0002-4248-3659
authors.initials: Y
authors.lastname: Albalawi
authors.affiliation: Health Promotion Research CentreNational University of Ireland GalwayGalwayIreland.
authors.forename: Jane
authors.identifier: 0000-0002-3212-8186
authors.initials: J
authors.lastname: Sixsmith
keywords: agenda setting, health promotion, social media, Twitter, health communication, Saudi Arabia, road traffic accidents