#HealthyLifestyle: A Q methodology analysis of why young adults like to use social media to access health information

Abstract

Social media has become an integral part of modern society. Many people now turn to social media platforms to share or gain knowledge about best practices for personal health. This new form of health information dissemination has greatly increased in popularity especially among young adults. Currently, more research is needed to identify why so many individuals choose to turn to social media for health information. Using Q methodology, this study aimed to uncover the attitudes, opinions, and beliefs of young adults who engage with social media as a means of obtaining health and fitness information. Results revealed four primary factors: the Health Connoisseurs, the Health Enthusiasts, the Loyalists, and the Virtual Befrienders. Each group possessed different motivations for accessing health-related content on social media. The insights gained from this study can benefit public health institutions, advertisers, and social media content creators as they disseminate health information on social media platforms.

Keywords

health influencers health information dissemination health literacy media literacy social media uses and gratifications

The role of social media as a tool for disseminating health information has drastically evolved in recent years. The affordances of social media platforms provide an avenue for a variety of sources, including everyday citizens, to become involved in the creation and delivery of health information (Chou et al., 2021). This is occurring at a time when social media platforms are being increasingly confronted for their role in spreading misinformation and disinformation in today’s highly fractured society (Melchior and Oliveira, 2022). Still, health researchers have argued that the heightened utilization of social media for health information has introduced both positive and negative outcomes for users (Moorhead et al., 2013).

As everyday citizens become more reliant on social media as a source for health information, more work is needed to examine the reasons why individuals turn to social media for this information. Applying a uses and gratifications framework, this study seeks to explore some of the primary motivations behind social media use and health information seeking behaviors.

Literature review

Social media is a form of communication which allows its users to display information in an informative and entertaining way. Although the collection of social media platforms may seem similar, each online platform hosts its own unique social context and culture in relation to its audience (Waterloo et al., 2018).

Social presence theory explores immersion in media, particularly on grounds of immediacy, intimacy, and efficiency (Johnson and Hong, 2023). Because social media platforms are developed to create deeply immersive contexts, many businesses, advertisers, and influencers utilize a multitude of affordances on social networking sites to create a more intimate, personal connection between them and their fans or consumers (Leite and Baptista, 2022; Walsh and Carter-Bawa, 2023). These interactive settings allow businesses to dialogically interact with a significant number of followers on a more one-to-one basis while simultaneously allowing those same fans an area where they can interact with each other (Kaplan and Haenlein, 2010).

Educational ventures have leveraged presence on social media and found great benefit in connecting educators with students, including influencers who are teaching skills connected to health, fitness, and nutrition. One such example is how students use Facebook to create an online community that can extend school relations outside the classroom (Kasperski and Blau, 2023). The use of these virtual environments has led researchers to study social presence and telepresence to further understand how they impact an individual’s social media experience and resultant behaviors. Social presence refers to the connection and interaction with other users and influencers within that social network (Dunlap et al., 2016). Telepresence connotes the idea of feeling physically present within a digital, computer-mediated environment (Khalifa and Shen, 2004). A duality of arrival and departure feelings are associated with telepresence; arrival due to the feeling of being in the virtual environment, and departure for feeling out of the physical environment (Khalifa and Shen, 2004). Social presence, on the other hand, involves the user’s ability to project themselves to other users within the medium. Successful social presence allows for a more intimate connection between users whether the interaction is one-way or two-way communication (Khalifa and Shen, 2004).

The internet’s fast expansion, as well as the medium’s benefits over traditional communication formats in terms of flexibility, speed, and reach, make it an obvious choice for research dissemination (Zientek et al., 2018). The communication of health information via technology has become an important way for both researchers and influencers to share knowledge on their experiences with health. Montagni et al. (2019: 105) defines digital health communication as “the creation and use of digital technologies to exchange health messages and data among individuals, organizations, and communities to increase awareness, inform decisions, influence behaviors, and improve outcomes in the health domain.” Moving from science communicators, who are trained in public health and information dissemination, to health influencers on social media platforms like Instagram and TikTok has led people to question if these sources are reliable. Health influencer’s words hold a lot of weight and can significantly impact viewer behavior (Dessart and Duclou, 2019).

History of health information dissemination

Throughout history there existed a passive acceptance and resignation when it came to stopping the spread of diseases or improving health-related quality of life due to a lack of knowledge (Institute of Medicine, 1988). It was not until the 18th century that scientific inquiry and innovation began taking off, which ignited the development of public health organizations and health information dissemination (Institute of Medicine, 1988). As scientific knowledge grew, it became apparent that individuals could prevent certain health conditions through behavior changes. In this era, public perceptions shifted resulting in a common understanding that it is the public’s responsibility to aid in the efforts of disease prevention (Institute of Medicine, 1988). From this time forward, public entities began to raise awareness on topics such as sanitation, immunization, and personal health care (Chave, 1984; Fee, 1987). This led to the creation and evolution of health campaigns and interventions geared toward enhancing personal health, preventing serious illness, and minimizing suffering (Institute of Medicine, 1988).

The health promotion profession seeks to “promote, maintain, and improve individual and community health” (Corttrell et al., 2018: 14) by informing the general populace. Today, health promotion and education professionals work in schools, universities, companies, hospitals, community organizations, and government agencies where they promote healthy lifestyles and disease prevention through onsite education, community classes, and intervention programs as well as through broader-scope tactics like brochures and public service announcements (Corttrell et al., 2018; University of Georgia, 2022). Healthcare organizations have been slow to utilize the power of social media to disseminate relevant health information (Bishop, 2019) and individuals without healthcare backgrounds or accreditation in health promotion and education have filled this void by posting about health on social media.

Social media and health promotion

Social media platforms, such as Facebook, Instagram, and YouTube, provide a place for established health entities and individuals alike to share and interact with users. Social media platforms are far reaching, and their popularity only continues to increase with approximately 302 million social media users in the United States, 58% of which frequent one or more of these platforms daily (Auxier and Anderson, 2021; Dixon, 2022). Social media adds a new dimension to healthcare by providing a channel for the public and health professionals to communicate about health concerns. Many users rely on social media to share or gain knowledge about health, ranging from personal experiences with diseases, diets, medications, exercise routines, treatments, and much more (Chen and Wang, 2021; Cohen et al., 2021; Dizon et al., 2012; Durau et al., 2022; McKeon et al., 2022; Zhou et al., 2018). Numerous virtual communities have also been created on social media specifically focused on a variety of these health-related topics (Bishop, 2019). These statistics suggest that health information is a prevalent topic on social media platforms.

In this study, health information is defined as any social media content that is geared toward health promotion within the realms of fitness, nutrition, wellness, or disease prevention or management. This includes videos or posts about topics such as what foods to eat to lose weight or build muscle, workout routines, or ways to improve health outcomes like decreasing stress, improving sleep, or increasing metabolic function. Additionally, this work treats “social networking sites” or “social media” as a broader term that includes platforms that emphasize the exchange of user-generated content (Pham, 2014). This approach has been used in other studies that have examined the intersection of health information and social media (Chou et al., 2021).

Social media can enable people to improve their health through encouraging the implementation of lifestyle changes (Zhou et al., 2018), but determining if the health information gleaned from social media is accurate can be both challenging and controversial. With the creation and widespread use of the internet came the ability for anyone with access to share information. This has led to the “democratization” of health information online and has resulted in a decreased perception of the credibility of healthcare professionals especially among those who are not health literate (Allmark and Tod, 2006; Turhan et al., 2022; Wu and McCormick, 2018: 1052). Because health information disseminated through social media is largely unregulated it is up to the reader to determine the accuracy of each source. Research has indicated that this can be problematic since readers who are novices concerning health-related topics assume message accuracy based on the likability of the speaker and the length of their message without regard to the use of reliable sources (Todorov et al., 2002). When viewers come across contradictory information, they begin to think that health professionals keep changing their minds about what is healthy even though they are not (Nagler, 2014). With the plethora of voices sharing opinion as fact online it is easy for readers to become frustrated and confused (Rotfeld, 2009).

Social media has become a common source of health information dissemination especially since the COVID-19 pandemic. A great deal of Americans use these platforms as one of their primary news sources to stay informed (Shearer and Mitchell, 2021). The mass spread of misinformation on social media has been shown to significantly impact behavior and makes counter arguments supplied by officials less effective (Cinelli et al., 2020). This can critically influence societal level responses to these kinds of events (Cinelli et al., 2020).

Fake news is ubiquitous on social media, and misinformation has penetrated nearly every subject, including health information (Li et al., 2022). Because of the magnitude of the situation and the pervasiveness of false information, health information experts must assist the general public in identifying fake news (Naeem, 2021). An urgent problem has developed as a rising number of unqualified social media influencers promote false health claims to viewers (Melchior and Oliveira, 2022). For example, many nutrition influencers make money by offering meal plans or nutrition recommendations and amassing large followings, but their guidance is often not based on scientific research and has led to the spread of many pseudo-facts (De Regt et al., 2019). Misinformation is powerful, travels quickly, and may be difficult to remedy (Harff et al., 2022). This multifaceted problem may never be totally resolved but encouraging critical thinking and healthy skepticism about material viewed online, as well as recognizing instances when influencers may have abused their position in the past, may help raise awareness of the issue (Lofft, 2020).

Uses and gratifications

Uses and gratifications research examines the ways in which interactive platforms meet audience goals (Quan-Haase and Young, 2010). Sundar and Limperos (2013: 504) observed that since its inception, uses and gratifications has challenged the assumption of a “passive audience” arguing that “the notion of an active audience has steadily moved from an assumption to obvious reality.” Sundar and Limperos (2013) also assert that new technology offers users new affordances that cultivate new user needs rather than strictly meeting pre-existing needs.

There has been a great deal of research on the uses and gratifications of social media users. Whiting and Williams (2013: 368) identified 10 uses and gratifications of social media use: “social interaction, information seeking, [to] pass time, entertainment, relaxation, communicatory utility, expression of opinions, convenience utility, information sharing, and surveillance.” Later, Quinn (2016: 81) identified nine uses and gratifications of social media use: “affect, companionship, voyeur, information sharing, habit, entertainment, communication, professional use, and escape.” Joinson (2008) identified seven uses and gratifications specific to Facebook use including social investigation, social network surfing, and status updating. While there is some overlap between researchers in the gratifications identified, there is a nearly endless supply of gratifications that can be achieved by social networking users given the rich array of functions available on these platforms. Despite this, more work is needed to understand the specific gratifications sought and obtained by users who engage with social media influencers to improve personal health outcomes. Uncovering some of these specific gratifications could benefit health professionals, as well as social media content creators and advertisers, as they develop content that aims to support reliable health information and challenge health misinformation on social media.

Research question

RQ1: What unique groups of like-minded young adults are evident regarding their personal motivations for using social media as a health information source in the United States?

Methodology

To better understand audience responses to the dissemination of health information on social media, we selected Q methodology. This method was selected because it provides a “foundation for the systematic study of subjectivity” (Brown, 1993: 93) by combining both quantitative (factor analysis) and qualitative (interviewing) methods to uncover “distinctive ways of thinking” (Brown, 1993: 120). The usefulness of Q methodology is in its comparative power in finding similarities and associations between subjects to create categories of behavior (Brown, 1993).

Q methodology involves the use of a research tool called a Q-sort, which requires an individual to rank-order (i.e. “most like me” to “least like me”) a group of statements that represent a particular domain of subjectivity called a concourse (Brown, 1980). For this study, the statements related to the question “Why do young adults like using social media for health and fitness information?” The concourse was made up of real statements based on “ordinary conversation, commentary, and discourse of everyday life” (Brown, 1993: 94), that individuals made when expressing their opinions and motivations to seek out health information online. Because of the wide range of opinions, needs, attitudes, and goals of people who use social media to access health-related information, it was necessary for us to gather statements from a variety of different sources including academic journals, social media posts, focus groups, personal interviews, and magazine articles that focused on health information on social media. From these sources, a total of 68 different statements were collected. Many statements were needed to reduce the chance that important opinions and beliefs, that may be used to direct the research, would be missed (Brown, 1980; Stephenson, 1963).

Once the 68 statements were collected, we evaluated the relevance of each statement to the study’s focus. We removed any duplicate concepts or similar expressions and verified that all perspectives were represented in the chosen statements. The goal of this process was to have a set of statements that was “as comprehensive as possible so as to mirror the range of commentary being voiced in the public” (Brown, 1980: 260). After our assessment, a representative Q sample of 38 statements (see Supplemental Appendix 1) was selected that best described why people use social media for obtaining health-related information.

To ensure that the results of this study came from consumers of health information on social media, potential participants were asked to complete a survey to determine if they qualified for the study. This survey was made available to students in a wide range of college courses at one U.S. university in the western United States. The survey included two questions: (1) Do you follow or subscribe to any page or anyone who frequently posts information about health, fitness, or nutrition? (2) How many times a week do you use social media? Because this study was interested in the opinions of active users of health information, only participants who self-reported that they subscribed or followed sites that provided health information and that they used social media three or more times per week were selected to participate in the study. This minimum qualification has been used as the cut-off amount of social media activity to qualify for participation in other scholarly work on health information and social media (Tankha et al., 2023).

The sample consisted of 39 individuals, 28 female and 11 male, between the ages of 18 and 30. Q methodology uses a small number of participants because in Q technique, subjects are treated as variables rather than a sample of the population. Brown (1980: 192) explained that when selecting respondents, “all that is required is enough subjects to establish the existence of a factor for the purposes of comparing one factor with another.”

The next step was to have the participants conduct their Q-sorts by reading through each of the 38 statements and ranking them on a 9-point scale ranging from “most like me” (+4) to “least like me” (−4). After the Q-sorts were completed, interviews were conducted with the participants to probe further into their decision-making processes to allow them to explain why they ranked some statements high and other statements low, and to let them express their thoughts and feelings about health information on social media. The interviews used a structured questionnaire with the following questions: (1) Why did you select these two statements as being most like you? (2) Why did you select these two statements as being least like you? (3) Is there anything else in this realm of health information and social media that you think is important and would like to share? The average time for each participant to complete each Q-sort and interview was approximately 25 minutes.

After the Q-sort information was gathered, results were tabulated using the PQMethod computer software program, and then the analyses were conducted. To finalize the number of factors, we followed the procedures outlined in Brown (1980). To qualify as a reportable factor, the criterion was at least two significant participant factor loadings at the 0.01 significance level. This significant correlation was calculated from a formula for the standard error of a zero-order loading as stipulated by Brown (1980). Positive and negative z-scores of each statement of ±1.0 were considered significant representing the “most like” and “least like” statements for participants grouped together in factors. Since Q methodology does not require large numbers of subjects (Brown, 1980), we were content to talk about typical patterns of perceptions found among health information followers. When dealing with subjectivity, there are no right or wrong answers, since “there is no outside criteria for a person’s own point-of-view” (Brown, 1980: 4). After the factors were identified, we interpreted the factor results by providing a detailed description of the participants’ attitudes, opinions, and beliefs.

Results

The factors were found by using principal components analysis to generate an unrotated factor matrix followed by a varimax rotation (Robinson et al., 2022). The reportable factors uncovered were verified through a qualitative analysis of interviews from participants in each identified factor. From this process, we discovered four statistically significant factors: the Health Connoisseurs, the Health Enthusiasts, the Loyalists, and the Virtual Befrienders.

Factor 1: The Health Connoisseurs

Individuals in the Health Connoisseurs factor were very skeptical of influencer reliability. They focus on the facts, not the community or sentimentality of social media. They ranked the following statements the highest: “I think that health influencers on social media are not credible” (z = 1.944), “I often come across videos on my ‘For You’ page that promote clean and healthy eating in a way that is actually restrictive and potentially harmful” (z = 1.801), and “I don’t use influencers as a guide for health” (z = 1.720). Participants in this factor were passionate about criticizing influencer credibility. Participant 6 noted that, “Influencers on social media to me are what career politicians are to politics. They’ll say whatever they need to [say] to stay relevant and make money. I don’t think they’re credible.” This lack of trust regarding social media influencers leads them to perceive content on these platforms as fake and potentially unsafe especially for individuals who are not media or health literate. Participant 36 explained, “It’s not a great place to find out if diets or fitness programs work in real life cause social media isn’t really real.” Participant 14 expanded on this idea when he stated, “I don’t think of social media as an authentic place even though, surely, it’s the only platform for authentic people to share real experiences, challenges, and tips, but it’s saturated with influencers who aren’t saying science and are famous cause they’re hot. Influencers are my last source. Social media is a good guide for toxic health.” The Health Connoisseurs saw right through the fluff on social media, and they were not swayed by influencer popularity or appearance in determining credibility. They believe that “social media is skewed. You’ll find what you want to find, just like the internet” (Participant 16).

The Health Connoisseurs disagreed the most with the following two statements: “I follow health influencers because I want my body to look like their body” (z = −1.601) and “I like following people on social media who are on weight loss journeys because it’s motivating to me” (−1.367). This suggests that they feel that influencer appearance promotes unrealistic expectations that can be harmful. Participant 29 said, “Everyone’s body is different. Even when promoting body positivity, influencers do it in a way that sexualizes the body. It’s still approached in a toxic way.” The Health Connoisseurs were also the most health literate and appeared to wholeheartedly trust scientists and the scientific process. They disagreed with the statement, “I think that scientists keep changing their minds about what is good to eat and how to exercise to lose weight, so I turn to real people on social media instead” (z = −1.338). Individuals in this factor rely on qualified professionals on social media to get their health information. Participant 22 stated, “I don’t like to follow people who promote health things that don’t know what they’re talking about, so I pretty much just follow doctors and dieticians.”

Factor 2: The Health Enthusiasts

The Health Enthusiasts know what they want on social media, and they go get it, meaning they actively seek out specific content. The statements that had the highest agreement in this factor were “I like to follow health influencers that promote mental and physical health” (z = 2.227) and “I often come across videos on my ‘For You’ page that promote clean and healthy eating in a way that is actually restrictive and potentially harmful” (z = 1.206). The Health Enthusiasts know that there is damaging, unreliable content on social media, so they purposefully seek out influencers with a holistic approach who consider mental and physical health on their social media platforms. Participant 20 related, “I really try to find influencers to follow who know the science and have experience on the physical side, but also promote the mental aspect that allows for a holistic type of health.” Participant 24 explains why the Health Enthusiasts seek out this type of influencer when she said, “I feel like I get the most out of [holistic influencers] because they give great workout ideas but also help you change your attitude toward working out which has really helped me.” Additionally, individuals in this factor appreciate the relatability and authenticity of the influencers they choose to follow as evidenced by Participant 20 who said, “Seeing real people go through things and seeing what works for them helps us understand a lot more [of] what we can do for ourselves.”

The statements that the Health Enthusiasts disagreed with the most were “I like following health influencers because I feel like I have developed a friendship with them from reading, watching, or interacting with their posts” (z = −1.994) and “I find support on social media as I share my health or fitness journey” (z = −1.696), suggesting that people in this factor do not use social media for connection. Instead, they use it to find information that they can apply to their lives. Participant 27 described this idea when she said, “I’m not the type of person to develop a connection with the people I follow. I don’t follow them to learn more about them. It’s more like how can what they’ve done help me on my journey.” Participant 9 further supported this sentiment saying, “When I look at social media it’s just like where do I put myself and what should I do more or less of to improve. How can this video help me?” The Health Enthusiasts tailor the health-related content they view on social media in order to find information that is applicable for them to meet their particular needs.

Factor 3: The Loyalists

The Loyalists are also skeptical of influencers but once they find ones they consider credible they become very faithful fans. The statements that resonated the most with individuals in this factor were “I frequently try to determine if a person who provided health information on social media is credible by finding out their occupation and/or education level” (z = 2.145) and “I like following health influencers because I feel like I have developed a friendship with them from reading, watching, or interacting with their posts” (z = 1.775). Regarding the importance of credibility verification, Participant 18 said, “I know that I’ve checked all the people I follow.” Participant 23 expanded further saying, “My natural tendency is to be skeptical on social media. I feel like if someone is more educated about, you know, nutrition, or whatever, I’m more likely to believe what they’re saying versus someone who just has like millions of followers.” Loyalists value reliable opinions on social media because knowing the truth is paramount to them. Participant 23 articulated, “It’s important to educate yourself so you can learn what is true and also learn how to critically think when you’re reading other people’s posts so you can determine if something makes sense or is true.” When Loyalists have determined that an influencer is a dependable source of information, they then watch a great deal of their content and develop a friendship with them similar to how someone feels about their favorite character in a television show or book series. Speaking about some influencers that she follows, Participant 18 explained, “I love who they are as people, and I know they’re credible so now I follow them on multiple platforms.”

It is also important to note that individuals in this factor also strongly agreed with two statements that contradicted one another: “I don’t use influencers as a guide for health” (z = 1.443) and “I have used information on social media to diagnose myself” (z = 1.276). This implies that they do not see themselves as influenced by the health information that they consume on social media, yet they still take it to heart and relate it to their own health circumstances. Participant 18 noted, “Social media is super easy to compare yourself to. People can be really influenced by it, and it can change your life.”

The statements that Loyalists disagreed with the most were “I find support on social media as I share my health or fitness journey” (z = −1.775), “I do workouts that are posted on YouTube because I feel embarrassed going to the gym” (z = −1.609), and “Health influencers make me feel bad about myself because I will never look like them” (z = −1.609). Loyalists do not judge by appearances and are not apt to share on social media. Instead, they gain support in reality with friends or family at home and at the gym. Participant 18 stipulated, “I’m not a big sharer on social media so I don’t share my health or fitness routines. That’s totally not me. I feel more support with in-person relationships.”

Factor 4: The Virtual Befrienders

The Virtual Befrienders use social media for community and support. The statements that they agreed with the most were “I like following health influencers because I feel like I have developed a friendship with them from reading, watching, or interacting with their posts” (z = 1.693), “I do workouts that are posted on YouTube because I feel embarrassed going to the gym” (z = 1.625), and “I frequently try to determine if a person who provided health information on social media is credible by finding out their occupation and/or education level” (z = 1.445). Though they do check for influencer credibility, Virtual Befrienders are optimistic and trusting, assuming that “a good chunk of health influencers on social media are credible,” which indicates that they are the least skeptical group out of all four factors (Participant 1). They also feel self-conscious about working out in front of others and prefer exercising in their own homes as noted by Participant 37 who stated, “Going to the gym is terrifying cause it’s embarrassing. I don’t know how to use the equipment and I don’t want people to watch me and stuff like that, so if I work out from home then it’s not embarrassing because no one is judging me.”

Virtual Befrienders form genuine connections with the influencers they follow and rely on their virtual support to keep them motivated. Participant 37 expressed how she feels when doing YouTube workouts stating, “Even though I’m technically alone when I’m working out, the influencers feel like they’re your friends and you hang out with them all the time and they’re just helping you on your health journey, so it feels like I have advocates.” In addition, they appreciate when influencers are genuine or at least appear to be. They like influencers who “are uplifting and show their more vulnerable side” (Participant 1).

The statements that the Virtual Befrienders disagreed with the most were “I have used information on social media to diagnose myself” (z = −1.761), “When I see someone on social media that has a good physical appearance, I follow them and look at their posts to find out what they do to look so good” (z = −1.693), and “I only watch YouTube channels about health information if the person speaking is attractive” (z = −1.625). Virtual Befrienders realize the folly in attempting to diagnose themselves based on the information they find on social media. One participant commented, “I don’t like to diagnose myself because everyone’s different. I don’t want to scare myself” (Participant 1). Furthermore, choosing which influencers to follow based on appearance is considered “ludicrous” by Virtual Befrienders and they do not allow body differences between themselves and influencers to diminish their self-worth (Participant 37). Another participant shared, “I definitely don’t think that looking at people’s healthfulness or the way that they look makes me feel sad about myself. Like, good for you but I’m not really comparing myself to them” (Participant 37).

Discussion

The purpose of this study was to identify the attitudes, opinions, and beliefs of young adults in the U.S. regarding motivations to view health influencer content on social media. Four factors were discovered: the Health Connoisseurs, the Health Enthusiasts, the Loyalists, and the Virtual Befrienders. Our findings support the notion that present day social media behaviors around obtaining health information are complex. Social media users’ engagement with health information on social media platforms tended to involve active, rather than passive seeking of information (Quan-Haase and Young, 2010; Sundar and Limperos, 2013). Certain groups were particularly active and scrupulous about the sources that they were willing to trust. Keeping uses and gratifications in mind, it should be noted that the degree of active versus passive seeking is both audience and platform dependent (Sundar and Limperos, 2013).

Social presence and telepresence

Utilizing social presence is important for influencers who wish to be successful because it allows them to form a more intimate connection with their followers (Khalifa and Shen, 2004). These influencers project themselves to their followers as they present content with vulnerability by addressing their own personal circumstances through self-disclosure, which increases relationship development between the influencer and their content viewers and elevates the feeling of social presence (Dunlap et al., 2016; Leite and Baptista, 2022). This practice was particularly effective with the Loyalists and Virtual Befrienders who felt relationally connected to the influencers they followed. Interestingly, it was these two factors that also experienced telepresence. The bond they felt with these influencers may have played a role in establishing this feeling of being physically present in a virtual environment (Khalifa and Shen, 2004).

Though the Virtual Befrienders and the Loyalists both connected deeply with the influencers, they formed different types of relationships with them. The Virtual Befrienders formed a two-way friendship with influencers in which they were more likely to react and interact with the influencers they followed by posting comments and liking content. The Loyalists, on the other hand, developed a fan/influencer relationship which was parasocial in nature. This parasocial relationship between the Loyalists and the influencers they followed was a “nonreciprocal socio-emotional connection” further solidified by their lack of personal sharing through comments and posts (Hoffner and Bond, 2022: 101306).

The Health Connoisseurs and the Health Enthusiasts were more firmly present in reality, rather than virtually, which created distance between them and the influencers they followed. This could potentially stem from their perspective of using social media as a tool to access influencers and their content which they then proceeded to critically review to determine legitimacy and, for Health Enthusiasts, relevancy for their own circumstances. Connection was not their purpose when viewing health information on social media and, therefore, they were not nearly as inclined to experiencing social presence or telepresence in this arena.

Health literacy and media literacy

The results indicate that health literacy and media literacy both play a role in an individual’s susceptibility to believing misinformation on social media. The Health Connoisseurs, who were both health and media literate, were the most immune to being deceived by fake news, disinformation, or illegitimate guidance presented by influencers because of their understanding of the scientific process, their focus on following only accredited health professionals, and their ability to research claims made to determine truth. The Health Enthusiasts were also more analytical in their view of health information on social media. Inherent in this group was a strong desire to use social media as a way to meet personal needs. This was demonstrated by the way in which this group was highly selective about the types of social media influencers that they were willing to follow. Criteria included that influencers had certain educational backgrounds (similar to the Health Connoisseurs), a priority on quality content over connection, and a preference for content that had a direct benefit in the form of implementable strategies. The Loyalists also recognized the importance of establishing if an influencer was credible before they allowed themselves to follow influencers and grow attached to them. The Health Connoisseurs, the Health Enthusiasts, and the Loyalists were aware of the prevalence of misinformation and its problematic nature of spreading pseudo-facts and decreasing trust in health professionals (De Regt et al., 2019; Harff et al., 2022; Nagler, 2014). They let their media and health literacy guide them as they explored health content on social media. This was not the case for the Virtual Befrienders who appeared to be novices in health and media literacy. Virtual Befrienders were more susceptible to the negative health-related impacts caused by following the guidance of influencers with no credibility due to their trusting natures and lack of health-related knowledge. Among this group were the people who assume message accuracy based on the likability of the speaker and the length of their message (Todorov et al., 2002). They were the most vulnerable to harmful or ineffective advice from illegitimate influencers who attempt to increase their popularity by promoting quick fixes (De Regt et al., 2019). These findings are enlightening considering the broader societal conversations about the effects of social media on audiences and beneficial to researchers as they seek to understand the ways in which social platforms act against users and ways in which users manifest personal choice and autonomy through their usage of a particular platform.

Application to theory

Our research primarily examined why individuals choose to use social media to access health-related content. Interestingly, our methodological approach, the uses and gratifications theory, allowed us to examine how gratifications sought by individuals vary greatly from one group to the next. For example, the Health Connoisseurs were entertained by viewing health information on social media and researching to determine their legitimacy, which provided further support that entertainment is one of the aspects of social media that entices people to continue to use it (Quinn, 2016; Whiting and Williams, 2013). The Health Enthusiasts also satisfied several needs outlined in previous uses and gratifications literature when accessing health information on social media including information seeking, convenience utility, and entertainment (Quinn, 2016; Whiting and Williams, 2013). Just as Sundar and Limperos (2013) argue that it is imperative to examine how social media creates new needs in audiences, it is also imperative for researchers to consider how unique audiences might vary in their motivations for using social media for individualized reasons. It is at the intersection of differences in media affordances and differences in media users that the nuance of uses and gratifications in the context of new media can be sufficiently examined.

Limitations and future directions

Though this study followed the sampling standards outlined in Q methodology (Brown, 1996) to ensure validity, the sample was not diverse. Convenience sampling was used to complete data collection in person. Future research would benefit from broadening this research to other contexts and populations. Specifically, because user norms and governmental regulations related to social media vary from country to country, an examination of how audiences use social media to access health-related content in these unique environments would be of significant value. Additionally, this study did treat social media as a broad construct that is perhaps more often considered at a platform level. Future work should consider the role of social media and health information uses among audiences on specific social media platforms as well. This approach, which has a narrower focus, may allow for more nuanced findings to emerge. Finally, no direct question regarding the level to which participants shared content or interacted with others on social media was asked during the interview process. Collecting this information in a future study would bring further depth to the factors uncovered in this study.

Conclusion

This work sought to uncover the different attitudes, opinions, and beliefs of young adults who enjoy accessing health information through social media in the Unites States. Four factors were uncovered: the Health Connoisseurs, the Health Enthusiasts, the Loyalists, and the Virtual Befrienders. The results indicate that social media behaviors around obtaining health information are complex and a variety of different needs are satisfied by individuals in these factors as they pursue health information on social media. Additionally, the results revealed that both health and media literacy impacted viewer ability to perceive credibility of content but not necessarily enjoyment of content. The results of this research also further develop the uses and gratifications theory in health-related social media research for the practice of creating more reliable and beneficial content for viewers and followers.

Supplemental Material

sj-docx-1-hpq-10.1177_13591053231200690 – Supplemental material for #HealthyLifestyle: A Q methodology analysis of why young adults like to use social media to access health information

Supplemental material, sj-docx-1-hpq-10.1177_13591053231200690 for #HealthyLifestyle: A Q methodology analysis of why young adults like to use social media to access health information by Christina Triptow, Jason Freeman, Paige Lee and Thomas Robinson in Journal of Health Psychology

Research Data

sj-docx-2-hpq-10.1177_13591053231200690 – Supplemental material for #HealthyLifestyle: A Q methodology analysis of why young adults like to use social media to access health information

sj-docx-2-hpq-10.1177_13591053231200690 for #HealthyLifestyle: A Q methodology analysis of why young adults like to use social media to access health information by Christina Triptow, Jason Freeman, Paige Lee and Thomas Robinson in Journal of Health Psychology

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sj-docx-3-hpq-10.1177_13591053231200690 for #HealthyLifestyle: A Q methodology analysis of why young adults like to use social media to access health information by Christina Triptow, Jason Freeman, Paige Lee and Thomas Robinson in Journal of Health Psychology

Research Data

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sj-pdf-4-hpq-10.1177_1358863X231175185 for #HealthyLifestyle: A Q methodology analysis of why young adults like to use social media to access health information by Christina Triptow, Jason Freeman, Paige Lee and Thomas Robinson in Journal of Health Psychology

Footnotes

Data sharing statement

The current article is accompanied by the relevant raw data generated during and/or analysed during the study, including files detailing the analyses and either the complete database or other relevant raw data. These files are available in the Figshare repository and accessible as Supplemental Material via the Sage Journals platform. Ethics approval, participant permissions, and all other relevant approvals were granted for this data sharing.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Ethics approval

This research was approved by the IRB at BYU. Approval number: IRB2021-336.

ORCID iD

Christina Triptow

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