Introduction

Social media platforms are Facebook, YouTube, X (former Twitter), WhatsApp, Instagram, LinkedIn, etc. (Lutkevich & Wigmore, 2021); among the most popular is Facebook (Biggest social media platforms 2023). Worldwide, 3.03 billion monthly active users use this platform (Lua, 2023). In Bangladesh, 59.2 people million use Facebook (Hossain, 2023). Users use Facebook for various reasons, such as for sharing and seeking information, entertainment, communication, and up to date with current information (Hossain et al., 2020). Besides these daily activities, users also share and seek health information on various social media, especially on Facebook groups, pages, and personal profiles (AlQarni, 2016). Health communication (HC) encompasses interpersonal and mass communication endeavors aimed at enhancing the well-being of individuals and communities at large (Ishikawa and Kiuchi, 2010). Reminders for appointments, blogs, emails, patient portals, telehealth visits, and two-way messaging are just a few of the tools and techniques used in health communication.  Other than these, at present, some of the most useful tools are social media platforms like Facebook, Messenger, WhatsApp, and so on. Several studies have been conducted worldwide regarding health information sharing through social media.

Users use social media platforms for health purposes, including sharing information, reserving information, sharing personal experience or knowledge, knowing about information, and gaining social and political benefits. According to De Choudhury et al. (2014), people use online platforms to ask questions, communicate with specialists and others who have gone through similar situations, share worries and queries about treatment options, and comprehend professional diagnoses. Patients can utilize social media for various purposes, including education, information, networking, research, support, goal setting, and monitoring their progress, according to Courtney's (2013) analysis of the effects of social media on healthcare organizations, physicians, and patients. Above all, patients can communicate, share their experiences, learn from others, and disseminate health information.  According to findings from another study, looking up health information online is one of the most common internet behaviors (Korda et al., 2011). In addition, the Internet has emerged as a primary resource for health information, and in the upcoming years, there will likely be a notable surge in users (Sambandam et al., 2007). According to Modahl et al. (2012), some doctors think social media might help patients with depression, cancer, unusual medical conditions, chronic illnesses, maternity and newborn care, weight management, well-being, and prevention. Facebook posts on health can benefit patients, doctors, and other users if they interact with each other's posts. According to Santiago (2023), Facebook engagement is defined as comments, sharing of a post, page, group, or advertisement, and reactions (such as likes, love, care, haha, wow, sad, and angry).

Bender et al. (2011) examined the use and objective of Facebook groups related to breast cancer. They discovered approximately 620 breast cancer groups on the social media platform. These groups were created for various purposes, including raising money (44.7%), knowledge (38.1%), goods or services advertising connected with raising funds or knowledge (9%), and patient/caregiver encouragement (7%). Setoyama et al. (2011) investigated the advantages associated with breast cancer patients' involvement in online communities. They discovered that there is a distinction between lurkers and posters, and posters believed they benefited more from online groups than did lurkers. The opportunity to vent feelings, assist other patients, and get emotional support was beneficial. Researchers discovered that even lurkers received some peer assistance, particularly when obtaining guidance and universality.

The previous research conducted by Bender et al. (2011) and Hale et al. (2014) focuses on content analysis of publicly available information at the group or page level (such as the group mission statement) but not at the post level (all posts posted by separate individuals). Rosa and Sen (2016) researched from within the direct post. We also conducted our research on actual Facebook posts. The central gap between Rosa and Sen's (2016) research and our study is that we analyzed both Facebook groups and friend lists publicly shared posts. They only use group posts. 

This research investigates the pattern of health information sharing in social media platforms, Facebook public posts, and user engagement. The focus of this study is to analyze the types of issues, characteristics of posts, sources of information, polarity of the language in the comment section, reasons for posts, and how the users engage with these posts. To the best of researchers’ knowledge, no research has been conducted in Bangladesh.

Conceptual framework

Researchers developed a conceptual framework to show the health-related information shared on social media platform Facebook and users’ engagement. On the social media platform Facebook, various information is shared from different pages, groups, and personal profiles. After these posts, users can see them on their timelines and engage by reacting, commenting, and sharing as they like.

Figure 1: Conceptual Framework on health-related Public Posts on Facebook Click here to view Figure

Methodology

Study design

A mixed-methods quantitative and qualitative content analysis was undertaken to assess Facebook (FB) posts written in Bangla, publicly available on the public group and users’ profiles. The search was undertaken between March 2020 and March 2023. The study was carried out in March 2020 because the 1st COVID-19 case was detected in Bangladesh.

Data collection

Researchers use FB friends who share their posts publicly, and FB search functions are used to identify groups related to health. A set of key terms involved with health in Bangla and English is used. Health information, Health information in Bangla, Coronavirus updates in Bangladesh, and Corona were the main terms for searching health-related public groups and public posts. Researchers also check their FB friend list. The researchers purposively selected two groups with more than 100k members from the search list. We only used posts written in the Bangla language and written by Bangladesh and the citizens of Bangladesh. Researchers analyze both the FB group and individual wall posts. From two groups and the researcher's FB friend lists, we found 45697 public posts; among them, 26551 were health-related FB public posts. Among these, researchers analyzed 485 public posts related to health awareness, doctor information, health advice, skin disease, dental, sleeping problems, asthma, Urinary infection, personal opinion, coronavirus updates, Government Initiatives, Symptoms of COVID-19, Vaccination, Product Advertisement, Personal Opinion. Researchers excluded repeated posts, FB accounts that have been used for less than four years, and posts that were not publicly shared from the analysis.

For collecting the data, researchers developed some variables (Table 1) from previous literature Rosa and Sen's (2016) study, and also researchers' thinking when they read health-related posts.

Table 1 Variables used in the study and their brief descriptions

Data analysis

Researchers used SPSS v.25 and JASP software to analyze the data. We used descriptive statistics like Mean, Std. Deviation, Minimum, and Maximum value to investigate how many health-related Facebook public posts are shared and how many people react to health-related FB posts by like, love, haha, angry, wow, care reactions, share, and comments. Qualitative analysis of each issue in one post and comment was employed to know the sharing of information related to health.

Result

Sharing health-related information through Facebook groups and personal profiles in Bangladesh

This study analyzed 485 public posts from health-related Facebook groups and users' timelines. We divide the posts into nine different segments. These are awareness, COVID-19, advice, information, general problems, a variety of diseases, government initiatives, advertisements, and opinions. The result shows that fourteen issues under these nine segments are discussed on Facebook.  Among these, the most (27.84%) posted segment is awareness, followed by COVID-19-related posts (24.54%), variety of disease (20.22%), doctors’ information (14%), and the bottom of this rank is personal opinion (1.86%). In the COVID-19 segment, researchers found three sub-categories. These are symptoms of COVID-19, coronavirus updates, and vaccination. In the disease section, we found four sub-categories posts. These are Skin disease, dental, Asthma, and Urinary infection. All of the others have one sub-category. The users who want to know about the various information from their profiles and groups mainly want to know about doctors' information (Table 2).

Table 2: the frequency and percentage of each issue with the example of posts and comment.

People's Engagement/reactions to the health-related posts

The figure below shows the posted issues and user engagement on them. In this study, researchers divided Facebook health posts into nine different segments. The nine segment's issues are numerically identified in the figure. Among these, 1 is awareness-related posts, 2 is COVID-19, 3 is advice, 4 is information, 5 is a general problem, 6 is the variety of diseases, 7 is government initiative, 8 is an advertisement, and 9 is health-related opinion posts. We analyzed 485 posts from these nine segments in our study. The results showed that the highest number of users engaged in posts related to COVID-19 and the least in posts related to personal opinions and general problems.

Figure 2: issues post vs. user engagement   Click here to view Figure

Frequency distribution of general findings of health-related posts

We analyzed the characteristics of health-related public posts used in the study, sources of information, the polarity of the language in the comment section, and reasons for posting. The following characteristics (personally made video, personally written text, news video, news video with text, news text, news text with personal text, YouTube video, YouTube video with personal text, personal text with picture) are observed in the posts. More than half, 284 (58.35%) of the posts are personally written text. Users have used personally made YouTube videos, TV channels, Newspapers, other Facebook posts, various websites, news portals, Facebook pages and groups, WHO, IEDCR, and DGHS as sources of information; among them, 204 of them (42.06%) posts have used personally made source or without source.

Of the language used in the comments, most 423 (87.22%) posts had positive language. Reasons for posting include sharing information, reserving information, sharing personal experience or knowledge, knowing about information, and gaining social and political benefits. Among them, 167 (34.43%) for knowledge sharing, and 162 of the posts were (33.40%) for knowing information.

Table 3: General findings of the health-related posts on Facebook

People engagement with the characteristics of the posts

In our study, we found nine characteristics of posts. These are: 1. Personally made video, 2. Personally written text 3. News video, 4. News video with text, 5. News text, 6. News text with personal text, 7. YouTube video,  8. YouTube video with text,  and 9. Personal text with picture. Out of this, the 2nd feature's post i.e. Personally written text posts had the highest engagement of users, and the least engagement was in news video.

Figure 3: Characteristics of post Vs. People engagement Click here to view Figure

Descriptive statistics of users’ engagement with health-related post

The result revealed that the number of reactions (M=129.44, SD=245.48) and comments (M=11.78, SD=21.71) have the highest engagement. The number of shares (M=4.63, SD=14.45) was the lowest engagement. The minimum share was zero, and the maximum was 97. Researchers also analyzed reactions like love, Wow, Haha, sad, anger, and care. The result shows that most users gave like reactions (M=104.49, SD=197.09) to various posts; the minimum is 12, and the maximum is 1900. The lowest single reaction was anger (M=0.11, S=0.56).

Table 4: Users’ engagement with health-related public posts.

Discussion

In the information revolution world, we search for the information we need and share almost all kinds of information through several media. Social media platform Facebook is one of them. In this study, we explored patterns of health-related information sharing on the social media site Facebook and user engagement with these. We chose Facebook as the medium because Facebook has the highest number of users in Bangladesh (Hossain, 2023). Moreover, Facebook is a popular medium for health-related discussions (Della & Sen, 2019).

Our research results show 14 types of health-related issues posts under nine categories that users made in groups or on their timelines. Asiri et al. (2017) researched Facebook groups related to HIV, depression, and sickle cell disease. Similarly, AlQarni et al. (2016) conducted their study on Diabetes mellitus. Bender et al. (2011) conducted their study on breast cancer. Most of the posts in our study were awareness related to health. The results of this study somewhat align with the findings of Asiri et al. (2017) and AlQarni et al. (2016).

Our analysis showed that user engagement was the highest in Corona-related posts. Hale et al. (2014) showed that chronic diseases like cancer and diabetes have the most engagement. The result of the study also revealed that personally written text posts were the most engaging post type. On the other hand, a previous study conducted by Kiet et al. (2016) showed that video posts were the most engaging post type of their study. The research results showed that most (42.06%) posts are made without any information source. 87.22% of the comments on this study were positive. However, 3.09% of comments on various posts were negative. Asiri et al. (2017) study had 1% negative comments about the disease. The result depicts that the main reason behind the posts was to share personal experience or knowledge. Followed by knowing about information. This result is partially consistent with the AlQarni et al. (2016) results. The result of the reactions showed that like reactions and comments have the most engagement. Della & Sen (2019) also found similar results in their study.

The study's results showed users' engagement on various health-related posts on the social media platform Facebook. The health professionals could implement these results to their own needs. For example, they can be encouraged to share their profile and give their opinions and suggestions on Facebook to create health awareness. Government can use the results of this study to formulate policies regarding health information sharing through social media.

This study analyzed the number of reactions, comments, and shares on posts to verify user engagement. Future research should use survey methods on users who engage with these posts to verify how much users use this information for their needs.

This study has some limitations. First, the study was conducted only on posts made publicly on two health-related groups and some users' timelines. From which the pattern of health-related posts can be deduced, the nature of user engagement cannot be ascertained because many more groups and pages are related to health on Facebook. Secondly, the study analyzed 14 types of problems but posted some other topics in the groups that were not included in this study. Thirdly, in the context of Bangladesh, the research has taken posts written in Bengali as a sample. So, the study's results do not apply to the whole world. As a qualitative analysis of the study, only one post and comment on each issue was highlighted.

Conclusion

There are numerous health-related pages and groups on the social media platform Facebook in Bangladesh. Also, many users post various health-related posts on their profiles. This number is increasing day by day. However, users get the information they need from these Facebook groups and pages. Many times, the expert doctor's opinion and advice are also received. However, in most cases, it is seen that many people are giving their own fabricated information despite not having any knowledge about the disease. Some are even mentioning the name of the medicine for various diseases. According to experts, the medicine dose will differ for each person depending on the age, physical condition, and absence or presence of other diseases, even if the disease is the same. Therefore, everyone should be made aware of sharing sensitive information related to their health through social media and taking advice from everyone. Policies should be made regarding sharing health-related information through social media if necessary. Awareness should be created in coordination with specialist doctors, and arrangements should be made to provide primary consultation for various diseases.

Acknowledgement

In this study, we would like to acknowledge Dr. Md. Nazrul Islam, Associate Professor, at the dept. of Mass Communication and Journalism, Begum Rokeya University, Rangpur for his valuable contributions and insights.

Conflict of interest

The authors declare no conflict of interest.

Funding Sources

This study did not receive any grant.

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