We used Google Insights to identify the 20 most searched for health conditions and then searched for these terms on Facebook. We found that a large number of pages were not about the health condition searched, but a similarly named topic. The most common type of page content was marketing/promotion, followed by information/awareness. Only a small number of pages were devoted to social support and six conditions were not represented by any support pages (ie, HPV, diarrhea, flu symptoms, pneumonia, spine, HIV). We also found that engagement measured by Likes was greater for general support and marketing/promotion than for patient support and information/awareness pages.
A Facebook search for health conditions returned a large number of page results that were not relevant to the health condition searched (29.4%, 280/953). Additionally, the percentage of relevant pages varies considerably by health condition. While 98% or more of pages listed for six conditions were relevant (flu symptoms, diabetes, breast cancer, cancer, thyroid, arthritis), less than 50% of pages were relevant for five conditions (HIV, stroke, spine, HPV, diarrhea; see Tables 4 and 5).
The variation in the number of relevant pages may be due to the breadth of health conditions that we searched for and/or the method used to identify the Facebook groups and pages. Previous research examining Facebook groups for specific health conditions found that most content was relevant. A total of 97% of the posts were relevant on the 25 largest Facebook groups, focusing on premature infants  and on the largest Facebook diabetes groups . Ahmed and colleagues  found that 89% of posts on 17 Facebook groups related to concussions were relevant. In contrast, using a search method similar to the one we used, Sajadi and Goldman  examined the usefulness of the first 30 listed results for the search term “incontinence” on Facebook, Twitter, and YouTube. They found that nearly half of the search results on Facebook led to pages with no useful information. This problem may be overrepresented in our study due to our search methodology of using a “clean” Facebook profile. With more information about a user, Facebook is likely to show pages that are more relevant to the user, which may also be more relevant to the condition searched.
The difficulty in finding Facebook pages with relevant health information may pose a significant barrier for people with inadequate digital skills. A growing body of literature finds that people with better Internet skills are more likely to go online to search for information, including health information [18,19], and make more varied and effective use of online information resources . Additionally, Internet and information seeking skills vary by socioeconomic status and prior Internet access and use [19,20]. These digital inequalities may limit the utility of Facebook as a health communication channel for people from socially disadvantaged groups and may in fact contribute to increasing knowledge gaps [21-24] and health disparities. Public health interventions that use Facebook as a health communication channel will need to be designed to ensure that information is easy to find for all members of the target population.
Page Content and Social Support
One benefit of using social media for health communication, identified by Moorhead et al  in a systematic review of 98 research articles, is the ability for people to draw social support from a large network of friends, relatives, and other users. We found, however, that only 13.0% (68/522) of pages were devoted to social support and that the largest percentage of pages were marketing/promotion (32.2%, 168/522) and information (20.7%, 108/522). Additionally, the percentage of social support pages varied considerably by health condition. For example, several health conditions were represented by few or no social support pages (HIV, AIDS, HPV, herpes, diarrhea, flu symptoms, pneumonia, anemia, blood pressure, and spine) and were largely represented by information and marketing/promotion pages. In contrast, five health conditions (stroke, lupus, cancer, breast cancer, stomach) were represented by 20-67% by social support pages.
Direct comparisons with other studies are difficult due to the differences in the focus on pages versus groups, classification schemes, and the range of health conditions examined. However, the relative lack of pages devoted to social support that we found is consistent with the findings of Bender et al  of Facebook breast cancer groups. Although we found a greater percentage of breast cancer pages devoted to social support (22.6%, 7/31) than Bender et al among groups (7%), they found that groups devoted to fundraising (45%) and raising awareness (38%) were most common. In contrast, Farmer et al  found that support groups made up a substantial percentage of groups for the 11 most prevalent non-communicable diseases on Facebook. They found that patient groups accounted for 47% of groups, followed by patient/caregiver support groups (28%), and fundraising groups (19%).
The relatively low percentage of social support pages for some health conditions may be due to the higher level of stigma associated with these conditions (ie, HIV, AIDS, HPV, herpes) compared to non-communicable diseases (ie, stroke, lupus, cancer, breast cancer). Rains  found that anonymity was one strategy used by people who are embarrassed by their illness and that people with high levels of online anonymity disclosed more health experiences. The lack of anonymity on Facebook may pose a barrier to people’s willingness to disclose information about their health condition or to provide open support to other users and limit the effectiveness of public health interventions for some health conditions. Further research is needed to explore how perceived stigma and illness-related embarrassment influences people’s willingness to disclose information and express social support.
Third, we found that engagement measured by Likes was disproportionate to the number of pages in each category. For example, general support and marketing/promotion pages comprised a larger percentage of Likes than would be expected given the percentage of pages. General support pages represented only 3.6% (19/522) of pages but comprised 35.89% (7,964,328/22,191,633) of Likes. Similarly, marketing/promotion represented 32.2% (168/522) of pages but comprised 46.73% (10,371,169/22,191,633) of Likes. In contrast, patient support and information/awareness pages were underrepresented in Likes compared to percentage of pages, while Wikipedia pages received no Likes.
The greater engagement with general support and marketing/promotion pages versus patient support and information/awareness pages may have to do with what Facebook users view as appropriate use and activities on the site. Lampe et al  studied the perception of Facebook’s value as an information source and found that on average, users did not find it appropriate to seek information on Facebook and were not likely to make extensive use of the site for information seeking. Another reason may be that marketing/promotion pages have commercial interest in gaining popularity and may employ methods like Facebook ads or viral campaigns to increase the visibility and engagement with their pages through likes. Future research should explore users’ perceived norms surrounding the use of Facebook and how these norms impact disclosure of health conditions, seeking health information, and providing social support to people who are ill.
Limitations and Future Research
Although this study has several strengths, including the examination of the search results for 20 health conditions and nearly 1000 Facebook pages and a content categorization scheme based on previous health communication research, it has several limitations.
First, in the time since we collected our data, Facebook has modified its search function. Starting in January 2013, Facebook began to roll out a new “graph search”, which became available to all of Facebook’s English (US) users by the end of July. The new search function includes three visible changes. First, search results are formatted slightly differently: profile pictures and fonts are larger and more prominent. Second, the search results now include a column on the right side of the page, which features the name, profile picture, and cover picture for the top search result as well as Web searches for the search term. Finally, search listings now include a line for each page that indicates pages that “people also like.”
In practice, these changes appear to have little impact on searches regarding health conditions. Even so, the new search may have network effects that will impact future search results and which pages users are likely to view. In particular, the “people also like” feature may guide users to certain pages. Given that it lists similar types of pages as well (other non-profit organizations in the example above), it may also help users find certain types of pages. Future research will be required to examine how changes in search engines impact users’ ability to find relevant information and pages.
Second, we evaluated the representation of health conditions only on Facebook pages and we did not examine private messages or private groups as we were interested in what is made public to all users when searching for health conditions on Facebook. Private messaging and groups might be more appropriate channels for communicating about sensitive health topics and warrant future research. This limitation is not unique to our study; previous research on health conditions among Facebook groups has focused on public groups and messages. Additionally, our data were collected over a limited time period and for only the first 50 pages returned in the search results. A more comprehensive set of data may yield evidence of longitudinal or seasonal patterns in the representation of health conditions that we were not able to detect.
Third, we did not attempt to formally evaluate the accuracy of the informational content of pages. Thus, pages that were categorized as relevant may vary greatly in the utility of the information provided for differing health conditions. Future research on the quality of content across key health conditions may highlight critical topics of misinformation and be used to support interventions designed to correct and/or counter poor information resources.
Fourth, our descriptive analysis does not provide any data on the characteristics of Facebook members who searched for health conditions or how they used the information they found. Future research should examine how people make use of Facebook as one element of a communication ecology to address their informational needs and to garner social support, and how this usage impacts their health care utilization, self-care, and health outcomes.
The rapid growth and diffusion of social media and SNS during the past 10 years has created new opportunities for people to find and share information about a wide variety of health conditions. Facebook is the most widely used SNS in the United States; however, little is known about the diversity of health conditions represented on Facebook. This research represents the first attempt to comprehensively describe the content and level of user engagement with health conditions on Facebook pages. Our findings provide useful baseline information and several insights to inform future research and interventions designed to improve public health. We found that a search of Facebook for common health conditions provided a large number of irrelevant pages. In addition, most pages were devoted to marketing/promotion and relatively few pages were devoted to social support. Social support was especially underrepresented in pages for health conditions for communicable diseases. 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 utility of Facebook as a channel for health communication. This line of research merits further investigation as Facebook and other SNS continue to evolve over the coming years.
Conflicts of Interest
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©Timothy M Hale, Akhilesh S Pathipati, Shiyi Zan, Kamal Jethwani. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.08.2014.
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