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How Adolescents Trust Health Information on Social Media: A Systematic Review

Open AccessPublished:December 26, 2022DOI:https://doi.org/10.1016/j.acap.2022.12.011

      Abstract

      Background

      Given the potential for social media to spread health misinformation, it is important to understand how trusts impact adolescents’ engagement with health content on social media.

      Objective

      To explore the concept of trust when adolescents (13–18 years) engage with health information on social media. Five relevant databases (MEDLINE, EMBASE, PsycINFO, ERIC, and CINAHL) were systematically searched alongside Google Scholar and reference lists of included papers. Studies were included if they examined adolescents’ trust when engaging with health information on social media.

      Study Appraisal and Synthesis Methods

      Thematic analysis was used to synthesize the findings from this review.

      Results

      Thirty-four papers were included. Three key domains were explored: trust in the social media platform/service (general distrust of social media for health information; safety and privacy); trust in other users (mistrust of unknown users; fear of bullying or judgment; trust in friends or peers; celebrities and popularity; trust in others’ experience and the importance of social support); trust in content (tone and appearance of health information; expertise and verification; advertising, pushed, and suggested content).

      Limitations

      Narrow geographic representation of papers and limited quantitative studies.

      Conclusions and Implications of Key Findings

      Adolescents’ trust in health information on social media involves a complex interplay between trust in: social media platforms, other users, and health content. Central to many of the findings is the social and identity work done by adolescents on and through social media.

      Keywords

      What This Systematic Review Adds
      • To our knowledge, this is the first systematic review to explore how adolescents trust health information specifically on social media
      • Friends and networks are important for adolescents’ trust in this space
      • The interface between adolescents’ trust and identity is central
      How to Use This Systematic Review
      • Clinicians caring for adolescents should understand how adolescents’ evaluations of trust on social media influence adolescents’ health-related knowledge
      • Health care organizations and academic pediatricians designing health resources on social media should consider aspects of trust to ensure evidence-based information reaches adolescents
      Social media is a space that allows adolescents to create and nurture social relationships and explore their interests.
      The Lancet
      Children and social media.
      A 2018 survey in the United States found that 97% of adolescents (aged 13–17 years) use social media platforms, such as Facebook, Instagram, and Snapchat.

      Anderson M, Jiang J. Teens, Social Media & Technology 2018. 2018:2018. May 31 2018. Available at:https://www.pewresearch.org/internet/2018/05/31/teens-social-media-technology-2018/. Accessed August 4, 2021.

      Social media is an increasingly important site for adolescents’ acquisition of health information.

      Swist T, Collin P, McCormack J, et al. Social media and the wellbeing of children and young people: a literature review. 2015. Available at:http://www.uws.edu.au/__data/assets/pdf_file/0019/930502/Social_media_and_children_and_young_people.pdf. Accessed November 6, 2022.

      ,
      • Wartella E
      • Rideout V
      • Montague H
      • et al.
      Teens, health and technology: a national survey.
      There are important opportunities to reach adolescents through these compelling and accessible platforms,
      • Hausmann JS
      • Touloumtzis C
      • White MT
      • et al.
      Adolescent and young adult use of social media for health and its implications.
      as well as reasons for caution around the potential spread of poor quality, biased, or harmful health information.
      • Syed-Abdul S
      • Fernandez-Luque L
      • Jian W-S
      • et al.
      Misleading health-related information promoted through video-based social media: anorexia on YouTube.
      Never has it been more apparent than during the COVID-19 pandemic that social media can widely and rapidly spread health information and mis-information.
      • Mian A
      • Khan S.
      Coronavirus: the spread of misinformation.
      Adolescents are often highly skilled at using the Internet for social purposes and to meet their specific needs
      • Boyd D.
      ; however, it is important that adolescents are armed with the expertise and resources necessary to safely navigate health information on social media.
      In this review, trust is understood as a belief in the reliability, accuracy, or credibility of something (eg, a social media post containing sexual health information). Additionally, trust is confidence that actors, objects, or processes will operate in a certain way. For example, confidence that social media platforms will maintain anonymity, or that other users will not respond negatively to health information posted on one's profile.
      In previous reviews conducted by our research team, we have explored how adolescents search for and appraise health information online, and the role of trust when adolescents access this information.
      • Freeman JL
      • Caldwell PHY
      • Scott KM.
      The role of trust when adolescents search for and appraise online health information.
      ,
      • Freeman JL
      • Caldwell PH
      • Bennett PA
      • et al.
      How adolescents search for and appraise online health information: a systematic review.
      Trust in online health information is positively associated with self-efficacy in managing one's own health.
      • Ye Y.
      A path analysis on correlates of consumer trust in online health information: evidence from the health information national trends survey.
      These previous reviews focus on health information on websites; however, given the importance of social media as a space for adolescents to encounter health information,

      Swist T, Collin P, McCormack J, et al. Social media and the wellbeing of children and young people: a literature review. 2015. Available at:http://www.uws.edu.au/__data/assets/pdf_file/0019/930502/Social_media_and_children_and_young_people.pdf. Accessed November 6, 2022.

      ,
      • Wartella E
      • Rideout V
      • Montague H
      • et al.
      Teens, health and technology: a national survey.
      there is a gap in understanding the role of trust in social media. To address this, the current review aimed to explore how adolescents trust health information on social media.

      Methods

      We conducted a systematic review to answer the research question: What are adolescents’ considerations of trust regarding health information on social media in terms of use of social media platforms and services, other social media users, content, and other related issues? We conducted this review in line with the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement
      • Tong A
      • Flemming K
      • McInnes E
      • et al.
      Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ.
      to ensure explicit and comprehensive synthesis of the qualitative studies included.

      Search Strategy and Selection Criteria

      Five databases (MEDLINE, EMBASE, PsycINFO, ERIC, and CINAHL) were systematically searched, from inception to 7th September 2022, for literature relevant to adolescents’ trust in health information on social media. Reference lists of included papers and Google Scholar were searched for additional relevant papers. Papers were managed using EndNote 20 (Clarivate, 2022).
      The search strategy was created with guidance from a health libraries research expert. The strategy was first prepared for MEDLINE (Table 1) and then applied to the other databases. Groups of terms, including Medical Subject Headings (MeSH) and “free terms,” relating to 4 domains (social media, trust, health information, adolescents) were developed. The terms for “trust,” “health information,” and “social media” built on terms in previous related reviews.
      • Freeman JL
      • Caldwell PHY
      • Scott KM.
      The role of trust when adolescents search for and appraise online health information.
      ,
      • Freeman JL
      • Caldwell PH
      • Bennett PA
      • et al.
      How adolescents search for and appraise online health information: a systematic review.
      ,
      • Cheston CC
      • Flickinger TE
      • Chisolm MS.
      Social media use in medical education: a systematic review.
      • Taggart T
      • Grewe ME
      • Conserve DF
      • et al.
      Social media and HIV: a systematic review of uses of social media in HIV communication.
      • Lange L
      • Peikert ML
      • Bleich C
      • Schulz H.
      The extent to which cancer patients trust in cancer-related online information: a systematic review.
      Table 1Search Strategy for MEDLINE
      • 1
        Social Media/
      • 2
        social media*.tw.
      • 3
        exp Social Networking/
      • 4
        Blogging/
      • 5
        (web 2* or user generated content or online community or online communities or virtual community or virtual communities or social media or social medium or Social network* or blog* or weblog* or microblog* or micro-blog* or Twitter or tweet* or mobile apps or mobile app or mobile applications or mobile application or online forum or online forums or bulletin board* or message board* or Skype or instant messag* or text messag* or texting or Patientslikeme or Patients Like Me or YouTube or Flickr or Facebook or LinkedIn or MySpace or SecondLife or Second Life or Listserv or listserve or mailing list* or podcast* or webcast* or wiki* or Snapchat or Instagram).tw.
      • 6
        1 or 2 or 3 or 4 or 5
      • 7
        Trust/
      • 8
        (Trust* or faith* or credibl* or confiden* or plausib* or belie* or rely or relied or reliance* or reliabil* or integrity or accept* or accuracy or accurate or quality or truth* or authentic* or depend or dependabil* or honest* or credence* or certain* or assur*).tw.
      • 9
        7 or 8
      • 10
        exp Health Education/
      • 11
        exp Health/
      • 12
        Health*.tw.
      • 13
        ((health* or wellness) adj2 (information or info or advice or messag* or news or notification* or fact* or material* or clue*)).tw.
      • 14
        10 or 11 or 12 or 13
      • 15
        6 and 9 and 14
      • 16
        Adolescent/
      • 17
        (teen* or young people or young person* or youth* or adolescen* or high school*).tw.
      • 18
        16 or 17
      • 19
        15 and 18
      All papers reporting primary data, including quantitative, qualitative, and mixed methods, studies, were included if they met the following criteria: participants were adolescents aged 13 to 18 years; papers explored health information on social media and examined adolescents’ trust when engaging with this. The definition of social media for this review was restricted to websites and applications that enable social networking (eg, YouTube, Instagram, Facebook) as this is where existing research has focused to date. Any systematic reviews on the topic were searched for relevant primary studies. There was no exclusion by language. The definition of adolescence varies in the literature. Studies that included a broader age bracket were included if they covered a portion of the 13 to 18 age range and did not extend either below the age of 10 or above 28. Papers on trust in information on social media not related to health or reporting the results of interventions were excluded.

      Study Selection

      The titles and abstracts of all retrieved articles were screened by 2 authors: J.F. reviewed every title and abstract; K.S. and P.C. each reviewed half. The full text of prospective eligible studies were retrieved and assessed if the information in the abstract was insufficient to make an informed decision about relevance. Any discrepancies between the researchers were discussed until consensus was reached.

      Critical Appraisal of Included Studies

      All included studies reporting primary research were appraised for methodological quality using the Mixed Methods Appraisal Tool (MMAT).
      • Hong QN
      • Fàbregues S
      • Bartlett G
      • et al.
      The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers.
      This framework included items relevant to areas including the clarity of research questions, adequacy of data collection methods, relevance of sampling strategy, and rationale of approach.

      Data Collection

      Data were extracted from all papers that met the inclusion criteria. The authors developed a data extraction table to record information regarding study design, year, location, setting, participants, recruitment, and potential risks of bias. In accordance with the research question, the authors used line-by-line coding to extract data in the form of descriptions and quotations, following Thomas and Harden.
      • Thomas J
      • Harden A.
      Methods for the thematic synthesis of qualitative research in systematic reviews.
      J.F. reviewed every paper; K.S. and P.C. each reviewed half. Each author's data inputs were combined into one data extraction table.

      Synthesis of Results

      Following Thomas and Harden,
      • Thomas J
      • Harden A.
      Methods for the thematic synthesis of qualitative research in systematic reviews.
      thematic synthesis methodology was used to analyze and synthesize the information from the included papers to develop analytical interpretations beyond the original papers’ findings.
      • Thomas J
      • Harden A.
      Methods for the thematic synthesis of qualitative research in systematic reviews.
      Concepts were identified to capture the meaning of each sentence, using NVivo 12 (QSR International Pty Ltd, 2019) software for data management. Similar concepts were compounded to form preliminary, descriptive themes. Quantitative data were included under the relevant theme. J.F. recorded the descriptive themes in an analytical framework with accompanying descriptions and quotations. This was reviewed by all authors and redeveloped as a higher-level theoretical framework with 11 analytical themes.

      Results

      Study Selection

      As illustrated in the PRISMA flow diagram (Fig. 1), the database search produced 8644 papers and a further 6 were identified through cited references, such as papers included in reviews that met our inclusion criteria, and Google Scholar. If relevance was unclear from the abstract alone and no full-text article was available, the authors were contacted to seek more information. One author responded and forwarded the full text, which was later excluded. The other author of 2 abstracts did not respond, so the abstracts were excluded as they did not contain relevant data for our review. In total, 351 full-text papers were assessed for eligibility, of which 317 were excluded, resulting in the inclusion of 34 titles. Full-text papers were excluded for the following reasons: not about adolescents or no relevant adolescent subgroup analysis (n = 61); not about online health information (n = 42); not about social media (n = 38); not about trust (n = 114); intervention (n = 54); review paper (n = 8). The 34 included titles described 31 studies. In 2 cases, 2 texts provided alternative yet complementary analyses of the same study. As these offered unique insights, they were individually included as separate papers. There was one PhD thesis and one published paper from this thesis. In this case, we have quoted the most comprehensive of these in the findings but included both titles in our table of included studies.
      Figure 1
      Figure 1PRISMA flow diagram illustrating search results.

      Critical Appraisal of Included Studies

      The 34 included papers reporting primary research underwent critical appraisal using the MMAT (Table 2). The MMAT analysis did not raise any significant concerns about the quality of the included papers and none were excluded on this basis.
      Table 2Results From MMAT Analysis of Included Papers
      Screening QuestionsAppraisal by Study TypeScore (%)
      First authorYearS1. Are There Clear Research Questions?S2. Do the Collected Data Allow to Address the Research Questions?
      Qualitative Studies1.1. Is the Qualitative Approach Appropriate to Answer the Research Question?1.2. Are the Qualitative Data Collection Methods Adequate to Address the Research question?1.3. Are the Findings Adequately Derived From the Data?1.4. Is the Interpretation of Results Sufficiently Substantiated by Data?1.5. Is There Coherence Between Qualitative Data Sources, Collection, Analysis, and Interpretation?
      Ahola Kohut
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      2017YesYesYesYesYesYesYes100
      Booth

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      2018YesYesYesYesYesYesYes100
      Booth
      • Booth KM
      • Trauth EM.
      2019YesYesYesYesYesYesYes100
      Byron
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      2013NoNoYesYesYesYesYes100
      Byron
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      2015YesYesYesYesYesYesYes100
      Fergie
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      2013YesYesYesYesYesYesYes100
      Goodyear
      • Goodyear VA
      • Armour KM
      • Wood H.
      Young people and their engagement with health-related social media: new perspectives.
      2019YesYesYesYesYesYesYes100
      Goodyear & Armour (“Young People, Social Media, and Health”)

      Goodyear VA, Armour KM. Young people, social media and health. Abingdon, Oxon: Routledge; 2019.

      2019YesYesYesYesYesYesYes100
      Goodyear & Quennerstedt
      • Goodyear V
      • Quennerstedt M.
      #Gymlad - young boys learning processes and health-related social media.
      2020YesYesYesYesYesYesYes100
      Gray
      • Gray NJ
      • Klein JD
      • Noyce PR
      • et al.
      Health information-seeking behaviour in adolescence: the place of the internet. Comparative study research support, non-U.S. Gov't.
      2005YesYesYesYesYesYesYes100
      Harris
      • Harris J
      • Atkinson A
      • Mink M
      • et al.
      Young people's experiences and perceptions of youtuber-produced health content: implications for health promotion. Research support, Non-U.S. Gov't.
      2021YesYes100
      Holland
      • Holland A.
      Osteoporosis knowledge translation for young adults: new directions for prevention programs.
      2017YesYesYesYesYesYesYes100
      Holmberg
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.
      2019YesYesYesYesCan't tellYesCan't tell80
      Kenny
      • Kenny R
      • Dooley B
      • Fitzgerald A.
      Developing mental health mobile apps: exploring adolescents' perspectives.
      2016YesYesYesYesYesYesYes100
      Lariscy
      • Lariscy R
      • Reber B
      • Paek H-J.
      Exploration of health concerns and the role of social media information among rural and urban adolescents: a preliminary study. Journal articles reports - research.
      2011YesYesYesYesYesYesYes100
      Lavis
      • Lavis A
      • Winter R.
      #Online harms or benefits? An ethnographic analysis of the positives and negatives of peer-support around self-harm on social media.
      2020YesYesYesYesYesYesYes100
      Macharia
      • Macharia P
      • Pérez-Navarro A
      • Inwani I
      • et al.
      An exploratory study of current sources of adolescent sexual and reproductive health information in Kenya and their limitations: are mobile phone technologies the answer?.
      2021YesYesYesYesYesYesYes100
      Malik
      • Malik FS
      • Panlasigui N
      • Gritton J
      • et al.
      Adolescent perspectives on the use of social media to support type 1 diabetes management: focus group study. Research support, N.I.H., Extramural.
      2019YesYesYesYesYesYesYes100
      Ortiz
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.
      2015YesYesYesYesCan't tellYesCan't tell80
      Patterson
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.
      2019YesYesYesYesYesYesYes100
      Raeside
      • Raeside R
      • Jia SS
      • Redfern J
      • et al.
      Navigating the online world of lifestyle health information: qualitative study with adolescents.
      2022YesYesYesYesYesYesYes100
      Selkie
      • Selkie EM
      • Benson M
      • Moreno M.
      Adolescents' views regarding uses of social networking websites and text messaging for adolescent sexual health education.
      2011YesYesYesYesYesYesYes100
      Selkie
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      2020YesYesYesYesYesYesYes100
      Simon
      • Simon L.
      Adolescents' sex education using new digital media: the personal motivations and interactive experiences of young people online at Reddit.com. Conference Abstract.
      2013YesYesYesYesCan't tellYesCan't tell80
      Thianthai
      • Thianthai C.
      What does social media have to do with health? A case study of Bangkok youths.
      2018YesYesYesYesYesYesYes100
      Van Dyck
      • Van Dyck D
      • D'Haese S
      • Plaete J
      • et al.
      Opinions towards physical activity interventions using Facebook or text messaging: focus group interviews with vocational school-aged adolescents. Research support, non-U.S. Gov't.
      2019YesYesYesYesYesYesYes100
      Veinot
      • Veinot TC
      • Campbell TR
      • Kruger DJ
      • et al.
      A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth.
      2013YesYesYesYesYesYesYes100
      Quantitative Descriptive Studies4.1. Is the Sampling Strategy Relevant to Address the Research Question?4.2.Is the Sample Representative of the Target Population?4.3. Are the Measurements Appropriate?4.4. Is the Risk of Nonresponse Bias Low?4.5. Is the Statistical Analysis Appropriate to Answer the Research question?
      Best
      • Best P
      • Manktelow R
      • Taylor BJ.
      Social work and social media: online help-seeking and the mental well-being of adolescent males.
      2016YesYesYesYesYesCan't tellYes90
      Esmaeilzadeh
      • Esmaeilzadeh S
      • Ashrafi-Rizi H
      • Shahrzadi L
      • et al.
      A survey on adolescent health information seeking behavior related to high-risk behaviors in a selected educational district in Isfahan. Research Support, Non-U.S. Gov't.
      2018YesYesYesYesYesYesYes100
      Zhang
      • Zhang MW
      • Tran BX
      • Le HT
      • et al.
      Perceptions of health-related information on Facebook: cross-sectional study among vietnamese youths.
      2017YesYesYesYesYesCan't tellYes90
      Mixed Methods Studies5.1. Is There an Adequate Rationale for Using a Mixed Methods Design to Address the Research Question?5.2. Are the Different Components of the Study Effectively Integrated to Answer the Research Question?5.3. Are the Outputs of the Integration of Qualitative and Quantitative Components Adequately Interpreted?5.4. Are Divergences and Inconsistencies Between Quantitative and Qualitative Results Adequately Addressed?5.5. Do the Different Components of the Study Adhere to the Quality Criteria of Each Tradition of the Methods Involved?
      Evans
      • Evans YN
      • Gridley SJ
      • Crouch J
      • et al.
      Understanding online resource use by transgender youth and caregivers: a qualitative study.
      2015YesYesYesYesYesNoNo80
      Leary
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.
      2019YesYesYesYesYesYesYes100
      Nikolaou
      • Nikolaou CK
      • Tay Z
      • Leu J
      • et al.
      Young people's attitudes and motivations toward social media and mobile apps for weight control: mixed methods study. Research support, non-U.S. Gov't.
      2019YesYesYesYesYesYesYes100
      Plaisime
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.
      2020YesYesYesYesYesYesYes100

      Study Characteristics

      The characteristics of the included studies are in Table 3. All were published in English, mostly during or after 2017 (n = 23). Primary studies were undertaken in a range of countries, including: the United States (n = 10), the United Kingdom (n = 10), Canada (n = 2), and Kenya (n = 1). Two studies reported cross-national data. Qualitative methods were used by most papers, although 6 reported some quantitative data analysis. Common methods included: surveys and demographic questionnaires (n = 11), as well as focus groups (n = 20) and interviews (n = 11), from which descriptions and quotations were extracted for analysis. A few papers included adolescents in clinical settings (n = 6). Health topics included general (n = 12), sexual health (n = 7), and physical activity, nutrition, and weight (n = 7).
      Table 3Characteristics of Included Studies
      Study, Country and SampleNSex DistributionAge Range, YearsConceptual Methodological FrameworkData CollectionAnalysisTopic
      Ahola Kohut et al (2017)
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.


      Canada

      Clinical sample from 3 pediatric hospitals
      3365% female; 36% male12–18 (M = 15.3, SD = 1.8)QualitativeSemistructured interviewsInductive content analysisNeeds and preferences of adolescents with chronic conditions for online support programs specific to living with a chronic condition
      Best et al (2016)
      • Best P
      • Manktelow R
      • Taylor BJ.
      Social work and social media: online help-seeking and the mental well-being of adolescent males.


      United Kingdom

      Nonclinical sample from 7 secondary schools in Northern Ireland
      527100% male14–15QuantitativeSurveyStatistical analyses (including chi-square tests for independence, t-tests, analyses of variance and standard linear regression for correlational analyses)The impact of online help-seeking behaviors on the mental wellbeing of adolescent males
      Booth (2018)

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.



      United States

      Nonclinical sample from 2 charter schools and 2 Parent-Teacher Associations (PTA)
      3076.7% female; 23.3% male13–18QualitativeSemistructured interviews and practical task (participants accessed known fitness content on social media)Thematic analysisStrategies young people use to assess fitness information online and intersecting identity characteristics that relate to how young people make these decisions
      Booth & Trauth (2019)
      • Booth KM
      • Trauth EM.


      United States

      Nonclinical sample from 2 low-SES and 2 high-SES school districts
      3077% female; 23% male13–18QualitativeSemistructured interviews and practical task (participants accessed known fitness content on social media)Thematic analysisHow teenagers interact with and make decisions about the quality of video-based exercise and nutrition content they interact with via social media
      Byron et al (2013)
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.


      Australia

      Nonclinical sample from urban and regional communities
      2250% female; 50% male16–22QualitativeFocus groups and design of delivery strategies for hypothetical social media sexual health campaigns for young peopleSituated discourse analysisSexual health promotion for young people via Facebook and other social media
      Byron et al (2015)
      • Byron P.
      Troubling expertise: social media and young people's sexual health.


      Australia

      Nonclinical sample from urban and regional communities
      2250% female; 50% male16–22QualitativeLiterature review and focus groupThematic analysisHow formal “expertise” is leveraged through the subjugation of young people's knowledge, and how this is problematic for sexual health promotion; seeking to engage with young people through social media
      Esmaeilzadeh et al (2018)
      • Esmaeilzadeh S
      • Ashrafi-Rizi H
      • Shahrzadi L
      • et al.
      A survey on adolescent health information seeking behavior related to high-risk behaviors in a selected educational district in Isfahan. Research Support, Non-U.S. Gov't.


      Iran

      Nonclnical sample of public school students
      39251.8% female; 48.2% male15–18QuantitativeSurveyStatistical analyses (including descriptive statistics, independent t-test, one-sample t-test, chi-square, Pearson correlation coefficient, and Mann-Whitney)Adolescent health information seeking behavior related to high-risk behaviors
      Evans et al (2015)
      • Evans YN
      • Gridley SJ
      • Crouch J
      • et al.
      Understanding online resource use by transgender youth and caregivers: a qualitative study.


      United States

      Clinical sample of self-identified transgender youth
      1520% trans-feminine; 47% trans-masculine; 33% other14–22 (M = 18)Mixed methodsFocus groups, interviews [plus online survey for caregivers (not adolescents) outside the scope of this review]Thematic analysisWhat online resources transgender youth and their caregivers use to acquire information about transgender health
      Fergie et al (2013)
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.


      United Kingdom

      Nonclinical sample of adolescents from a range of socioeconomic areas in Scotland
      3470.5% female; 29.5% male14–18QualitativeFocus groups and practical task (participants looked for examples of health-related content on social media)Thematic analysisYoung people's perceptions and experiences of engaging with health content online, particularly through social media, and their strategies for negotiating reliability online
      Goodyear et al (2019)
      • Goodyear VA
      • Armour KM
      • Wood H.
      Young people and their engagement with health-related social media: new perspectives.


      “Young people and their engagement with health-related

      social media: new perspectives”

      United Kingdom

      Nonclinical sample from 10 schools in the West Midlands and the South of England

      1296Phase 1: 40% female; 60% male

      Phase 2: 57.2% female; 23.8% male

      Phase 3: 67.1% female; 23.9% male
      13–18Mixed methodsPhase 1: piloting and coconstructing participatory class activities

      Phase 2: participatory class activities and interviews

      Phase 3: survey
      Descriptive statistics and thematic analysisThe ways in which young people engage with health-related social media and the influences they report on their health in the specific areas of physical activity, diet/nutrition and body image
      Goodyear & Armour (2019)

      Goodyear VA, Armour KM. Young people, social media and health. Abingdon, Oxon: Routledge; 2019.



      “Young People, Social Media and Health”

      United Kingdom

      Nonclinical sample from 10 schools in the United Kingdom
      1346Phase 1:

      Participatory activities (57.2% female; 42.8% male); Focus groups (58.3% female; 41.7% male); survey (66.5% female; 32.9% male)

      Phase 2: Stakeholders (not adolescents)

      Phase 3: Unspecified
      13–18Case study methodologyPhase 1: participatory activities, focus groups, survey

      Phase 2: workshop with key stakeholders

      Phase 3: workshop with young people
      Case study analysisThe opportunities and risk-related impacts of social media on young people's health
      Goodyear & Quennerstedt (2020)
      • Goodyear V
      • Quennerstedt M.
      #Gymlad - young boys learning processes and health-related social media.


      United Kingdom

      Nonclinical sample from 10 schools in the United Kingdom
      8458.3% female; 41.7% male13–15Practical Epistemology Analysis (PEA)Participatory class activities (including a questionnaire) and focus group interviews

      (Note: paper focuses on analysis of focus group interviews)
      Thematic analysisYoung boys’ health-related learning in relation to social media
      Gray et al (2005)
      • Gray NJ
      • Klein JD
      • Noyce PR
      • et al.
      Health information-seeking behaviour in adolescence: the place of the internet. Comparative study research support, non-U.S. Gov't.


      “Health information-seeking behavior in adolescence: The place of the Internet.”

      United Kingdom and United States

      Nonclinical sample from UK high schools and US middle schools and high schools
      157NS11–19QualitativeFocus groupsThematic analysisUK and US adolescents’ perceptions and experiences of online health information seeking
      Harris et al (2021)
      • Harris J
      • Atkinson A
      • Mink M
      • et al.
      Young people's experiences and perceptions of youtuber-produced health content: implications for health promotion. Research support, Non-U.S. Gov't.


      United Kingdom

      Nonclinical sample from 3 secondary schools and sixth-form colleges in North West England
      8553% female; 47% male13–18QualitativeFocus groupsThematic analysisYoung people's perceptions and experiences of YoutTuber-produced health content
      Holland (2017)
      • Holland A.
      Osteoporosis knowledge translation for young adults: new directions for prevention programs.


      Canada

      Nonclinical sample from McMaster University, Mohawk college, and the community in Hamilton, Ontario
      6050% female; 50% male17–30QualitativeSociodemographic questionnaire and semistructured interviewsDescriptive statistics and thematic analysisSources and types of information young adults consult for information on nutrition and bone health
      Holmberg et al (2019)
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.


      Sweden

      Clinical sample of pediatric patients undergoing treatment

      for obesity at a Swedish University Hospital
      2055% female; 45% male13–16QualitativeSemistructured interviews and practical search taskContent analysisHow patients search for and select online information regarding food, body weight, and health, and how they experience this information
      Kenny et al (2016)
      • Kenny R
      • Dooley B
      • Fitzgerald A.
      Developing mental health mobile apps: exploring adolescents' perspectives.


      Ireland

      Nonclinical sample from 2 single-sex secondary schools in Dublin, Ireland
      3440% female; 60% male15–16QualitativeFocus groupsThematic analysisAdolescents’ needs from mental health mobile apps and adolescents’ perspectives on a mental health mobile app prototype
      Lariscy et al (2011)
      • Lariscy R
      • Reber B
      • Paek H-J.
      Exploration of health concerns and the role of social media information among rural and urban adolescents: a preliminary study. Journal articles reports - research.


      United States

      Nonclinical sample of rural and urban seventh-grade students
      4250% female; 50% maleSeventh-grade studentsGrounded theoryFocus groupsThematic analysisAdolescents’ health concerns and the sources they rely on most for health information
      Lavis & Winter (2020)
      • Lavis A
      • Winter R.
      #Online harms or benefits? An ethnographic analysis of the positives and negatives of peer-support around self-harm on social media.


      United Kingdom

      Online ethnography and nonclinical sample for interviews recruited on social media
      10100% female10–24 for online ethnographyEthnographyOnline ethnography (Instagram, Twitter, and Reddit) [plus semistructured interviews with those over 18 years, outside the scope of this review]Thematic analysisThe harms and benefits of young people's engagements with self-harm content on social media, including why and how young people engage in online self-harm discussions and what they post
      Leary et al (2019)
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.


      United States

      Nonclinical sample from middle schools and high schools
      27100% female12–18Mixed methodsFocus groups and surveys for adolescents and adultsDescriptive statistics and content analysisUse of and exposure to social media among adolescent girls with regard to health-related content
      Macharia et al (2021)
      • Macharia P
      • Pérez-Navarro A
      • Inwani I
      • et al.
      An exploratory study of current sources of adolescent sexual and reproductive health information in Kenya and their limitations: are mobile phone technologies the answer?.


      Kenya

      Nonclinical sample from Kibra, a suburb in the city of Nairobi
      13354% female; 46% male15–19QualitativeFocus groupsThematic analysisAdolescents’ current sexual and reproductive health information sources, existing information gaps, and the role of technology in accessing this information
      Malik et al (2019)
      • Malik FS
      • Panlasigui N
      • Gritton J
      • et al.
      Adolescent perspectives on the use of social media to support type 1 diabetes management: focus group study. Research support, N.I.H., Extramural.


      United States

      Clinical sample of adolescents with Type 1 Diabetes from Seattle Children's Hospital Diabetes Clinics
      4542% female; 58% male13–19 (M = 15.9, SD = 1.7)QualitativeFocus groups and demographic questionnaireDescriptive statistics and thematic analysisThe experiences and perspectives of adolescents with type 1 diabetes on the feasibility of social media use as a tool to collaboratively manage their diabetes with their diabetes care team
      Nikolaou et al (2019)
      • Nikolaou CK
      • Tay Z
      • Leu J
      • et al.
      Young people's attitudes and motivations toward social media and mobile apps for weight control: mixed methods study. Research support, non-U.S. Gov't.


      United Kingdom, Belgium, Finland, Greece, Singapore, and New Zealand

      Nonclinical sample recruited via an online advertisement service
      2285 (610 adolescents)Survey: 70% female; 30% male

      Focus groups: 57–67% female; 33–43% male
      13–24Mixed methodsSurvey and focus groupsDescriptive statistics, inferential statistics, and thematic analysisYoung people's attitudes and motivations toward social media and mobile apps for weight control
      Ortiz et al (2015)
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.


      United States

      Clinical sample from a pediatric and adolescent clinic in North Carolina
      3834% female; 66% male11–21 (M = 15.86)QualitativeFocus groupsThematic analysisFeasibility and strategies for using social media to promote HPV vaccination to patients
      Patterson et al (2019)
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.


      United Kingdom

      Nonclinical sample of local youth in Scotland
      4961% female; 39% male16–19QualitativeInterviews and practical search tasksThematic analysisBarriers and challenges faced by adolescents when searching for sexual health information on the Internet
      Plaisime et al (2020)
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.


      United States

      Nonclinical sample from schools in Philadelphia and Drexel University College of Medicine
      178Survey: 46% female; 46% male; 7.2% not reported

      Focus groups: 53.8% female; 46.3% male
      13–18Mixed methodsSocial media usability survey and focus groupsDescriptive statistics and content analysisTeen social media use and the role of social media as a health promotion tool
      Raeside et al (2022)
      • Raeside R
      • Jia SS
      • Redfern J
      • et al.
      Navigating the online world of lifestyle health information: qualitative study with adolescents.


      Australia

      Nonclinical sample from existing database and known networks
      3246% female; 41% male; 3% prefer not to say13–18QualitativeFocus groupsThematic analysisAdolescent perceptions of obtaining information or advice related to lifestyle health from contemporary digital platforms
      Selkie et al (2011)
      • Selkie EM
      • Benson M
      • Moreno M.
      Adolescents' views regarding uses of social networking websites and text messaging for adolescent sexual health education.


      United States

      Nonclinical sample from recreational centers and schools in urban and suburban areas
      2934.5% male; 65.5% female14–19Grounded theoryFocus groupsThematic analysisAdolescents' views regarding uses of social networking websites and text messaging for sexual health education
      Selkie et al (2020)
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.


      United States

      Clinical sample from pediatric gender clinic in Midwestern United States
      2544% trans-feminine; 52% trans-masculine; 4% nonbinary15–18 (average = 16)QualitativeSemistructured interviewsThematic analysisHow transgender adolescents use social media to find social support
      Simon (2013)
      • Simon L.
      Adolescents' sex education using new digital media: the personal motivations and interactive experiences of young people online at Reddit.com. Conference Abstract.


      Sweden

      Nonclinical sample of adolescents who had experiences of sexual learning on the Internet
      15NSNSQualitativeInterviewsThematic analysisThe personal motivations and interactive experiences of sex education for young people online at Reddit.com
      Thianthai (2018)
      • Thianthai C.
      What does social media have to do with health? A case study of Bangkok youths.


      Thailand

      Nonclinical sample from public schools and a youth camp in the Bangkok metropolitan area
      7448.6% female; 51.4% male15–24QualitativeInterviews and practical search taskContent analysisHow youths perceive social media affects their physical, psychological, social, and spiritual health
      Van Dyck et al (2019)
      • Van Dyck D
      • D'Haese S
      • Plaete J
      • et al.
      Opinions towards physical activity interventions using Facebook or text messaging: focus group interviews with vocational school-aged adolescents. Research support, non-U.S. Gov't.


      Belgium

      Nonclinical sample of first graders from 3 secondary vocational schools in Flanders
      4149% female; 51% male12–14Mixed methodsFocus groups and demographic questionnaireDescriptive statistics and thematic analysisOpinions of adolescents toward the use of different behavior change techniques and toward Facebook/text messaging as a delivery mode for physical activity interventions
      Veinot et al (2013)
      • Veinot TC
      • Campbell TR
      • Kruger DJ
      • et al.
      A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth.


      United States

      Nonclinical sample of African-American youth from urban areas in Midwestern United States
      7571% female; 29% male14–24 (M = 18.3)QualitativeFocus groupsContent analysisThe user requirements of African-American youth inform the design of a culturally appropriate, network-based informatics intervention for the prevention of HIV and other sexually transmitted infections
      Zhang et al (2017)
      • Zhang MW
      • Tran BX
      • Le HT
      • et al.
      Perceptions of health-related information on Facebook: cross-sectional study among vietnamese youths.


      Vietnam

      Nonclinical sample initially recruited from high schools and universities
      108058.06% female; 41.94% male15–25QuantitativeOnline surveyStatistical analyses (including chi-square, t-test, analysis of variance, and multivariate logistic Regressions)Use of Facebook and youths’ perception of the reliability and usefulness of health-related information that they previously encountered while using Facebook

      Results Synthesis

      Themes were drawn out with findings relevant to each of our 3 key areas (trust in social media platforms/services; trust in other users; trust in content). We identified the concept of “identity formation and performance” within many of these; no other related issues were identified.
      On trust in social media platforms/services, 2 themes were identified: i) general distrust of social media for health information; ii) safety and privacy.
      With respect to trust in other users, 6 themes were identified: i) mistrust of unknown users; ii) fear of bullying or judgment; iii) trust in friends or peers; iv) celebrities and popularity; v) trust in others’ experience; vi) the importance of social support.
      Three themes were established under trust in content: i) tone and appearance of health information; ii) expertise and verification; iii) advertising and pushed or suggested content.
      Quotations from adolescents illustrating each theme are in Table 4 and highlighted below. The authors have separated these into 3 key areas to provide structure in this review; in practice, these themes are inextricably linked and feed into and out of one another. This emphasizes the complexity of adolescents’ trust in health information on social media and its role in adolescents’ identity formation and performance.
      Table 4Illustrative Quotations From Included Studies
      ThemeQuotationsReferences Where Theme Is Mentioned
      Trust in the social media platform/service
      General distrust of social media for health information“Bea: [You] can't always trust the information that you find.

      Alison: And if you do trust it, [. . .] you could do more harm than good.

      Cara: Yeah.”
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.


      “[social media] isn't reliable, it's just someone's opinion”
      • Holland A.
      Osteoporosis knowledge translation for young adults: new directions for prevention programs.


      “Tumblr, that's a bad site. That's a bad site to get your medical information from. People spread misinformation like it's going out of fashion.”
      • Evans YN
      • Gridley SJ
      • Crouch J
      • et al.
      Understanding online resource use by transgender youth and caregivers: a qualitative study.


      “Not all the social media information is true, the best thing to do is just look for a health organization providing reproductive health services.”
      • Macharia P
      • Pérez-Navarro A
      • Inwani I
      • et al.
      An exploratory study of current sources of adolescent sexual and reproductive health information in Kenya and their limitations: are mobile phone technologies the answer?.
      • Lariscy R
      • Reber B
      • Paek H-J.
      Exploration of health concerns and the role of social media information among rural and urban adolescents: a preliminary study. Journal articles reports - research.
      • Best P
      • Manktelow R
      • Taylor BJ.
      Social work and social media: online help-seeking and the mental well-being of adolescent males.
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      • Macharia P
      • Pérez-Navarro A
      • Inwani I
      • et al.
      An exploratory study of current sources of adolescent sexual and reproductive health information in Kenya and their limitations: are mobile phone technologies the answer?.

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      • Zhang MW
      • Tran BX
      • Le HT
      • et al.
      Perceptions of health-related information on Facebook: cross-sectional study among vietnamese youths.
      • Evans YN
      • Gridley SJ
      • Crouch J
      • et al.
      Understanding online resource use by transgender youth and caregivers: a qualitative study.
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.
      ,
      • Holland A.
      Osteoporosis knowledge translation for young adults: new directions for prevention programs.
      • Harris J
      • Atkinson A
      • Mink M
      • et al.
      Young people's experiences and perceptions of youtuber-produced health content: implications for health promotion. Research support, Non-U.S. Gov't.
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      • Esmaeilzadeh S
      • Ashrafi-Rizi H
      • Shahrzadi L
      • et al.
      A survey on adolescent health information seeking behavior related to high-risk behaviors in a selected educational district in Isfahan. Research Support, Non-U.S. Gov't.
      ,
      • Thianthai C.
      What does social media have to do with health? A case study of Bangkok youths.
      Safety and privacy“You can't always rely on technology...if someone hacks into it for whatever reason”
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.


      “I came out online first and then to friends in school including teachers. But I felt... I felt like I could. It's… it's really contradictory online because it's so impersonal yet personal at the same time. But it felt like I was seen on as a male online, and if I can do that here then I can do that in school and in my home and in other places where that impacts my life.”
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      • Best P
      • Manktelow R
      • Taylor BJ.
      Social work and social media: online help-seeking and the mental well-being of adolescent males.
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      • Macharia P
      • Pérez-Navarro A
      • Inwani I
      • et al.
      An exploratory study of current sources of adolescent sexual and reproductive health information in Kenya and their limitations: are mobile phone technologies the answer?.
      ,
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.
      ,
      • Harris J
      • Atkinson A
      • Mink M
      • et al.
      Young people's experiences and perceptions of youtuber-produced health content: implications for health promotion. Research support, Non-U.S. Gov't.
      ,
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      • Esmaeilzadeh S
      • Ashrafi-Rizi H
      • Shahrzadi L
      • et al.
      A survey on adolescent health information seeking behavior related to high-risk behaviors in a selected educational district in Isfahan. Research Support, Non-U.S. Gov't.
      • Kenny R
      • Dooley B
      • Fitzgerald A.
      Developing mental health mobile apps: exploring adolescents' perspectives.
      • Malik FS
      • Panlasigui N
      • Gritton J
      • et al.
      Adolescent perspectives on the use of social media to support type 1 diabetes management: focus group study. Research support, N.I.H., Extramural.
      • Nikolaou CK
      • Tay Z
      • Leu J
      • et al.
      Young people's attitudes and motivations toward social media and mobile apps for weight control: mixed methods study. Research support, non-U.S. Gov't.
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      • Selkie EM
      • Benson M
      • Moreno M.
      Adolescents' views regarding uses of social networking websites and text messaging for adolescent sexual health education.
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      • Simon L.
      Adolescents' sex education using new digital media: the personal motivations and interactive experiences of young people online at Reddit.com. Conference Abstract.
      • Gray NJ
      • Klein JD
      • Noyce PR
      • et al.
      Health information-seeking behaviour in adolescence: the place of the internet. Comparative study research support, non-U.S. Gov't.
      • Van Dyck D
      • D'Haese S
      • Plaete J
      • et al.
      Opinions towards physical activity interventions using Facebook or text messaging: focus group interviews with vocational school-aged adolescents. Research support, non-U.S. Gov't.
      • Goodyear V
      • Quennerstedt M.
      #Gymlad - young boys learning processes and health-related social media.
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.
      Trust in other users
      Mistrust of unknown users“if who you are talking to is really who you are talking to.”
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      • Best P
      • Manktelow R
      • Taylor BJ.
      Social work and social media: online help-seeking and the mental well-being of adolescent males.
      ,
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      ,
      • Holland A.
      Osteoporosis knowledge translation for young adults: new directions for prevention programs.
      ,
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      ,
      • Gray NJ
      • Klein JD
      • Noyce PR
      • et al.
      Health information-seeking behaviour in adolescence: the place of the internet. Comparative study research support, non-U.S. Gov't.
      Fear of bullying or judgment“On Facebook, simply ‘Liking’ sexual health content was deemed sufficient to attract judgement,” as Josie and Kyle explained:

      Kyle: Like you've liked it an’ then everybody's like “Oh, why?”

      Josie: Like, “What's he dae'in (doing) that for?!”

      Kyle: Yeah, “What are you dae'in that for, you dirty (a promiscuous person)?! (laughing)”
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.


      “[Cyberbullying] occurs more on social media these days, [more] than it occurs in person. There are [like] new bullies. [Fights] start on social media — [someone writes something] on Instagram or whatever, and then it's a problem in the [whole] school because of what [one] person wrote.”
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.


      “...it should be moderated...in case somebody who is just out there to find a site to start a mess.”
      • Veinot TC
      • Campbell TR
      • Kruger DJ
      • et al.
      A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth.


      “…if you could find other reasons that people should watch the videos without that direct link to the diseases that you are talking about – because that's a lot of where the stigma comes from.”
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.


      “I don't put it on Instagram. I don't think I have the confidence to do that really. I feel like I'd get bullied, I'm not going to lie.”
      • Goodyear V
      • Quennerstedt M.
      #Gymlad - young boys learning processes and health-related social media.
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      • Macharia P
      • Pérez-Navarro A
      • Inwani I
      • et al.
      An exploratory study of current sources of adolescent sexual and reproductive health information in Kenya and their limitations: are mobile phone technologies the answer?.

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      ,
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.
      ,
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Kenny R
      • Dooley B
      • Fitzgerald A.
      Developing mental health mobile apps: exploring adolescents' perspectives.
      ,
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      ,
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      ,
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      ,
      • Van Dyck D
      • D'Haese S
      • Plaete J
      • et al.
      Opinions towards physical activity interventions using Facebook or text messaging: focus group interviews with vocational school-aged adolescents. Research support, non-U.S. Gov't.
      • Goodyear V
      • Quennerstedt M.
      #Gymlad - young boys learning processes and health-related social media.
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.
      • Goodyear VA
      • Armour KM
      • Wood H.
      Young people and their engagement with health-related social media: new perspectives.
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.

      Goodyear VA, Armour KM. Young people, social media and health. Abingdon, Oxon: Routledge; 2019.

      • Veinot TC
      • Campbell TR
      • Kruger DJ
      • et al.
      A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth.
      Trust in friends or peers“I'd definitely trust my friends more than celebrities although I do aspire and like them.”
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.


      “It would be nice to create a Facebook page from our class on Facebook, to share activities

      Moderator: Can other people be allowed to join your group?

      No, only people I know!”
      • Van Dyck D
      • D'Haese S
      • Plaete J
      • et al.
      Opinions towards physical activity interventions using Facebook or text messaging: focus group interviews with vocational school-aged adolescents. Research support, non-U.S. Gov't.


      “Female: ‘Yeah. With health information, I think it's better if it's anonymous because I don't think everyone's really comfortable about talking about that kind of stuff with random [people]... It's something they want to keep to themselves.’

      Female: ‘Close friends, yeah, but not like everyone I have on Facebook.’”
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.
      ,
      • Holland A.
      Osteoporosis knowledge translation for young adults: new directions for prevention programs.
      ,
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Esmaeilzadeh S
      • Ashrafi-Rizi H
      • Shahrzadi L
      • et al.
      A survey on adolescent health information seeking behavior related to high-risk behaviors in a selected educational district in Isfahan. Research Support, Non-U.S. Gov't.
      ,
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      • Selkie EM
      • Benson M
      • Moreno M.
      Adolescents' views regarding uses of social networking websites and text messaging for adolescent sexual health education.
      ,
      • Van Dyck D
      • D'Haese S
      • Plaete J
      • et al.
      Opinions towards physical activity interventions using Facebook or text messaging: focus group interviews with vocational school-aged adolescents. Research support, non-U.S. Gov't.
      ,
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.
      ,
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.
      ,

      Goodyear VA, Armour KM. Young people, social media and health. Abingdon, Oxon: Routledge; 2019.

      Celebrities and popularity“well, I feel, I get jealous sort of… that's how I feel… I am happy for their sake, but still, I can feel like no, it will never work and stuff like that… and that is not so nice”
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.


      “Interviewer: What's a good amount of likes?

      Female 1: 500

      Female 2: 100, or like 110….

      Interviewer: So if a picture of something—an exercise someone was doing—had 100 odd likes, does that show it's good?…

      Female 1: It doesn't appeal to us as much, because it's only 100 likes—so it shows that if other people are not interested, why should we.”
      • Goodyear VA
      • Armour KM
      • Wood H.
      Young people and their engagement with health-related social media: new perspectives.


      “Darnell (18) explained that if a video has over 100,000 views, that means it has a good audience. When searching for videos, Jasmine (17) selects the video in her search results that has the most views.”

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.



      “on Facebook [. . .], reliability could be determined by how many people ‘like’ the page, cos that would mean that it's been around for a while and [. ..] it's a popularity sort of thing”
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.


      “When you see someone on Instagram [and] you know they look good because of how they [look] and how they exercise”
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      ,

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      ,
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.
      ,
      • Holland A.
      Osteoporosis knowledge translation for young adults: new directions for prevention programs.
      • Harris J
      • Atkinson A
      • Mink M
      • et al.
      Young people's experiences and perceptions of youtuber-produced health content: implications for health promotion. Research support, Non-U.S. Gov't.
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.
      ,
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      ,
      • Goodyear V
      • Quennerstedt M.
      #Gymlad - young boys learning processes and health-related social media.
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.
      • Goodyear VA
      • Armour KM
      • Wood H.
      Young people and their engagement with health-related social media: new perspectives.
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.

      Goodyear VA, Armour KM. Young people, social media and health. Abingdon, Oxon: Routledge; 2019.

      ,
      • Raeside R
      • Jia SS
      • Redfern J
      • et al.
      Navigating the online world of lifestyle health information: qualitative study with adolescents.
      Trust in others’ experience and the importance of social support“it feels good… like they are helping me… and that we help each other since we have the same problem”
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.


      “You can form really strong bonds over the internet and I think if you have something as big as diabetes in common then like you could probably bond really fast. I mean I trust you guys and I've only met you today”
      • Malik FS
      • Panlasigui N
      • Gritton J
      • et al.
      Adolescent perspectives on the use of social media to support type 1 diabetes management: focus group study. Research support, N.I.H., Extramural.


      “…but it would have to be a real story, not a made up one.”
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.


      “Sometimes it feels good to just let it out and then people comment and they're like yeah this happened to me too or they say something positive about that experience and how it is handled. It makes you feel good.”
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.


      "Peter: Social media is most likely to have personal opinions I think and the more informative like official sites they would have dry facts about the illness or any other problem you might have, so you kind of should look at both, to have the facts and then see how other people react to that, I think that's a great combination.

      Anya: It's true."
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.


      “If you were talking to someone [on social media] that had a certain way they handled their diabetes, that you liked...you could exchange tips and tricks for treating diabetes.”
      • Malik FS
      • Panlasigui N
      • Gritton J
      • et al.
      Adolescent perspectives on the use of social media to support type 1 diabetes management: focus group study. Research support, N.I.H., Extramural.


      “that's the-the thing that…I get the most support out of right now, because […] that's a part of my identity.”
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      ,

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      ,
      • Evans YN
      • Gridley SJ
      • Crouch J
      • et al.
      Understanding online resource use by transgender youth and caregivers: a qualitative study.
      ,
      • Harris J
      • Atkinson A
      • Mink M
      • et al.
      Young people's experiences and perceptions of youtuber-produced health content: implications for health promotion. Research support, Non-U.S. Gov't.
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Malik FS
      • Panlasigui N
      • Gritton J
      • et al.
      Adolescent perspectives on the use of social media to support type 1 diabetes management: focus group study. Research support, N.I.H., Extramural.
      ,
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      ,
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      • Simon L.
      Adolescents' sex education using new digital media: the personal motivations and interactive experiences of young people online at Reddit.com. Conference Abstract.
      • Gray NJ
      • Klein JD
      • Noyce PR
      • et al.
      Health information-seeking behaviour in adolescence: the place of the internet. Comparative study research support, non-U.S. Gov't.
      ,
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.
      ,

      Goodyear VA, Armour KM. Young people, social media and health. Abingdon, Oxon: Routledge; 2019.

      ,
      • Raeside R
      • Jia SS
      • Redfern J
      • et al.
      Navigating the online world of lifestyle health information: qualitative study with adolescents.
      ,
      • Lavis A
      • Winter R.
      #Online harms or benefits? An ethnographic analysis of the positives and negatives of peer-support around self-harm on social media.
      Trust in content
      Tone and appearance of health information“If they really wanna put the websites, put stuff that we can relate to. Not just ‘if you do this, [then you'll be] more like this.’ [We] need, ‘I tried this, and this is what happened,’ be specific and maybe we would understand more. I think girls wouldn't be so insecure.”
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.


      “It doesn't matter as it is the same information. It is more that this [showing video clip on YouTube] is easier to understand”
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.


      “if it makes sense and [it] all adds up; I believe it's true.”
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.


      “Male: ‘You have also got to be aware that when you put something on the internet, there are a lot of clever people out there that can manipulate things really easily and in really funny ways and just turn things into huge jokes.’

      Female: ‘Whereas if you are already making the jokes about it, people aren't going to take it and make jokes about it because it is already funny...’”
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      ,

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      ,
      • Evans YN
      • Gridley SJ
      • Crouch J
      • et al.
      Understanding online resource use by transgender youth and caregivers: a qualitative study.
      ,
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.
      ,
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Nikolaou CK
      • Tay Z
      • Leu J
      • et al.
      Young people's attitudes and motivations toward social media and mobile apps for weight control: mixed methods study. Research support, non-U.S. Gov't.
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      ,
      • Simon L.
      Adolescents' sex education using new digital media: the personal motivations and interactive experiences of young people online at Reddit.com. Conference Abstract.
      ,
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.
      • Goodyear VA
      • Armour KM
      • Wood H.
      Young people and their engagement with health-related social media: new perspectives.
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.

      Goodyear VA, Armour KM. Young people, social media and health. Abingdon, Oxon: Routledge; 2019.

      ,
      • Raeside R
      • Jia SS
      • Redfern J
      • et al.
      Navigating the online world of lifestyle health information: qualitative study with adolescents.
      Expertise and verification“If there is a place where only doctors or medical professionals could post information and then if teenagers or other kids wanted to post information it would have to go through someone that would check all the information to make sure it was valid I guess. So that you knew it was reliable and like good information.”
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.


      “If you see similar information on different sites like a website and then on Facebook and then hear it from someone, it's most likely true.”
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.


      "Maybe I saw something that was happening and later I found out from the news that it was wrong"
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.


      “Normally, if there is a verified tick or someone like known that's more trustworthy in that area, in health. So, it's like, if there is someone new with barely any followers...then it makes it less likely for you to follow that person.”
      • Raeside R
      • Jia SS
      • Redfern J
      • et al.
      Navigating the online world of lifestyle health information: qualitative study with adolescents.
      • Best P
      • Manktelow R
      • Taylor BJ.
      Social work and social media: online help-seeking and the mental well-being of adolescent males.
      ,

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      ,
      • Evans YN
      • Gridley SJ
      • Crouch J
      • et al.
      Understanding online resource use by transgender youth and caregivers: a qualitative study.
      ,
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.
      ,
      • Holland A.
      Osteoporosis knowledge translation for young adults: new directions for prevention programs.
      ,
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      • Selkie EM
      • Benson M
      • Moreno M.
      Adolescents' views regarding uses of social networking websites and text messaging for adolescent sexual health education.
      ,
      • Gray NJ
      • Klein JD
      • Noyce PR
      • et al.
      Health information-seeking behaviour in adolescence: the place of the internet. Comparative study research support, non-U.S. Gov't.
      ,
      • Goodyear V
      • Quennerstedt M.
      #Gymlad - young boys learning processes and health-related social media.
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.
      • Goodyear VA
      • Armour KM
      • Wood H.
      Young people and their engagement with health-related social media: new perspectives.
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.
      ,
      • Raeside R
      • Jia SS
      • Redfern J
      • et al.
      Navigating the online world of lifestyle health information: qualitative study with adolescents.
      ,
      • Thianthai C.
      What does social media have to do with health? A case study of Bangkok youths.
      Advertising, pushed, and suggested content“it is like advertisements sort of … and if it is shown often then it gets stuck … and then you start to drink these [points at an Instagram depicting energy drinks] and that is not good for me”
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.


      “I usually ignore the ads. They say stuff about ‘take this pill and make your body look better.’ ‘Ten foods that can kill you’ I didn't believe it.”
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.


      “It's not really our age, because they're like in their early 20s and just a bigger age group”
      • Goodyear VA
      • Armour KM
      • Wood H.
      Young people and their engagement with health-related social media: new perspectives.


      “Usually it's just crap, so I don't look at ads that are on a side bar or anything like that, I just ignore them.”
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.


      “When they advertise other websites or other things at the beginning of their videos, I don't usually trust those, because, I mean, I just don't know. I just don't trust those ads…Yeah, they're advertising something, like: ‘Oh you should get this’ or ‘Oh, you should try out this,’ then I usually don't trust it… It seems more of just a way to get publicity for something else that they need, rather than trying to help other people in that subject.”

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.



      “M7: I was watching this video about like weight loss and stuff and then half way through they mention this diet pill that you can take and I was like ah no, I'll just get off it do you know what I mean. You can't trust any of it.”
      • Harris J
      • Atkinson A
      • Mink M
      • et al.
      Young people's experiences and perceptions of youtuber-produced health content: implications for health promotion. Research support, Non-U.S. Gov't.
      • Lariscy R
      • Reber B
      • Paek H-J.
      Exploration of health concerns and the role of social media information among rural and urban adolescents: a preliminary study. Journal articles reports - research.
      ,
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      ,

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      ,
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.
      ,
      • Harris J
      • Atkinson A
      • Mink M
      • et al.
      Young people's experiences and perceptions of youtuber-produced health content: implications for health promotion. Research support, Non-U.S. Gov't.
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      ,
      • Goodyear VA
      • Armour KM
      • Wood H.
      Young people and their engagement with health-related social media: new perspectives.
      ,
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.
      ,
      • Raeside R
      • Jia SS
      • Redfern J
      • et al.
      Navigating the online world of lifestyle health information: qualitative study with adolescents.

      Trust in Social Media Platforms or Services

      General Distrust of Social Media for Health Information

      Some adolescents differentiated between more “traditional” websites and social media for health information.
      • Lariscy R
      • Reber B
      • Paek H-J.
      Exploration of health concerns and the role of social media information among rural and urban adolescents: a preliminary study. Journal articles reports - research.
      • Best P
      • Manktelow R
      • Taylor BJ.
      Social work and social media: online help-seeking and the mental well-being of adolescent males.
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      • Macharia P
      • Pérez-Navarro A
      • Inwani I
      • et al.
      An exploratory study of current sources of adolescent sexual and reproductive health information in Kenya and their limitations: are mobile phone technologies the answer?.
      Websites were trusted over social media: “You can get information from the Internet, but not online communication...because they might be lying.”
      • Lariscy R
      • Reber B
      • Paek H-J.
      Exploration of health concerns and the role of social media information among rural and urban adolescents: a preliminary study. Journal articles reports - research.
      There was a general distrust toward Facebook

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      and only half (50.74%) of youths thought health information on Facebook was reliable.
      • Zhang MW
      • Tran BX
      • Le HT
      • et al.
      Perceptions of health-related information on Facebook: cross-sectional study among vietnamese youths.
      Perceptions of health information on social media were mediated by factors including gender and educational level of the user, and interpersonal influences from Facebook (eg, talking to new people on social media).
      • Zhang MW
      • Tran BX
      • Le HT
      • et al.
      Perceptions of health-related information on Facebook: cross-sectional study among vietnamese youths.
      Some adolescents recognized the potential to encounter misinformation or “fake news” on social media.
      • Macharia P
      • Pérez-Navarro A
      • Inwani I
      • et al.
      An exploratory study of current sources of adolescent sexual and reproductive health information in Kenya and their limitations: are mobile phone technologies the answer?.
      ,
      • Evans YN
      • Gridley SJ
      • Crouch J
      • et al.
      Understanding online resource use by transgender youth and caregivers: a qualitative study.
      ,
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.
      Many expressed a general distrust of health information from social media;
      • Lariscy R
      • Reber B
      • Paek H-J.
      Exploration of health concerns and the role of social media information among rural and urban adolescents: a preliminary study. Journal articles reports - research.
      ,
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.
      • Thianthai C.
      What does social media have to do with health? A case study of Bangkok youths.
      • Holland A.
      Osteoporosis knowledge translation for young adults: new directions for prevention programs.
      however, these sources were still popular as they are convenient while using social media for other purposes, easily accessible, highly familiar, and relevant.
      • Lariscy R
      • Reber B
      • Paek H-J.
      Exploration of health concerns and the role of social media information among rural and urban adolescents: a preliminary study. Journal articles reports - research.
      ,
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      • Macharia P
      • Pérez-Navarro A
      • Inwani I
      • et al.
      An exploratory study of current sources of adolescent sexual and reproductive health information in Kenya and their limitations: are mobile phone technologies the answer?.

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      ,
      • Thianthai C.
      What does social media have to do with health? A case study of Bangkok youths.
      ,
      • Harris J
      • Atkinson A
      • Mink M
      • et al.
      Young people's experiences and perceptions of youtuber-produced health content: implications for health promotion. Research support, Non-U.S. Gov't.
      • Holmberg C
      • Berg C
      • Dahlgren J
      • et al.
      Health literacy in a complex digital media landscape: pediatric obesity patients’ experiences with online weight, food, and health information.
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      • Esmaeilzadeh S
      • Ashrafi-Rizi H
      • Shahrzadi L
      • et al.
      A survey on adolescent health information seeking behavior related to high-risk behaviors in a selected educational district in Isfahan. Research Support, Non-U.S. Gov't.
      Pinterest was identified as a source with a more trustworthy reputation for health and fitness content.

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      Safety and Privacy

      One of the most pressing concerns for adolescents was the assurance of safety and privacy afforded by the social media platform or service.
      • Macharia P
      • Pérez-Navarro A
      • Inwani I
      • et al.
      An exploratory study of current sources of adolescent sexual and reproductive health information in Kenya and their limitations: are mobile phone technologies the answer?.
      ,
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      • Esmaeilzadeh S
      • Ashrafi-Rizi H
      • Shahrzadi L
      • et al.
      A survey on adolescent health information seeking behavior related to high-risk behaviors in a selected educational district in Isfahan. Research Support, Non-U.S. Gov't.
      • Kenny R
      • Dooley B
      • Fitzgerald A.
      Developing mental health mobile apps: exploring adolescents' perspectives.
      • Malik FS
      • Panlasigui N
      • Gritton J
      • et al.
      Adolescent perspectives on the use of social media to support type 1 diabetes management: focus group study. Research support, N.I.H., Extramural.
      • Nikolaou CK
      • Tay Z
      • Leu J
      • et al.
      Young people's attitudes and motivations toward social media and mobile apps for weight control: mixed methods study. Research support, non-U.S. Gov't.
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      Adolescents had to balance the tension between anonymity, which affords users the opportunity to be more open, with concerns about privacy if others found out that information was associated with them.
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Esmaeilzadeh S
      • Ashrafi-Rizi H
      • Shahrzadi L
      • et al.
      A survey on adolescent health information seeking behavior related to high-risk behaviors in a selected educational district in Isfahan. Research Support, Non-U.S. Gov't.
      ,
      • Selkie EM
      • Benson M
      • Moreno M.
      Adolescents' views regarding uses of social networking websites and text messaging for adolescent sexual health education.
      For some, anonymity and privacy controls made social media advantageous for accessing and sharing health information, particularly for sensitive health concerns
      • Best P
      • Manktelow R
      • Taylor BJ.
      Social work and social media: online help-seeking and the mental well-being of adolescent males.
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      • Harris J
      • Atkinson A
      • Mink M
      • et al.
      Young people's experiences and perceptions of youtuber-produced health content: implications for health promotion. Research support, Non-U.S. Gov't.
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      • Selkie EM
      • Benson M
      • Moreno M.
      Adolescents' views regarding uses of social networking websites and text messaging for adolescent sexual health education.
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      • Simon L.
      Adolescents' sex education using new digital media: the personal motivations and interactive experiences of young people online at Reddit.com. Conference Abstract.
      • Gray NJ
      • Klein JD
      • Noyce PR
      • et al.
      Health information-seeking behaviour in adolescence: the place of the internet. Comparative study research support, non-U.S. Gov't.
      : “I think it's more comfortable to have anonymous postings, because if they don't know who you are then you're a little bit more comfortable saying something.”
      • Selkie EM
      • Benson M
      • Moreno M.
      Adolescents' views regarding uses of social networking websites and text messaging for adolescent sexual health education.
      Anonymity provided adolescents with an opportunity to ask questions that they felt uncomfortable asking in other settings (eg, offline), while simultaneously offering a personal and social environment in which to express themselves.
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      Adolescents stressed the importance of password protection for preserving privacy, and distinguished between information for sharing publicly and for certain people.
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.
      ,
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Kenny R
      • Dooley B
      • Fitzgerald A.
      Developing mental health mobile apps: exploring adolescents' perspectives.
      • Malik FS
      • Panlasigui N
      • Gritton J
      • et al.
      Adolescent perspectives on the use of social media to support type 1 diabetes management: focus group study. Research support, N.I.H., Extramural.
      • Nikolaou CK
      • Tay Z
      • Leu J
      • et al.
      Young people's attitudes and motivations toward social media and mobile apps for weight control: mixed methods study. Research support, non-U.S. Gov't.
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      • Selkie EM
      • Benson M
      • Moreno M.
      Adolescents' views regarding uses of social networking websites and text messaging for adolescent sexual health education.
      ,
      • Van Dyck D
      • D'Haese S
      • Plaete J
      • et al.
      Opinions towards physical activity interventions using Facebook or text messaging: focus group interviews with vocational school-aged adolescents. Research support, non-U.S. Gov't.
      ,
      • Goodyear V
      • Quennerstedt M.
      #Gymlad - young boys learning processes and health-related social media.
      Adolescents differentiated access given to close friends compared with unknown users or acquaintances (ie, “friends” on Facebook), allowing them to perform different identities for different audiences.
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      Private messages through social media platforms were often more appealing than public posts for sharing health information.
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.
      ,
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Malik FS
      • Panlasigui N
      • Gritton J
      • et al.
      Adolescent perspectives on the use of social media to support type 1 diabetes management: focus group study. Research support, N.I.H., Extramural.
      ,
      • Selkie EM
      • Benson M
      • Moreno M.
      Adolescents' views regarding uses of social networking websites and text messaging for adolescent sexual health education.
      This was not fool-proof as some adolescents were fearful of privacy breaches, and potential hacking of personal health information
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      • Malik FS
      • Panlasigui N
      • Gritton J
      • et al.
      Adolescent perspectives on the use of social media to support type 1 diabetes management: focus group study. Research support, N.I.H., Extramural.
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      : “Even in messages like in private, people forward them to each other.”
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      Due to these concerns, some adolescents adopted different personas in different online spaces. For example, some used irony or humor in public spaces on social media, while reserving more literal or explicit health information for private spaces.
      • Goodyear V
      • Quennerstedt M.
      #Gymlad - young boys learning processes and health-related social media.
      Adolescents described how humorous or ironic tones could be used to encourage comfort in the sharing of health information on social media
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.
      ,
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      ,
      • Goodyear V
      • Quennerstedt M.
      #Gymlad - young boys learning processes and health-related social media.
      and could help to counter stigma around sensitive mental health topics.

      Trust in Other Users

      Mistrust of Unknown Users

      The importance of anonymity for adolescent users was contrasted with the challenge of trusting unknown users
      • Best P
      • Manktelow R
      • Taylor BJ.
      Social work and social media: online help-seeking and the mental well-being of adolescent males.
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      • Gray NJ
      • Klein JD
      • Noyce PR
      • et al.
      Health information-seeking behaviour in adolescence: the place of the internet. Comparative study research support, non-U.S. Gov't.
      : “if who you are talking to is really who you are talking to.
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      In response, adolescents highlighted the importance of being wary of opinions and verifying that user-generated content was trustworthy.
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      ,
      • Holland A.
      Osteoporosis knowledge translation for young adults: new directions for prevention programs.
      ,
      • Gray NJ
      • Klein JD
      • Noyce PR
      • et al.
      Health information-seeking behaviour in adolescence: the place of the internet. Comparative study research support, non-U.S. Gov't.
      This was difficult for adolescents in a social media landscape where “people can just make up anything.”
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.

      Fear of Bullying or Judgment

      Adolescents expressed a hesitance to share and be identified with health information online for fear of bullying, stigma, or judgment; they did not trust others’ responses to their shared health information.
      • Macharia P
      • Pérez-Navarro A
      • Inwani I
      • et al.
      An exploratory study of current sources of adolescent sexual and reproductive health information in Kenya and their limitations: are mobile phone technologies the answer?.
      ,

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      ,
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.
      ,
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Kenny R
      • Dooley B
      • Fitzgerald A.
      Developing mental health mobile apps: exploring adolescents' perspectives.
      ,
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      ,
      • Van Dyck D
      • D'Haese S
      • Plaete J
      • et al.
      Opinions towards physical activity interventions using Facebook or text messaging: focus group interviews with vocational school-aged adolescents. Research support, non-U.S. Gov't.
      • Goodyear V
      • Quennerstedt M.
      #Gymlad - young boys learning processes and health-related social media.
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.
      • Goodyear VA
      • Armour KM
      • Wood H.
      Young people and their engagement with health-related social media: new perspectives.
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.

      Goodyear VA, Armour KM. Young people, social media and health. Abingdon, Oxon: Routledge; 2019.

      This was particularly apparent for young people with long term health conditions, sexual or mental health concerns, and transgender youth.
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.
      ,
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Kenny R
      • Dooley B
      • Fitzgerald A.
      Developing mental health mobile apps: exploring adolescents' perspectives.
      ,
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      ,
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      ,
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.
      This fear was exacerbated by the public, anonymous nature of social media, which could enable cyberbullies to send abusive or hurtful responses to others
      • Kenny R
      • Dooley B
      • Fitzgerald A.
      Developing mental health mobile apps: exploring adolescents' perspectives.
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      : “It's public. Which is both a blessing and a curse because you can connect with all these people but also you are open to a lot of hate.”
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      Witnessing victimization aimed at others could be harmful and influenced adolescents’ approach to sharing health information on social media
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      : “people go out of their way to hate on certain people and even if it's not targeted at me, it makes me feel bad for the people it's targeted at.”
      • Selkie E
      • Adkins V
      • Masters E
      • et al.
      Transgender adolescents' uses of social media for social support.
      It was not only anonymous or unknown others that adolescents were concerned about. In sharing health information, adolescents sometimes lacked trust in friends’, peers’, or family's responses

      Booth KM. Youth and information quality: An intersectional exploration of how teens assess fitness information on social media. [PhD Thesis]. Pennsylvania, PA: The Pennsylvania State University; 2018.

      ,
      • Patterson SP
      • Hilton S
      • Flowers P
      • et al.
      What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Research Support, Non-U.S. Gov't.
      and this could impact on their conceptions of their own identity. For example, adolescents discussed fearing others’ responses to images of themselves or their bodies on social media and highlighted its negative psychological effects
      • Goodyear VA
      • Armour KM
      • Wood H.
      Young people and their engagement with health-related social media: new perspectives.
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.

      Goodyear VA, Armour KM. Young people, social media and health. Abingdon, Oxon: Routledge; 2019.

      : “It promotes insecurity, lower self-esteem... like a girl posts a picture on Instagram.. And a bunch of guys leave negative comments.”
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.
      Distrust in others’ responses was also seen in adolescents’ concerns about the stigma surrounding health information, particularly for sensitive information including mental or sexual health concerns
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      • Kenny R
      • Dooley B
      • Fitzgerald A.
      Developing mental health mobile apps: exploring adolescents' perspectives.
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      : “with the stigma of, if you found something about a sexual health infection, then you don't really want to be like, hey it's made me think of you. It just has that connotation.”
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      Due to distrust in others’ online responses, some stressed the importance of social media moderation, “blocking,” and holding users and “trolls” accountable for online behaviors.
      • Fergie G
      • Hunt K
      • Hilton S.
      What young people want from health-related online resources: a focus group study.
      ,
      • Kenny R
      • Dooley B
      • Fitzgerald A.
      Developing mental health mobile apps: exploring adolescents' perspectives.
      ,
      • Veinot TC
      • Campbell TR
      • Kruger DJ
      • et al.
      A question of trust: user-centered design requirements for an informatics intervention to promote the sexual health of African-American youth.

      Trust in Friends or Peers

      Adolescents largely trusted their friends and peers online
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.
      ,
      • Byron P
      • Albury K
      • Evers C.
      “It would be weird to have that on Facebook”: young people's use of social media and the risk of sharing sexual health information.
      ,
      • Ahola Kohut S
      • LeBlanc C
      • O'Leary K
      • et al.
      The internet as a source of support for youth with chronic conditions: a qualitative study.
      • Byron P.
      Troubling expertise: social media and young people's sexual health.
      • Selkie EM
      • Benson M
      • Moreno M.
      Adolescents' views regarding uses of social networking websites and text messaging for adolescent sexual health education.
      ,
      • Van Dyck D
      • D'Haese S
      • Plaete J
      • et al.
      Opinions towards physical activity interventions using Facebook or text messaging: focus group interviews with vocational school-aged adolescents. Research support, non-U.S. Gov't.
      ,
      • Ortiz R
      • Shafer A
      • Cates J
      • Coyne-Beasley T.
      Assessing feasibility and strategies for clinicians to communicate via social media with adolescent patients about HPV vaccination. Conference Abstract.
      ,
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.
      and information was often shared, or forwarded, through friends and networks.
      • Leary MP
      • Clegg EN
      • Santella ME
      Consumption of health-related content on social media among adolescent girls: mixed-methods pilot study.
      ,
      • Plaisime M
      • Robertson-James C
      • Mejia L
      • et al.
      Social media and teens: a needs assessment exploring the potential role of social media in promoting health.
      Friends were also trusted sources for recommendations of health information to look for on social media.
      • Holland A.
      Osteoporosis knowledge translation for young adults: new directions for prevention programs.
      ,