Evaluating the impact of different message strategies about OSA employed in the American Academy of Sleep Medicine Count on Sleep campaign

Abstract

Health campaigns hold promise for promoting general awareness about obstructive sleep apnea. In 2023, the American Academy of Sleep Medicine developed a series of messages as part of their “Count on Sleep” campaign. Three distinct messaging strategies were employed in posts disseminated on Facebook: (1) positive outcome (benefits of obstructive sleep apnea treatment); (2) negative outcome (consequences of untreated obstructive sleep apnea); and (3) partner-focused. We evaluated Facebook analytics to explore which of the 3 strategies was most impactful. The impressions were highest for the positive outcome message (n = 120,062), followed by the negative outcome (n = 12,286) and partner-focused (n = 10,259) messages. Female users were more likely to engage with positive (39% vs 28%) and negative (34% vs 25%) message than males, but sexes were quite balanced in engagement with the partner-focused message (36% vs 36%). There was more engagement from older adults (65 years and older) than from younger adults across all message types.

Citation:

Robbins R, Morkous SSW, Honaker S, Darby CV, DelRosso LM. Evaluating the impact of different message strategies about OSA employed in the American Academy of Sleep Medicine Count on Sleep campaign. J Clin Sleep Med. 2025;21(2):417–419.

INTRODUCTION

Obstructive sleep apnea (OSA) affects between 10% and 20% of the adult population in the United States.¹ Untreated OSA has many adverse outcomes, ranging from excessive daytime sleepiness and mood disturbances² to accidents³ and adverse cardiometabolic outcomes such as hypertension.⁴ Snoring is the most common symptom and predictor of OSA.⁵ Unfortunately, despite the sleep disturbances, snoring, and daytime symptoms, many adults at risk for OSA remain undiagnosed and hence untreated; in a sample of employed adults, 80–90% of those with moderate-to-severe symptoms were untreated for the condition.⁶ Low public awareness about OSA symptoms and treatments is a driver of the low levels of OSA diagnosis and care.

Public health campaigns hold promise as a tool for promoting awareness about OSA.⁷ Social media platforms such as Facebook provide a unique opportunity to reach a large number of people and are becoming increasingly important for health information dissemination. Extensive research has been done on campaign messaging strategies, examining such questions as gain-framed vs loss-framed messages, or narrative-style messages, in other behavior contexts (eg, smoking cessation). Minimal attention has been paid to developing or evaluating public health campaign–type messages relating to OSA, but in 2023 the American Academy of Sleep Medicine (AASM) initiated “Count on Sleep,” a public health campaign with the goal of raising awareness of OSA among primary care health practitioners and the general public.⁸ Three public-facing campaign messages were designed and disseminated on social media in 2023. We examined the impact of these campaign messages using back-end analytics from the social media platform (Facebook).

METHODS

In 2023, the AASM disseminated 3 health campaign messages on social media (Facebook). There were 3 different message strategies tested: (1) positive outcome expectations (eg, “improve other health conditions”); (2) negative outcome expectations (eg, “increase your risk of major health problems”); and (3) partner-focused messages (eg, “have you heard your partner snore?”) (see Figure 1). Budgets varied across the 3 messages (message 1: $989, message 2: $200, message 3: $200).

Figure 1. Screenshots describing the 3 American Academy of Sleep Medicine Count on Sleep messages disseminated on social media.

(A) Positive expectation message. Text below the graphic reads: “Seeking treatment for sleep apnea can improve other health conditions and your overall quality of life.” (B) Negative outcome expectation message. Text below the graphic reads: “Sleep apnea is more than a snore. It is a serious but common condition that causes you to stop breathing during your sleep. Without treatment, it can increase your risk of major health problems, like diabetes, stroke, heart attack, and depression. Learn more about sleep apnea: www.countonsleep.org #MoreThanASnore #CountonSleep”. (C) Partner-focused message. The text below the image reads: “Does your partner snore? Do you notice pauses in their breathing while they sleep? These could be signs of sleep apnea, a serious but treatable condition. Learn more about sleep apnea: www.countonsleep.org #MoreThanASnore #CountonSleep”.

Social media analytics

We obtained these data for each of the 3 posts in December 2023 from the AASM Facebook account that was used to promote each of the 3 campaign posts. Post engagement was assessed using the following metrics: impressions, which are the number of times a post appeared on someone’s screen; reactions, or the number of times a user who read the message assigned an emotion, such as a thumbs up or a heart; shares, or the number of times a user distributed the post to their network; comments, which were the number of comments a person made on the post; and clicks, or the number of individuals who clicked the link to the AASM campaign webpage from the social media post. Finally, we obtained data on the sex and age of users who engaged with each post.

Analysis

We computed descriptive statistics summarizing the available social media analytics for each post by age group and sex. We also computed a cost-per-click ratio, which is the total amount spent on each message divided by the number of clicks on each message.

RESULTS

The overall impressions were highest for the positive outcome expectation (n = 120,062), followed by the negative outcome expectation (n = 12,286) and partner-focused (n = 10,259) messages. The number of reactions were higher for the negative expectation (n = 1,740) and partner-focused (n = 1,718) messages than for the positive expectation message (n = 119); similarly, shares were highest in the negative expectation (n = 165) and lowest in the positive expectation message (n = 12). The link clicks were highest for the positive expectation message (n = 3,006) and far lower for the negative outcome expectation (n = 21) and partner-focused (n = 11) messages. Cost per click was $0.33 for the positive expectation message, $9.52 for the negative expectation message, and $18.18 for the partner-focused message. See Table 1.

Table 1.

Summary statistics for the social media analytics for each post.

	Positive Outcome Message	Negative Outcome Message	Partner-Focused Message
Impressions	120,062	12,286	10,259
Engagements	3,156	2,027	1,900
Reactions	119	1,740	1,718
Shares	12	165	99
Comments	2	21	15
Clicks	3,006	21	11
Ad spend ($)	988.99	200.00	200.00
Cost per click ($)	0.33	9.52	18.18

With respect to demographics, there were more impressions among females than among males for the positive expectation message (60.1% v. 39.3%) and negative expectation message (58.1% vs 41.1%), but female and male users were balanced in their engagement with the partner-focused message (49.7% vs 49.1%). There were more impressions among those 65 years of age and older for each of the 3 messages than among any other age category (positive expectation message: 57.9%; negative expectation message: 41.1%; partner-focused message: 46.5%).

DISCUSSION

More public awareness is necessary to decrease the unfavorable health consequences of unrecognized and untreated OSA. The AASM “Count on Sleep” campaign was one effort to design and implement strategies aimed at increasing OSA awareness among primary care providers and the public.⁸ Our analysis of several Count on Sleep campaign messages revealed that messages emphasizing positive outcome evaluations of OSA treatment received the most engagement and, notably, the most clicks to the AASM Count on Sleep campaign website from the post. It is interesting, however, that reactions and shares were greater in the negative outcome and partner-focused messages than in the positive outcome expectation message, despite a lower advertising budget. It could be argued that clicks to a website from a post are a more desirable message outcome than reactions or shares, because clicking the website for more information could suggest a higher level of message processing and cognitive elaboration of the arguments. A similar study evaluating the impact of various food-related messages agreed with our findings in that positive emotion messages were more likely to be retweeted; in this study other characteristics of retweeted messages included having an image, coming from an authoritative source, and stating a direct message.⁹

Our study revealed that females were more likely to engage with positive and negative outcome expectation messaging than were males, and older adults (age 65 years and above) were more likely to engage with the OSA messages. This sex disparity is interesting, particularly because males are at greater risk for OSA than females.⁶ In fact, females seem to be slightly more represented than males in Facebook; 53.8% of its more than 2 billion active users report being female.¹⁰ It is possible that females engage with the messages to get more information about OSA because they have a partner who may be at risk. Of further interest is the balanced male engagement with partner-focused messages despite lower engagement with positive and negative messages, potentially indicating increased partner-related motivation among male users.

This research reveals important information about the factors that will influence engagement with an OSA message published on social media. The engagement observed herein with positive messages is not unique to OSA and could be explained by cultural or psychological norms. For instance, positive messages might be persuasive because they inspire action, whereas negative messages may induce fear or anxiety and lead to avoidance, paralysis, or denial.

Despite the strength of this study as one of the first to examine different health campaign message tactics for promoting OSA awareness, a few limitations are notable. First, the analytics were derived from the social media company. Second, the demographic factors are self-reported and may be prone to bias. Future research will be needed and can explore the impact of these messages on beliefs and behaviors in a more controlled setting where attention to the message could be more closely evaluated.

DISCLOSURE STATEMENT

All authors have reviewed and approved the final version. Work for this study was performed at the American Academy of Sleep Medicine, Darien, Illinois. The American Academy of Sleep Medicine Count on Sleep campaign was funded by the Centers for Disease Control and Prevention of the US Department of Health and Human Services. Dr. Robbins is supported by the National Heart, Lung, and Blood Institute (K01HL150339) and has received consulting income from Hilton Hotels, Oura Ring, Nacht GmbH, and Savoir Beds Ltd. Dr. Honaker’s time was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award K23HL150299. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.