Engaging with patients with diabetes: the role of social media in low-income healthcare organisations

Abstract

Background

Type 2 diabetes is the fastest-growing global health concern, and its global prevalence is projected to affect 643 million individuals by 2030. Social media platforms, like Facebook, have become crucial channels for healthcare organisations to engage with the public to promote prevention and disease management, especially in low-resource settings like Honduras. This study aims to perform a retrospective analysis of Honduran healthcare organisations’ Facebook posts to understand how effectively they engage diabetes-related content with their followers.

Methods

The top 10 followed healthcare organisations’ Facebook pages were taken as a sample. Data were retrieved from October 2023 to March 2024. Diabetic-related posts were identified using keywords and categorised based on their contents and features.

Results

Findings reveal significant disparities in the frequencies of posts and public engagement among different types of organisations. The majority of posts were classified under the miscellaneous category and text+image feature. Recipes and food-related posts were liked and shared the most among the followers.

Conclusion

The results of the study found that patients’ engagement with diabetes-related content was low in social media. The gap between patients’ participation and engagement highlights the need for reassessment and refinement of social media communication strategies for healthcare organisations to empower patients with diabetes through social media and increase public engagement.

WHAT IS ALREADY KNOWN ON THIS TOPIC

• Social media platforms have been identified as valuable tools for enhancing health outcomes and promoting behaviour change in chronic conditions through improved patient engagement, participation and empowerment.

WHAT THIS STUDY ADDS

• This study highlights the need for healthcare organisations to refine their social media strategies to effectively communicate with and support patients with diabetes in low-income settings.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

• These results can guide healthcare organisations in transforming how they engage with their audience through social media, aiming to enhance patient participation, engagement and empowerment by understanding and addressing their followers’ interests and concerns effectively.

Introduction

Diabetes mellitus, particularly type 2 diabetes (T2D), has become a pressing global health concern, with its prevalence steadily rising over the past few decades. According to the Diabetes Atlas,¹ approximately 537 million adults aged 20–79 years worldwide will be living with diabetes in 2021, and the number is projected to escalate to 643 million by 2030. In 2021, diabetes was responsible for 6.7 million deaths, making it one of the leading causes of death worldwide.¹ Honduras, like many other developing countries, faces high rates of non-communicable diseases, with diabetes becoming one of the leading causes of morbidity and mortality.² Additionally, the country lacks updated national prevalence data on diabetes; however, in 2016, the WHO estimated that 7.2% of the population was living with this condition.³ Limited access to specialised diabetes care, especially in rural areas, further exacerbates this problem.

The alarming global and local surge in diabetes underscores the urgent need for effective communication and engagement strategies to support individuals in managing their conditions and preventing complications. Effective management of T2D requires continuous education, lifestyle modifications and adherence to treatment regimens, all of which are heavily influenced by the quality and accessibility of health communication.⁴ Traditionally, healthcare providers have relied on face-to-face consultations, pamphlets and community outreach programmes to disseminate information on diabetes management. However, these methods often lack the accessibility, frequency and engagement required to maintain effective patient communication. The WHO⁵ recommends integrating social media with traditional media interventions to enhance the convergence and trust of that information.

The rapid growth of digital technology, particularly in developing nations like Honduras, provides organisations with potent tools to boost communication among organisations, patients and their support networks. According to DataReportal,⁶ ‘internet penetration in Honduras reached 65.9% in early 2024’, which is a significant increase from just 1.2% in 2000.² This significant rise in internet access has directly contributed to the growing digital landscape, with approximately 42.6% of the population now being social media users. As more individuals connect online, social media platforms (eg, Facebook, Twitter (X), Instagram and YouTube) have risen as formidable allies in health communication and education.⁷ They offer unique opportunities for healthcare organisations to overcome logistical, social and financial barriers.⁸ Studies have shown that social media interventions can improve health outcomes and promote behaviour change in various chronic conditions, including diabetes.^{8 9}

Engagement, participation and empowerment of patients are crucial elements in managing chronic diseases. Patient engagement involves patients actively participating in their own care, which has been linked to better health outcomes and improved disease management.¹⁰ Patient participation is linked with the concept of obtaining required, understandable and meaningful information by the patient that can enable them to feel confident.¹¹ Patient empowerment, on the other hand, refers to providing patients with the knowledge, skills and confidence to manage their own health, leading to improved self-efficacy and adherence to treatment plans.¹² Social media platforms can facilitate these aspects by providing interactive spaces where patients can share experiences, access educational content and receive emotional support. They can lead to better adherence to treatment plans, more informed decision-making and a stronger support network for patients.¹³ Understanding how these outcomes are influenced by social media communication can inform better practices for health communication strategies, ultimately benefiting public health initiatives globally.¹⁴

By analysing the contents and interaction patterns on healthcare organisations’ Facebook pages, we sought to gain insights into the role of social media in diabetes management. This research is significant because it has the potential to inform healthcare communication strategies and contribute to the growing body of literature on social media in healthcare and diabetes. Understanding how patients engage with and are empowered by digital platforms can help to tailor more effective interventions and support systems to improve health outcomes in the diabetic population. Specifically, we sought to address the following questions:

• What was the impact of various content topics on patient engagement (measured by likes, reactions, comments and shares) with diabetes-related posts?

• How did specific features of posts (such as the inclusion of videos, images or text-only) influence the level of patient engagement with diabetes-related social media content?

• How effectively were healthcare institutions using their platforms to provide diabetes-related content?

Methods

Study design

This retrospective study aimed to evaluate the engagement, empowerment and participation of patients with T2D through the Facebook pages of healthcare organisations in Honduras. Facebook was specifically chosen over other social media platforms for two reasons. First, due to its widespread popularity in Honduras, where it has over 4.25 million users, making it the leading platform for social interaction and information sharing in the country.⁶ Second, Facebook’s demographic user base aligns with the population most affected by T2D, as the platform is predominantly used by adults aged 30 and above.¹⁵ The selection of the top 10 Facebook pages was based on the following criteria.

Inclusion criteria

The inclusion criteria for the selection of pages were as follows:

• Each page must have a minimum of 10 000 followers.

• Each page should be actively involved in attending to or distributing information related to T2D.

Exclusion criteria

The following exclusion criteria were applied for the Facebook pages:

• Pages not primarily focused on or operated within Honduras.

• Pages inactive for more than 6 months consecutively within the study period.

• Personal pages, groups or unofficial fan pages not affiliated with recognised healthcare organisations.

Data collection

Posts published between October 2023 and March 2024 were retrieved for analysis. During this period, all posts from the selected Facebook pages were captured and stored in an image format to preserve the original content format. Posts related to diabetes were manually identified and extracted based on predefined inclusion criteria, which required the presence of specific keywords, such as ‘diabetes’, ‘diabetic’, ‘sugar’ and ‘glucose’. After filtering for these keywords, engagement metrics data, including reactions (like, love, care, haha, wow, angry and sad), comments and shares, were collected and organised into a spreadsheet. Additionally, post features, such as the number of images and videos, were also recorded. Each post was then categorised based on its content type.

Research over the past years has demonstrated that engagement metrics, such as reactions, comments and shares, serve as valuable indicators of user interaction on social media platforms.^{16 17} These metrics are commonly used to assess the popularity and effectiveness of content, as well as to gauge audience involvement and brand influence.¹⁸ To gain deeper insights into these interactions, we applied the concept of Social Media Engagement Behaviour (SMEB), a framework that helps analyse how users actively engage with content and reveals patterns of influence, participation and community building across digital networks.¹⁹ The SMEB approach provides a comprehensive understanding of how different forms of engagement contribute to the overall social media experience and interaction.²⁰

Post categories

To analyse the contents, we used post categories based on the content topics classification by Gabarron et al,²¹ and classified posts into: (1) health education, (2) research and innovation on diabetes, (3) diabetes-related technology, (4) interviews and personal stories, (5) awareness days and other celebrations, (6) recipes and food-related information and (7) miscellaneous.

Post classification

To ensure consistency, two independent reviewers classified each post’s main topic, and discrepancies were resolved by a third reviewer. The interrater reliability was calculated using Cohen’s kappa (k) analysis. This analysis aimed to understand how effectively healthcare organisations use Facebook to support patients with T2D, ultimately contributing to enhanced healthcare communication strategies.

Results

The study period for this work spanned from October 2023 to March 2024. However, the Facebook page posts were reviewed and analysed during a dedicated review phase from 4 May to 18 May 2024. A detailed breakdown of Facebook page activities is summarised in table 1. The Ministry of Health was the largest contributor, accounting for 35% of the posts, followed closely by the Honduran Institute of Social Security (IHSS)—a public institution in Honduras that administers social security programs—with 30% of the posts. Together, these two entities encompass a combined follower base of 163 000. Out of the 4507 posts retrieved, only 517 were related to diabetes. The National Institute of Diabetics (INADI) was the leading source of diabetes-related posts, contributing 400 posts and ranking third overall in terms of the total number of posts.

Table 1. Number of posts showing Facebook pages activity.

Facebook pages	Followers	Total posts	Diabetes-related posts
Ministry of Health Honduras	30 000	1555	47
Honduran Institute of Social Security	133 000	1341	41
National Institute of Diabetic	19 000	400	400
OPS Honduras-PAHO Honduras	96 000	308	6
National Escuela Hospital	70 000	238	2
Del Valle Hospital	64 000	179	6
Cemesa Hospital	65 000	162	2
Bendaña Hospital	33 000	145	1
Viera Hospital and clinics	23 000	135	7
San Jorge Hospital and clinics	42 000	44	5
Total	575 000	4507	517

Various Honduran health organisations on Facebook posted diabetes-related content in three distinct formats: text-only, text with pictures and text with videos (see table 2). The INADI stood out as the most prolific, emphasising visual content with 293 posts featuring pictures and 107 posts including videos. The Ministry of Health and the IHSS also showed a preference for text with pictures. Overall, the data revealed a strong preference for multimedia content among the organisations.

Table 2. Number of posts by features.

Facebook pages	Text only	Text+picture	Text+video
Ministry of Health Honduras		42	5
Honduran Institute of Social Security		35	6
National Institute of Diabetic		293	107
OPS Honduras-PAHO Honduras	1	5	0
National Escuela Hospital		1	1
Del Valle Hospital		6	0
Cemesa Hospital		1	1
Bendaña Hospital		0	1
Viera Hospital and clinics		6	1
San Jorge Hospital and clinics		6	0
Total	1	395	121

Content topic classification

The inter-rater agreement of the posts’ main topics was k=0.634. As seen in online supplemental figure 1, most of the content posted on social media by these organisations fell into miscellaneous categories, comprising 406 out of 517 posts, accounting for 78.5%. The following one was health education with 57 posts (11.02%) and awareness days and other celebrations with 43 posts (8%). Diabetes-related technology and research and innovation on diabetes had the lowest representation, with one post each over 6 months.

Engagement: reactions, comments and shares

In this section, we focus on INADI’s posts to analyse the engagement given their substantial contribution of 400 diabetes-related posts, the highest among all organisations. This high volume ensured a comprehensive dataset and specific relevance to the diabetes contents. With 19 000 dedicated followers, the engagement metrics provided direct insights into audience interactions with diabetes-focused posts.

We used the SMEB definitions provided by Dolan et al²⁰ and engagement levels defined by Aldous et al²² to construct table 3, focusing exclusively on active engagement. Our analysis began with Level 1, where users revealed their preferences and feelings, distinguishing between two levels: ‘1a. Likes’ and ‘2b. Reactions’. Moving to Level 2, users expressed opinions and extended content reach beyond personal engagement, categorised as ‘2a. Comments’ and ‘2b. Shares’. The average engagement metrics per post category, providing a clear comparison of interaction levels across different content topics, are presented in table 4.

Table 3. Levels of engagement of the National Institute of Diabetic.

Categories	Sample	Level of active engagement
		1		2
	N	Likes	Reactions	Comments	Share
Content topics
Awareness days and other celebrations	26	481	109	17	178
Diabetes-related technology	0	0	0	0	0
Health education	32	654	131	45	205
Interviews and personal stories	3	81	11	2	17
Miscellaneous	333	7022	1344	426	1919
Recipes and food-related information	6	191	15	5	56
Research and innovation	0	0	0	0	0
Post feature
Video	1	35	0	0	7
Video+text	106	1958	358	91	618
Images+text	293	6436	1098	404	1750

Table 4. Average engagement per post categories.

Categories	Average engagement per post
	1		2
	(a) Likes	(b) Reactions	(a) Comments	(b) Share
Content topics
Awareness days and other celebrations	19	4	0.6	7
Health education	20	4	1	6
Interviews and personal stories	27	3	0.67	6
Miscellaneous	21	4	4	6
Recipes and food-related information	31	3	3	9

Discussion

The analysis of Facebook posts from various health organisations over 6 months provided critical insights into how these institutions communicate about diabetes. Of the 4507 posts collected, 11.47% (n=517) were specifically related to diabetes. The most common format was text with pictures, followed by text with videos. Our findings revealed significant differences in the frequency of posts and level of public engagement among different types of organisations. Governmental organisations posted the most diabetes-related content, whereas private organisations posted the least.

Participation

Participation from health organisations can be gauged through the frequency of their posts and the size of their follower base. As shown in table 1, most healthcare organisations in Honduras have adopted broader content strategies, with a relatively small percentage of their posts dedicated to diabetes. Despite this, the significant number of followers attracted by these pages indicated a strong user interest in these contents.

The INADI stood out for its focused efforts on diabetes-related posts, reflecting a strong commitment to raising awareness of diabetes. In contrast, larger organisations, such as the Ministry of Health Honduras and IHSS, had broader content strategies, with only 3.02% and 3.06% of their posts related to diabetes, respectively. Despite the IHSS having a substantial follower base of 133 000, it posted minimally about diabetes, missing an opportunity to leverage its reach for a significant public health impact.

Recent studies have underscored the importance of targeted health communication for enhancing public health outcomes. A study by Hinyard and Kreuter²³ showed that narrative communication, particularly with multimedia content, is effective in engaging users and conveying complex health information. These findings align with our analysis suggesting that visually enriched and focused posts can significantly improve user interactions and health outcomes.

In light of these insights, it is recommended that healthcare organisations, especially those with large follower bases, increase the frequency of diabetes-related posts and use more multimedia content. This approach could harness their potential to positively influence public health, aligning with recent recommendations for social media strategies in health communication.

Empowerment

Social media platforms have emerged as powerful tools for health organisations to disseminate content, particularly in the realm of diabetes awareness and management.²⁴ Through a diverse array of content types, Facebook facilitates engagement, education and community-building, ultimately empowering individuals to take control of their diabetes journey.²⁵ During our content analysis, a total of 517 posts were identified. The frequency of posts’ categories identified is summarised in table 3.

Similar to Gabarron et al,²¹ miscellaneous had the highest post coded (n=406), indicating that 78.5% of the posts published by organisations essentially highlight the organisations’ activities. Miscellaneous contents, while important, are less directly empowering on a daily basis. However, staying informed about policies helps individuals advocate for their rights and needs. Announcements about events, conferences and courses keep the community engaged and connected, but these posts primarily serve to maintain engagement rather than provide direct empowerment. Information about organisational activities builds trust and transparency, focusing more on maintaining support and engagement than direct empowerment.

Health education is the most significant form of empowerment among all categories, representing 11.02% of the diabetes-related posts. Self-management and self-monitoring content, in particular, offered immediate empowerment by providing essential skills and knowledge for daily diabetes management, especially in social media, providing the benefit of less time and money constraints for the users.^{26 27} Studies have shown that health education equips individuals with the tools for better health outcomes.^{28 29} By prioritising health education, individuals are empowered to take proactive steps in managing their diabetes effectively.

It is noteworthy that certain pivotal topics of empowerment, such as awareness days and celebrations (n=43), recipes and food-related information (n=6) and interviews and personal stories (n=3), appeared to be under-represented in the contents shared on organisations' Facebook pages. These themes play a fundamental role in fostering empowerment among individuals with diabetes by offering valuable support, inspiration and practical guidance. Gabarron et al²¹ found that people who engaged most users featured interviews and personal stories and those who mentioned awareness days and other celebrations. The results also showed a lack of posts related to diabetes-related technology, research and innovation. These areas hold significant promise for empowering individuals by providing them with access to cutting-edge tools, therapies and knowledge that can profoundly influence their diabetes management outcomes.

Engagement

Analysing the engagement patterns of patients on Facebook provides valuable insights into their preferences and behaviours regarding healthcare-associated content. Patient engagement, especially on social media platforms, such as Facebook, plays a pivotal role in promoting health literacy, facilitating peer support and enhancing patient-provider communication.³⁰ Examining engagement levels across different content topics reveals interesting trends in patient preferences. As suggested by Gabarron et al²¹ ‘social media liking patterns more accurately reflect users’ actual interests than do their responses to questionnaires about their preferences’, so this could be a powerful tool to lead organisations in developing better interventions.

Health education emerged as a prominent area of interest for patients, with consistently high levels of engagement across multiple metrics. This suggests that patients actively seek informative resources and value content aimed at empowering them with knowledge about their health. Healthcare organisations can capitalise on this interest by prioritising the creation and dissemination of educational content to meet patients’ information needs and support their decision-making processes regarding their health and well-being.

Interviews and personal stories also exhibited notable levels of engagement. These findings underscore the importance of human-centred content that fosters empathy, understanding and connection within online communities. By sharing personal experiences and narratives, healthcare pages can cultivate a sense of community and encourage meaningful interactions among patients.

Recipes and food-related information garnered the highest average engagement per post compared with other content categories, indicating patients’ interest in the content addressing dietary and nutritional concerns. Healthcare organisations can leverage this interest to incorporate practical lifestyle advice into their communication strategies. Providing patients with relevant and actionable information about nutrition can empower them to make healthier choices and improve their overall lifestyle and well-being. While awareness days, other celebrations, as well as miscellaneous topics, received comparatively lower levels of engagement, they still play a role in engaging patients on social media platforms.

Moreover, the analysis of engagement by posts’ features highlighted the significance of multimedia content in driving patients’ engagement on social media platforms. As demonstrated by previous studies,^{31 32} health organisations mainly use photos (76.4%) to communicate. This is likely due to the fact that visuals can make the presentation of complex information easier to comprehend, make it more attractive and can reach people of all literacy and education levels.³³ Overall, multimedia content, images and videos are effective in capturing and maintaining audience attention, thereby encouraging patient interaction and engagement. The key findings related to healthcare communication strategies for diabetes management are summarised in table 5.

Table 5. Summary of healthcare communication strategies for diabetes management.

Categories	Key insights	Recommendations
Participation	Governmental organisations lead in diabetes-related posts.	Increase the frequency of diabetes-related posts, particularly from large organisations.
	The National Institute of Diabetics shows a strong focus on diabetes awareness.	Target broader audience engagement through consistent and relevant diabetes content.
	Larger organisations (eg, Honduran Institute of Social Security and Ministry of Health) have low diabetes post percentages (3.02%–3.06%).	Leverage large follower bases for diabetes awareness campaigns.
Engagement	Health education content received high engagement metrics.	Prioritise educational content to meet patient information needs.
	Personal stories and interviews foster empathy and community connection.	Share personal experiences to enhance community engagement.
	Recipes and food-related posts garnered the highest average engagement per post.	Incorporate practical dietary advice in posts to improve patient engagement.
	Multimedia content (images/videos) is effective in driving engagement.	Use a mix of multimedia formats for diverse audience reach and improved information retention.
Empowerment	Health education represented 12.76% of diabetes-related posts, crucial for self-management.	Enhance focus on health education to equip individuals with the necessary skills for diabetes management.
	Key empowerment topics like personal stories and technology were underrepresented.	Increase content on diabetes technology, personal stories and awareness days to empower users.
Overall strategy enhancement	Current strategies lack emphasis on targeted health communication.	Develop tailored campaigns based on audience insights to enhance public health impact.
		Regularly review post’s performance to adapt strategies and ensure continued audience engagement.

With the pros of using social media platforms for the interaction, engagement and empowerment of patients with diabetes, along with their overall role in reshaping healthcare, there are various barriers and limitations associated with them, which must be considered for their practical usage. Although these forms of communication may be helpful for healthcare professionals, some of the associated risks, such as social media’s potential for providing misinformation and questionable patient-to-patient medical advice, pose possible threats and must not be overlooked. Therefore, rather than fall victim to the pitfalls of social media, healthcare professionals can leverage these technologies appropriately to ensure their participation in meeting their patients’ education and support needs.

This study analysed data from healthcare organisations' Facebook pages in Honduras, acknowledging limitations in generalising findings to diabetes patients not engaged in social media. Moreover, by concentrating solely on Facebook, insights from platforms like Twitter (X) and health-focused websites, such as WebMD, which may provide distinct perspectives and engagement levels, were not considered. Variations in healthcare systems, cultural dynamics and social media usage among individuals with T2D underscore the need for comprehensive research across diverse online health communication channels. A key limitation of this study was the underrepresentation of rural organisations, as rural-based pages did not engage with their audiences as frequently and thus did not meet the inclusion criteria set in the Methods section. This underscores the need for further future research that addresses disparities in online healthcare communication, particularly for underserved rural areas.

Conclusions

The research highlighted different content topics and post features that significantly had an impact on patients’ engagement with diabetes-related social media posts. Health education, personal stories and food-related content are particularly engaging topics. Multimedia content, especially posts that include images and videos, significantly enhances overall engagement.

Despite the broad reach of healthcare organisations (with over 500 000 followers collectively) in Honduras, engagement with diabetes management posts is notably low. This gap between participation and engagement indicates that healthcare organisations are not fully capitalising on their potential to empower individuals with diabetes through social media. This discrepancy highlights the need for healthcare institutions to reassess and refine their social media communication strategies. By focusing on actively engaging their audience with relevant and compelling content and fostering a supportive online community, healthcare organisations can better meet the interests and needs of individuals with diabetes. Such efforts can enhance engagement and ultimately lead to improved health outcomes for this population.

In general, the findings from our study can be helpful for the government in designing, implementing and evaluating the needed digital services, especially for diabetes and chronic disease management. For future work, we suggest that additional exploratory studies should use other social media platforms and social networking channels as well to consolidate the feedback from the diabetes community in other regions.

Data availability statement

Data are available upon reasonable request.