Community health workers and social media: benefits, drawbacks, and training needs

Abstract

Background

Community health workers (CHWs) are an essential and rapidly growing part of the public health workforce. CHW activities are traditionally conducted in person, such as in clinics and at community events; social media could further extend their impact. Many health professionals use social media for disseminating health information, engaging patients, and promoting positive health change, while also navigating risks, such as privacy concerns. Training could be an effective approach to equipping CHWs with skills to maximize social media’s benefits while mitigating risks. Furthermore, artificial intelligence (AI) tools are increasingly popular for creating, refining, or tailoring social media content and could be useful for CHWs who use social media. In this study, we conducted qualitative interviews to explore the potential benefits and drawbacks of using social media as a CHW tool, CHW preferences for social media skills training, and interest in learning how to use AI for social media content creation.

Methods

We recruited CHWs in Louisiana, USA, through targeted e-mails to a CHW professional organization and agencies that employ CHWs. Between October 2024 and February 2025, we conducted 15 interviews. Interviews were audio-recorded and transcribed for analysis. We used deductive and general inductive approaches to analyze transcripts and generate themes. Results were finalized with input from experienced CHWs.

Results

We identified five themes related to the benefits and drawbacks of social media use: reach and engagement, privacy and confidentiality, health education, organizational policy and expectations, and time and effort. For example, in terms of reach and engagement, CHWs highlighted social media as being particularly effective for reaching specific groups, such as young people, but also recognized that many clients they serve live in rural areas with limited internet access. All participants were supportive of a social media skills training, except for one. Participants commented on the format, teaching approaches, and content they would like to see in a social media skills training program for CHWs, such as incorporating interactive elements and teaching how to develop culturally sensitive content and navigate personal-professional boundaries. Many CHWs expressed hesitancy about training on how to use AI for content creation, noting concerns about authenticity and accuracy.

Conclusions

Social media could be a powerful tool for boosting outreach efforts and expanding access to health information. However, using social media can present challenges in maintaining personal-professional boundaries and the privacy and confidentiality of CHWs and their clients. Results from our study can be used to inform the development and testing of a social media skills training that is responsive to CHW needs.

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Key findings

• Community health workers (CHWs) perceive several benefits and drawbacks to social media use related to its reach and engagement, health education, organizational policy and expectations, and time and effort.

• CHWs are receptive to formal social media skills training and have concrete recommendations for format and key topics.

• CHWs are hesitant about using artificial intelligence tools for social media content creation and may be more receptive to formal training.

What is known and what is new?

• Social media is widely used and leveraged by many health professionals, but little is known about its use among CHWs.

• This study identified benefits and drawbacks to CHW social media use that could be addressed in a social media skills training.

What is the implication, and what should change now?

• Social media is a promising platform to expand CHW impact, but presents notable challenges, including navigating personal-professional boundaries, that can hamper its full potential.

• Results from this study can inform the development of a formal social media skills training tailored to the needs and preferences of CHWs.

Introduction

Community health workers (CHWs) are essential members of the public health workforce. As knowledgeable, trusted, and credible frontline public health workers who often share life experiences with the communities they serve, CHWs are significant sources of nonclinical support. They provide culturally competent linkage to health and social services and build individual and community-level capacity through outreach, advocacy, education, informal counseling, and social support (1). Furthermore, CHWs are partners and participate in clinical and population-based research (2). There are many titles used for CHWs, such as promotores, patient navigators, care coordinators, community health advocates, and health educators. CHWs traditionally educate their communities and navigate services in person at health fairs, clinics, home visits, community events, and through street outreach (3). More recently, CHWs have also been leveraging telehealth to provide services (4,5). While these approaches are critical, social media presents an opportunity for CHWs to substantially expand their reach and impact.

More than 80% of people in the United States (US) use social media (6). Social media is effective for engaging groups that can be challenging to reach through in-person efforts—such as youth, rural communities, and people with limited mobility—and supports activities inherent to the CHW role, including sharing health information, preparing individuals for medical visits, and providing emotional support (7,8). Health professionals and “health influencers” have already demonstrated the ability of social media to disseminate health information, engage patients, promote positive behavior change, and combat misinformation (9,10).

Now in the ‘post-truth era’ political views and emotional appeals often supersede factual information which has led to widespread proliferation of misinformation on social media (11,12). A review of 64 studies that evaluated nutrition-related social media content showed that almost half of the included studies reported that information was inaccurate or of low quality (13). For example, some studies described misinformation regarding weight loss diets, which can lead to problematic eating behaviors (14). It is arguably more important than ever for health professionals to serve as credible sources to counter the spread of misinformation on social media and its influence on population health.

Yet, using social media as a health professional also introduces risks, including breaches of confidentiality, blurring of personal and professional boundaries, and potential harm to professional credibility if inaccurate or unprofessional content is shared (15,16). These challenges indicate a need to understand CHW social media use and identify the necessary supports to maximize benefits and mitigate risks.

Most research on social media use among CHWs is limited and outdated. A 2015 study of 196 CHWs across the US found that 77% of CHWs reported using social media for work purposes, with social influence and performance expectancy significantly associated with social media use (17). Studies of Certified Health Education Specialists, who, like CHWs, provide health information also identified self-efficacy as a predictor of social media use (18,19). Training in social media skills is a noted facilitator of use (17,20), yet no standardized social media skills training exists for CHWs.

A 2025 study in the southeastern US explored CHW perspectives on using social media in their work (21). Participants discussed beneficial uses of social media such as quickly engaging with and disseminating health-related information to large numbers of people and connecting with other CHWs for support. However, CHWs mentioned concerns with counteracting the extensive amount of online misinformation and challenges in managing personal and professional boundaries and building a dedicated following. The study also identified interest among participants in training on developing social media skills to navigate challenges demonstrating an area for further research.

Artificial intelligence (AI) has rapidly emerged as a prominent tool for social media content creation. AI tools are commonly used in marketing and health communication to enhance efficiency, generate ideas, and refine messaging (22,23). However, it is unclear how CHWs perceive AI as a support tool for social media content creation or whether they are interested in AI being incorporated into social media skills training.

To expand our understanding of social media use among CHWs and inform development of a social media skills training responsive to their needs, we conducted qualitative interviews with CHWs or supervisors of CHWs in Louisiana, US. Louisiana, located in the southern US, has a population of approximately 4.6 million people (24) and experiences a disproportionately high burden of chronic and infectious diseases, and a lower primary care provider to patient ratio (264 per 100,000) compared to the US average of 284 per 100,000 (25). Within this context, CHWs represent a critical resource for engaging underserved communities across the state using social media. However, little is known about how CHWs in Louisiana perceive social media use in their professional roles, or development of social media skills. In this study, we explored the following:

1. What do CHWs and CHW supervisors perceive to be the benefits and drawbacks of using social media?

2. What are CHW and CHW supervisor preferences for a social media skills training?

3. What is CHW and CHW supervisor’s interest in learning to use AI as a tool for social media content creation?

Methods

Participants and procedures

Study inclusion criteria were: (I) were currently employed as a CHW (or any variations of that title), or supervised CHWs; (II) were 18 years and older; (III) lived in Louisiana; (IV) were able to complete a survey and interview in English; and (V) had a CashApp account to receive compensation. We included CHW supervisors because they possess insight into CHW training, duties, and workflow needs. We sent e-mails with recruitment flyers to the Louisiana Community Health Outreach Network (LACHON) and community-based organizations, clinics, and health departments in our networks.

Potential participants completed an eligibility screener using an emailed hyperlink or a quick response (QR) code on the flyer. Respondents who screened as eligible completed a contact form and were contacted by study staff through phone, text, or email (based on participant preference) to confirm their interest and schedule a session to provide written electronic consent and conduct the interview. Written electronic consent and interview procedures took place on Zoom software. Participants received $50 for their time and effort.

Data collection

Between October 2024 and February 2025, we conducted 15 interviews. The first author (M.A.O.) and a research assistant conducted all interviews. Interviews ranged from 25 minutes to an hour and 20 minutes and were audio recorded and transcribed for coding and analysis. M.A.O. generated an initial draft of the interview guide and finalized it with input from experienced CHW co-authors, C.A.H. and T.D. Notably, none of the authors held any supervisory role over participants. We began interviews by building rapport with participants and discussing their work responsibilities and use of social media in their roles. Then, we conducted a decisional balance exercise that included questions about perceived benefits and drawbacks to using social media as a CHW. The interviewer shared a document on the screen with two blank columns labeled benefits and drawbacks, respectively, and populated it in real time as the participant discussed their perceptions. We confirmed with the participant that the content on the table matched what they said prior to proceeding with the next part of the interview. Regarding the preferences for a social media skills training, we asked about the likelihood the participant would participate in a social media skills training, if offered, and what they would want in the training. We explored practical aspects of the training, such as format and length, and probed about content, such as types of social media skills and strategies they would find most useful. Finally, we asked about participants’ thoughts on learning how to use AI as a tool for social media content creation. At the end of the interview, the interviewer sent a link to a brief sociodemographic questionnaire.

The study protocol was approved by the Tulane University Social and Behavioral Sciences Committee Institutional Review Board (No. 2024-709-Online). This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments.

Data analysis

We used deductive and general inductive approaches to analyze transcripts and data from decisional balance tables (26). We created a codebook deductively by using predetermined categories (i.e., benefits, drawbacks, training format, training content, AI) based on the interview questions to guide the coding process. Codes were organized into the categories, and then we explored themes within each category. We also explored the data for potential emergent codes that did not fit into an existing category. The first (M.A.O.) and second (J.F.) authors independently coded and met to compare codes and themes and resolve inconsistencies until they reached consensus. The third (C.A.H.) and fourth (T.D.) authors, who are both CHWs with decades of experience and users of social media, reviewed results prior to finalizing.

Results

Sample characteristics

Table 1 describes participant characteristics. All but one participant provided sociodemographic data. Participants ranged from 24 to 64 years of age, most identified as women (64%), Black (79%), and had earned a bachelor’s degree or higher (57%). One-third of participants held supervisory positions (Operations director, CHW supervisor). Participants were employed in diverse settings, with most working in non-profit organizations (33%) or health departments (27%). As the first author (M.A.O.) is a human immunodeficiency virus (HIV) researcher, 73% of CHWs focused on HIV-affected communities. The remaining 27% addressed multiple health conditions. All CHW employer organizations had a social media presence, and all but one participant supported the idea of participating in a social media skills training (93%). Here, we summarize the a priori codes (benefits and drawbacks of social media use by CHW, training format, training approaches, training topics, and AI for content creation) along with exemplary quotes.

Table 1. Participant characteristics (n=15).

Characteristic	Value
Age†, years	48 [24–64]
Gender†
Woman	9 [64]
Man	3 [21]
Nonbinary	1 [7]
Genderqueer	1 [7]
Racial identity†
Black	12 [79]
White	2 [14]
Educational attainment†
Tech/trade school	2 [14]
High school/GED	1 [7]
Associates	2 [14]
Some college	1 [7]
Bachelors	5 [36]
Graduate/professional	3 [21]
Role/title
CHW	7 [47]
Coordinator	3 [20]
CHW supervisor	3 [20]
Director	2 [13]
Employer
Non-profit organization	5 [33]
Health department	4 [27]
Federally qualified health center	3 [20]
Hospital	1 [7]
Church	1 [7]
Health insurance company	1 [7]
Health focus
HIV	11 [73]
Multiple health conditions	4 [27]
Organizational social media (yes)	15 [100]
Interest in skills training (yes)	14 [93]

Data are presented as median [interquartile range] or number [%]. ^†, data were missing for 1 participant. CHW, community health worker; GED, general educational development; HIV, human immunodeficiency virus.

Benefits and drawbacks of social media use by CHW

Five main themes emerged from our review of the perceived benefits and drawbacks of social media use by CHW. These themes included reach and engagement, privacy and confidentiality, health education, organizational policy and expectations, and time and effort. We report the job title and age of the participant for each exemplary quote provided.

Reach and engagement

There was general agreement that social media was beneficial as a tool for increasing reach and engagement. Participants observed that almost all their clients used social media. One person noted that social media may be a better option than phone calls to communicate with their clients:

“Everybody’s using it… And if you needed to reach out to somebody, you could reach them that way. If they don’t pick up the telephone, they will answer that social media because they always have the telephone in their hand. And they’re looking at social media for something.” (Executive director, 59 years old).

Some participants mentioned that social media could be particularly effective in reaching specific groups, such as young people, who use social media more frequently. Another participant noted that social media may be the only vehicle for communicating with people who are bound to their homes and beneficial for connecting these people to healthcare:

“A lot of people don’t have cars, and they’ve become hermits of their own homes, and social media is the only outlet. A lot of people don’t leave their houses…, especially a lot of people that are now on disability or after COVID have certain mental illness where they don’t want to leave their home… So, it is more or less a tool. It’s not the only thing that we can do, but it is a tool that in the past has been helpful to get people into care.” (Education coordinator, 46 years old).

However, some participants pointed out that access to social media is not universal. One participant who worked in rural Louisiana identified limited internet access in rural areas as a barrier to social media use by CHWs:

“When you think about rural Louisiana, like, I run across some people who… if they don’t have adequate wi-fi services in the areas that they live in, it’s hard for them to get on social media.” (CHW, 48 years old).

Nearly all CHWs noted that they used social media to promote health-related community activities and events, such as health fairs. They also used social media to promote and engage people in the services and activities provided and/or sponsored by their organizations. One participant highlighted social media’s unique advantage that allowed for promoting health-related events in real time.

“You’re also able to make posts wherever you are. So, if you know people need something like a health fair or something that you’re at, you can do it in real time. Make a post, and people see where you are, and if they need those services, they can come on out and get the services that they need.” (Executive director, 59 years old).

Privacy and confidentiality

Most participants cited privacy and confidentiality as critical factors that influence their use of social media for engaging with clients. Some participants were worried that their personal information might be “hacked” and that some clients or community members may not want to be visible on social media. Some participants noted the importance of obtaining consent before posting content. One participant provided a hypothetical example of the untoward consequences of taking candid photos without consent at an event and then posting them on social media to promote the event.

“So, for example… if you wanted to take pictures at an event. About how successful it was. And then you posted on social media. And then you never know who’s gonna run across that from Facebook or whatnot. And they’re gonna be like, ‘Oh, my gosh! Like, Hey! I’ve been looking for this person. I saw that they were at this event in this town, in this city.’ You just exposed where somebody may potentially be who may have been hiding.” (Outreach supervisor, 29 years old).

One participant who used social media to post sexual health content often had young people contact them through direct messages (DMs), and highlighted the challenges associated with communicating with minors about sensitive topics.

“I definitely don’t want to turn them away when they ask me a question but just having to stay within the lines of confidentiality. Certain things I know that I cannot discuss with them.” (Education coordinator, 46 years old).

Health education

Although most participants recognized social media’s potential as a source of health information and a dissemination tool, they mentioned both benefits and drawbacks. CHWs who worked in the HIV field noted a general lack of knowledge around HIV and sexual health, and how social media could be leveraged to fill the gap in knowledge.

“I would specifically say, education, awareness, understanding the nature of HIV, which, to be honest, in 2024, a lot of people really don’t have very much knowledge of what HIV is.” (Operations director, 36 years old).

One participant highlighted how, while being mindful of confidentiality, direct messaging capabilities on social media provided a unique opportunity to educate younger people who do not feel comfortable discussing sexual health topics with others.

“I work with a lot of kids, and… they DM me a lot... They’re comfortable with asking me certain questions that they haven’t been able to ask anyone else... I make them feel comfortable enough to speak with me.” (Education coordinator, 46 years old).

Some participants noted the potential for information shared on social media being misconstrued and damaging to the communities they serve. One participant gave an example of how promoting HIV testing services at a Pride event could perpetuate HIV stigma in lesbian, gay, bisexual, transgender, queer, plus (LGBTQ+) communities. They described that the intent would be:

“… mainly just to make sure that community members that come out are educated about their status. However, that sends a negative connotation about Pride... Pride is specifically for people in the LGBTQ community. HIV can happen to anyone, and the education is still so limited, and that’s what still makes it so stigmatizing.” (Outreach supervisor, 29 years old).

Other participants shared that many people distrust information posted on social media, and this distrust could hamper health education efforts.

“Some people think social media is lies. Some people think that they don’t know who to trust.” (Church CHW, 52 years old).

Organizational policy and expectations

Many participants discussed the implications of using social media as representatives of their organizations and differentiating themselves personally and professionally on social media. Organizational policy and expectations were predominantly seen as drawbacks to effectively using social media. A participant shared how their organization limited any social media content promoting late-night HIV testing at gay bars despite requests from transgender community members for information about safely accessing testing.

“When we’re with community, we get that feedback from them…they want to know what area is safe for trans women to go and test in. We test at some of the gay bars. So, of course, we test late after hours. Well, you can’t promote that. You’re testing late after hours… that kind of… ties your hands at the end of the day.” (Education coordinator, 46 years old).

These types of limitations on social media content may be tied to funding sources. One participant recognized how much more leeway their organization was afforded in social media communications relative to others because of funding.

“Because, like, they’re not funded by the State like we are, we are an advocacy organization. So, we can be as loud as we want to be. But many community health workers work for community-based health organizations or federally qualified healthcare centers or receive some form of funding from the State and are really muzzled right now.” (Education coordinator, 38 years old).

Some participants also commented on balancing a personal and professional presence on social media, particularly in terms of the type of content they could post. One participant described the difference in content between their personal and professional accounts:

“Well, on my personal account, I could kind of just post anything that I want. But when you’re posting on a business professional account, you know you have to keep things respectful. You have to not overstep boundaries. Make sure that you’re respecting the community that you’re trying to reach as well, which, on my personal social media account, I don’t post like that.” (HIV Prevention Coordinator, 24 years old).

Another participant noted that some clients tried to add them as a friend on social media but declined these requests to set a clear boundary:

“I have, like an Instagram account that I pay attention to, but… people would try and become friends with me who are my clients or my patients, and I had to come up with strong, like I draw a line here.” (Education coordinator, 46 years old).

They also described moderating their social media content in case a client would see their posts:

“I only posted things that I felt like if a client or a patient were to find it, I would feel comfortable with it… I’m a queer trans freak, so like… that means there’s shit that I could have been posting. But I wasn’t, you know, because, like I knew.” (Education coordinator, 46 years old).

Time and effort

A majority of participants noted that generating social media content was time-consuming. They also described challenges in juggling content generation in addition to carrying out their other duties and responsibilities.

“I would say it’s a drawback, especially in my role, because I also have to focus on in-clinic and try to organize, you know, events in the community as well, and with testing. So, it [generating social media content] definitely takes a lot of time. And sometimes that can be a drawback, especially if you’re trying to, you know, maintain patient scheduling when it comes to PrEP, just making sure that they come on their appointment sometimes.” (HIV Prevention Coordinator, 24 years old).

While recognizing the effort it takes to incorporate social media in their day-to-day activities, one participant noted that with increased familiarity, using social media would make using it less onerous:

“I think the time it takes to use social media won’t be a factor once you learn how to use it. It’s the learning how to use it… time that it takes, at least for me. Because I’m [am] still calling people and saying, ‘Now, how do you do this? And how do you do that?’ Because I’m not confident in myself that I’m doing it correctly...” (Executive director, 59 years old).

On the other hand, some participants noted that using social media in their day-to-day work was relatively easy: “It may just take a minute to stop and post something.” (CHW, 57 years old).

Social media skills training

We asked participants to comment on the format, teaching approaches, and content they would like to see in a social media skills training program for CHWs.

Training format

Most participants preferred a virtual or hybrid training format, citing that this format would increase accessibility. The majority of participants envisioned a multi-session training program. The sessions should be delivered weekly or monthly and would last no more than three hours:

“Not all in one day… for some [people] I feel like that can be a tad bit overwhelming... Personally, I wouldn’t go over more than 3 hours. I guess it depends because you have some people who are not really tech-savvy and social media savvy. So they probably would need longer than some people who you know interact with social media on a daily basis. I would say about like 5 or 6 weeks.” (HIV Prevention Coordinator, 24 years old).

Training approaches

To accommodate varying skill levels in social media use, some participants recommended developing standalone modules on select topics. Trainees could then enroll in the modules as needed based on skill or preference.

“I might not need the whole kit and caboodle, but I might be into the days that had something that was more relevant to the work that I’m doing.” (Coordinator, 38 years old).

Some participants noted that sessions should have interactive elements. One participant noted that other trainees could be valuable sources of feedback for social media content developed in the training:

“I like the idea of… both mixed and individual work...if the goal is to make content for your own organization, for your own pet project, then you’re gonna need some individual time. But I like the idea of group feedback to being able to… give… real-time consumer feedback about what someone… thinks about the thing.” (Coordinator, 38 years old).

Most participants were supportive of incorporating homework assignments as part of the training modules. However, some participants were concerned that homework would interfere with their work responsibilities.

“I really don’t have the time working full-time. As long as it’s not a lot and overwhelming... I wouldn’t mind doing it, because it’s something that I’m learning. But I just don’t want it to be so time-consuming if that makes sense.” (HIV Prevention Coordinator, 24 years old).

Training topics

Some participants were interested in learning the basic functions of popular apps, specifically TikTok, Threads, LinkedIn, and YouTube, and how to use certain content creation tools, such as Instagram reels or Canva. Participants also suggested skills training on how to create tailored, visually appealing, and attention-grabbing content.

“… learning how to use attention grabbers. Because that’ll be the most important. That’s the most important thing with social media, having the attention grabbers and making it interactive.” (CHW, age unknown).

Some participants suggested training on tailoring content to intended audiences, such as using terminology that resonates with youth or ensuring content is up-to-date with current trends. Many participants, especially those who worked in the HIV field, noted that the training should include how to develop culturally sensitive content. One participant suggested including ways to incorporate input from members of the focal communities:

“Whatever you do… there’s like a section that really focuses on how you vet your images through community by the communities that are going to be most impacted by whatever your messaging is, I think there should always be community advisory input on any social media.” (Coordinator, 36 years old).

Participants also expressed interest in learning other engagement strategies, including how to build a following and how to respond to posts and comments. One participant described wanting to know how to maximize visibility of content through strategic placement and scheduling of posts.

“If I need to get the word out about a particular event, and I’m trying to think of okay, who’s the demographics that I wanna invite? Who’s the people that we really want to get the word out to? Okay, is it gonna be strategic for me to share this on this platform versus that one? So just kind of knowing like, what’s your goal? That way, you can plan your strategies.” (Outreach supervisor, 29 years old).

Many participants were interested in learning how to mitigate privacy and confidentiality concerns for themselves and their clients. One participant wanted to know how to share client stories “based on Health Insurance Portability and Accountability Act (HIPAA) laws”. Other participants were interested in how to secure their own privacy to avoid their accounts being hacked and limit unauthorized sharing of their content. One participant described how public information on her profile was used to access and change her account:

“So yeah, hackers and sharing your information. What information you should put in your status, and what information you shouldn’t on your personal, on your personal profile on your bio… those are things I would like to know? Because they were able to take my birthday on social media and change information. So, should you put your birthday here? Should you not put that?” (Education coordinator, 29 years old).

AI for content creation

When asked about using AI for social media content creation, most participants were hesitant and expressed uncertainty and fear. Some participants also had no prior experience with using AI. One participant said:

“I don’t know, because it’s kind of scary. I don’t know. I’m not gonna say yes, just leave me as I don’t know. ‘Cause from my understanding, AI thinks for you, so I don’t know. I would have to first learn more about AI.” (CHW, 62 years old).

Participants noted that AI can limit creativity and authenticity. One participant stated that this was currently happening with Chat Generative Pre-trained Transformer (ChatGPT):

“We’ve already seen kind of the nature of like ChatGPT really influencing, like the writing skills of individuals, where it almost like creates… a level of… unauthenticity.” (Operations director, 36 years old).

However, there were some participants who supported the idea. One participant described already having received AI training and stated that AI is part of our current and future reality that everyone should be prepared for:

“Oh, hey! That’s the way to go. Our company, we’ve had trainings on AI, because that was new for people like me. So, they constantly give us training on using AI and different things. So, I think it’s the way of the world, and it’s the way of change.” (Outreach specialist, 62 years old).

Some participants said AI should not replace content creation by humans, but rather it can be used as a supplement to refine language or ideas.

“So yeah, I like it. I like using AI as a tool. I’m sorry, I have my own brain. I can definitely write all of my own things, but I can also have the confidence of putting it in an AI chat or a ChatGPT, and say, ‘Hey, how does this sound?’ And it can give me a whole bunch of different things of how I could make it better. So yeah, I like using AI as a tool. I don’t think it should be the primary thing of how to get your work done, but you definitely can use it as a tool.” (Education coordinator, 46 years old).

Discussion

Our study describes the perceived benefits and drawbacks of social media use by CHWs, in addition to recommendations for social media skills training among a diverse group of CHWs and their supervisors in Louisiana. CHWs reported clear advantages to using social media in terms of their broad reach and ability to promote resources and engage new and existing patients in organizational services. Some CHWs emphasized that this was especially true for communicating with youth and people with limited mobility, who would otherwise be difficult to reach through in-person efforts. Social media was also seen as a powerful tool for health education, particularly in expanding knowledge around HIV and sexual health. Conversely, CHWs also expressed considerable drawbacks, such as mistrust of information on social media and the time and effort required to maintain a social media presence. CHWs also raised ethical concerns shared by other public health professionals, namely setting personal and professional boundaries and navigating privacy and confidentiality, that require organizational guidance and could be addressed through training.

As well-connected members of their communities who may have a strong personal social media following, CHWs can be particularly vulnerable to the blurring of professional and personal boundaries, a concern echoed by CHWs in the 2025 study by Chen et al. (21). Prior studies have reported that public health professionals are concerned about possible identity theft or unwanted attention from patients or colleagues (27). Furthermore, if personal content is unprofessional, it may adversely impact one’s credibility and employment status (15). Participants in our study discussed implementing various strategies to set boundaries on social media, such as adjusting the type of content they posted, avoiding “friending” patients, and having separate personal and professional social media accounts. However, these strategies may be insufficient, and CHWs and other healthcare professionals may need guidance in navigating social media use professionally and personally.

In a study of US-based physicians who use social media, participants described the tension in separating their professional and personal selves and how the overlap was unavoidable and, for the most part, not desirable (10). Public health professionals wanted to be perceived as warm and personable to build trust and relatability (10). Furthermore, when information was shared through personal narratives, viewers perceived their messages to be more effective compared to providing impersonal guidance (28). Despite their powerful impact, personal narratives describing patients can introduce additional concerns regarding client privacy and confidentiality.

Most participants expressed privacy and confidentiality concerns for their clients. Some participants addressed this by obtaining prior consent, but this may not be a well-known or consistently implemented solution. A 2020 study on Twitter (now called X) reported that an estimated 32.1% of tweets by healthcare professionals about patients were likely identifiable by patient friends or family members, suggesting a breach of patient confidentiality (29). This high frequency indicates a clear need for organizations to support CHWs and other public health professionals in navigating privacy and confidentiality concerns in general, and particularly in using social media.

The idea of a social media skills training was positively received by nearly all CHW participants, and we solicited their recommendations on the training format, approaches, and topics to include in a CHW social media skills training. Most participants preferred a virtual or hybrid format delivered over multiple sessions with activities that fostered interaction among trainees. Notably, prior studies have noted that virtual CHW trainings that enhance interactivity can increase engagement and improve learning outcomes (30). Furthermore, they may be more efficient and cost-effective than traditional face-to-face approaches.

We found that participants were attuned to varying levels of familiarity and comfort with social media among CHWs, which was reflected in the training topics they suggested. At the most introductory level, some participants recommended covering basic functionality of the apps and how to use programs to create content. CHWs also expressed interest in various engagement strategies, such as timing of posts, developing original content, and ensuring that content resonates with focal populations, which were up to date with trends.

Social media skills training should also review existing social media policies, particularly as they pertain to professional boundaries, privacy, and confidentiality. Healthcare workers are often unfamiliar or unclear as to what social media policies are and uncertain about how to implement them in practice (31,32). This uncertainty increases the likelihood of unintended violation of standards for professional conduct, which can damage credibility (15) and have legal repercussions (29). Furthermore, current policies often focus on the risks and consequences of violating standards rather than providing practical guidance on navigating social media use (7,33). Training focused on social media conduct has been developed and implemented for healthcare professional trainees, such as medical and pharmacy students (34,35). To our knowledge, no such training exists for CHWs. This points to the importance of reviewing policies and providing practical strategies to ensure compliance and mitigate risks when developing a CHW social media skills training.

Our results also suggest that organizational policies may hinder CHWs from harnessing the full potential of using social media in their roles. One participant discussed their organization’s prohibition on the posting of content that addressed safety concerns in accessing HIV testing services, despite many of their client population specifically requesting such information. Tension between community public health needs and restrictive policies is not uncommon and was seen early in the coronavirus disease 2019 (COVID-19) pandemic. Some hospitals restricted staff from and disciplined them for posting critical information, such as shortage of personal protective equipment or severity of cases (36). Furthermore, organizational policies often require the separation of personal and professional identities, which may impede personal expression and reduce message effectiveness (28). We stress the importance of listening to the community’s needs and developing flexible social media use policies that can be helpful in addressing these needs and allow CHWs and other healthcare professionals to present themselves personably and professionally.

Participants were mixed in their interest in and openness to training in the use of AI for content creation. This is unsurprising given that over half of Americans are more concerned than excited about AI (37). Some CHWs expressed concerns that AI limited creativity and authenticity, which could color their perceptions of AI-generated content. Some research suggests that more value is placed on content when it is perceived to be original compared to AI-generated or AI-co-created content (38,39). On the other hand, positive attitudes towards AI are associated with having more favorable views of AI-generated content (38,40). For CHWs to embrace AI as a tool for content generation, it may require targeted educational efforts that address their stated concerns and help build a positive attitude towards AI use. For instance, a social media skills training should include introductory information to help demystify AI, reduce hesitations, and discuss responsible ways of using AI to generate content.

Our study has some limitations. Although we recruited 15 participants, we reached data saturation (41). Furthermore, the narrowness of our topic and population of focus instills confidence that the sample size was adequate. We also acknowledge that most participants focused on populations affected by HIV, which could limit transferability to CHWs who work with populations at risk for or with other health conditions. Similarly, CHW participants were based in Louisiana, and their experiences may not reflect those of CHWs in other states in the South or the US; this study can provide a foundation for future studies on a larger scale. Although one-third of our sample held leadership roles at their respective organizations, these participants may not have been familiar with the implications of social media use among CHWs as employees of their organizations. As such, future research should include organizational perspectives to ensure that social media skills training not only meets the needs of CHWs but also addresses factors that impact successful training implementation and promote optimal social media use among CHWs.

Conclusions

CHWs identified benefits and drawbacks to social media use in their role and described their needs and preferences for social media skills training. Social media could be a powerful tool for boosting outreach efforts and expanding access to health information. However, using social media can present challenges in maintaining personal-professional boundaries and the privacy and confidentiality of CHWs and their clients. While organizational policies address some of these challenges, CHWs are often unfamiliar with these policies. A formalized training could equip CHWs with the skills necessary to optimize social media use and provide practical guidance on navigating organizational social media policies, and teach them to use tools such as AI. Organizational and CHW insights should be incorporated throughout the development process to ensure that the training is feasible to implement, while reflecting CHW priorities.

Supplementary

The article’s supplementary files as

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study protocol was approved by the Tulane University Social and Behavioral Sciences Committee Institutional Review Board (No. 2024-709-Online). This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. Respondents who screened as eligible completed a contact form and were contacted by study staff through phone, text, or email (based on participant preference) to confirm their interest and schedule a session to provide written electronic consent and conduct the interview. Written electronic consent and interview procedures took place on Zoom software.

Data Sharing Statement

Available at https://mhealth.amegroups.com/article/view/10.21037/mhealth-20251-68/dss

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DOI: 10.21037/mhealth-20251-68