ABSTRACT
Studies
have shown that the burden of non-communicable diseases such as diabetes,
cancer, and hypertension is on the increase in Nigeria. Adequate knowledge,
positive attitude and intention to adopt health-enhancing behaviour as espoused
in NEWSTART (Nutrition, Exercise, Water, Sunlight, Temperance, Air, Rest and
Trust in God) can reduce the incidence. Social media are increasingly being
utilised by individuals, health professionals and organisations for health
communication as they offer significant potentials. In Nigeria, the usage of social media is high
however their utilisation for health communication is arguably low. This study
examined the effects of social media health communication on knowledge, attitude
and intention to adopt health-enhancing behaviour among undergraduates in Lead
City University and Tai Solarin University of Education, Nigeria.
The
study adopted quasi-experimental design. Study population was 26,000 undergraduates of Lead City
University and Tai Solarin University of Education. Sample size of 200
undergraduates were purposively selected and assigned 25 each to the 4
experimental groups and 4 control groups.
A validated questionnaire was used for data collection at baseline and
endline from the experimental groups and control groups. The reliability test
yielding Cronbach’s Alpha coefficients: knowledge of health-enhancing behaviour
= .733; attitude to health-enhancing behaviour = .741; subjective norms=.825;
perceived behavioural control =.914; intention to adopt health-enhancing
behaviour=.933 and the composite Cronbach’s Alpha result was 0.940. Baseline
data of students’ knowledge, attitude and intention to adopt health-enhancing
behaviour were collected. This was followed by the exposure of NEWSTART
messages via Facebook and WhatsApp to the experimental groups for five weeks,
after which endline data were collected. Data were analysed using inferential
(paired samples T-test and multiple linear regression) statistics.
Findings
revealed that there was a significant difference (t=-2.303; p<0.05) in
students’ knowledge of health-enhancing behaviour before and after the social
media health communication intervention. No significant difference was observed
(t=-.323; p>0.05) in students’ attitude to health-enhancing behaviour before
and after the social media health communication intervention. There was no
significant difference (t=1.73; p>0.05) in students’ intention to adopt
health-enhancing behaviour before and after the intervention. For the theory of
planned behaviour, attitude was not a significant predictor (R2=0.0031,
β=0.056, p>0.05) of intention to adopt health-enhancing behaviour while
subjective norms (R2=0.0481, β=0.220, p<0.05) and perceived behavioural
control (R2=0.2916, β=0.540, p<0.05) significantly predicted
intention to adopt health-enhancing behaviour with perceived behavioural
control being a better predictor.
The
study concluded that social media health communication intervention was
effective in increasing students’ knowledge of health-enhancing behaviour but
not effective in influencing attitude and generating intention to adopt
health-enhancing behaviour. Attitude does not predict intention to adopt
health-enhancing behaviour but subjective norms and perceived behavioural
control predict intention to adopt health-enacting behaviour. It was
recommended that health communicators should use social media for health
communication if the goal is to increase knowledge but other communication
channels should be used where the goals are to influence attitude and
behavioural intention.
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Health concerns globally are shifting from
infectious diseases to non-communicable diseases (NCDs) as they are becoming
the leading cause of mortality even in developing countries. (Adogu, Ubajaka, Emelumadu,
&Alutu, 2015; Mahmood, Ali
and Islam, 2013; WHO, 2008). Scholars
have advanced that most non-communicable diseases are linked to lifestyle
patterns and choices of individuals and thus they are termed ‘lifestyle
diseases’ (Chandola, 2012; Sharma & Majumdor, 2009). The occurrence of
these diseases are associated with the neglect of health-enhancing behaviours
such as proper nutrition, exposure to sunlight, exercise, adequate sleep,
adequate water intake as espoused in NEWSTART health regimen. Mahmood, Ali and Islam (2013) affirms this
noting that “the leading global risks
for mortality are high blood pressure (responsible for 13% of deaths globally),
tobacco use (9%), high blood glucose (6%), physical inactivity (6%), and
overweight and obesity (5%).”(p. 38).
Examples of lifestyle diseases are heart diseases, stroke, diabetes, and
cancer. The World Health Organisation (WHO)(2014a) reports that NCDs present a
new challenge for the Nigerian health system and they accounted for 24% of
total deaths in the country (World Health Organisation, 2014b).
Lifestyle disease or NCDs are avoidable
with right information and adoption of healthy practices even from early stages
of life. Mahmood, Ali and Islam (2013)
assert that the key to controlling non-communicable disease is “primary
prevention through promotion of healthy life style which is necessary during
all phase of life” (p. 37). NEWSTART is a total
wellness/health regimen that promotes health-enhancing
behaviours aimed at achieving optimal health and
body function which in turn reduces the likelihood of lifestyle diseases.
NEWSTART is an acronym for Nutrition, Exercise, Water, Sunlight, Temperance,
Air, Rest and Trust in God. It is health
regimen targeted at complete physical, mental, physiological and spiritual
wellbeing (Aja, 2001; Ashley & Cort, 2007).
Health promotion philosophies like NEWSTART has to first be communicated
and individuals encouraged to adopt these behaviours, so as to positively
impact their health. This is one of the major task of health communication,
which according to Rimal and Lapinski (2009), is concerned with health
promotion, wellbeing and improved quality of life among people. Parrott (2004) explains that “health
communication is the art and technique of informing, influencing and motivating
institutional and public audiences about important health issues” (p.
751). The basic objective of health
communication is to increase public’s knowledge of health issues, influence
their attitude and behaviour for optimal health by disseminating information on
healthy living and practices, prevention and treatment of diseases. Given the health challenges and increasing
incidence of non-communicable diseases in Nigeria which are associated with
lifestyle choices and practices, there is the need to employ as many
communication tools as possible, including social media, for health
communication to really influence the adoption of healthy practices among the
populace. Alluding to the need for using
social media for health-related purposes, Oyelami, Okuboyejo and Ebiye (2013)
maintain that the health situation can be different in Nigeria if the populace
are aware of the availability of health information on the new media and take
advantage of it.
Social media are highly interactive
communication platforms enabled by the Internet and Web 2.0 in which users can
connect with each other, generate, modify, share, and discuss contents in the
form of text, audio, video or images. According to Nwafor, Odomeleam,
Orji-Egwu, Nwankwo and Nweze (2013), “social media are Internet-based tools and
services that allow users to engage with each other, generate content,
distribute and search for information online” (p. 70). Social media are about content generation,
sharing, collaboration, interaction, and community input. They have
the “innate ability to communicate information in real time, as well as link
groups of people together around common issues” (Hughes, 2010, p. 3). It is the interactive nature of these
platforms that makes them ‘social’. With social media, users can share
opinions, experiences, contacts, knowledge, expertise and information between
and among themselves. Social media makes
for rapid and widespread distribution of information across nations and
continents and communication and interaction on these platforms take place on
one-to-one, one-to-many and many-to-many basis.
Ajilore and Adekoya (2016) noted that “these platforms are used to send
information from one individual or one account to another, therefore
information spreads at an accelerating rate.”(p. 151). Bryer and Zavataro (2011) added that social
media make for interaction that is across boundaries, time and space. The uniqueness of social media lie in the
characteristics of openness, user-centeredness, conversation, immediacy, reach,
ease of use, not bound by geography, interactivity, participation, and variety
of content format (Ekeli & Enobakhare, 2013; Okeke, Nwachukwu & Ajaero,
2013). Social media platforms are diverse and evolving; yet can be categorised into
groups to reflect their range and nature. As such, there are Social Networking
Sites (SNS) (e.g. Facebook, LinkedIn, WhatsApp); Blogs and Microblogs (e.g.
Twitter); Video and Image sharing sites (YouTube, Instagram, Flickr, Snapchat);
Collaborative projects (Wikipedia, Kickstarter); Internet Forums
(eHealthforum); Virtual Social World (e.g. Second Life) and Virtual Game Worlds
(e.g. World of Warcraft) (Kaplan & Haenlein, 2010; Wong, Merchant &
Moreno, 2014).
The increasing availability of Internet
access and smartphones makes the use of social media widespread. According to
wearesocial (2016), a global social media consultancy firm, there were 3.42
billion Internet users globally, equalling 46% global penetration and 2.31
billion social media users. As at June, 2016, Nigeria was said to have the
largest Internet population in Africa (with 92 million users) and ranked
seventh in the world (Internet World Stats, 2016). PewResearchCenter (2016)
reports that 76% of Internet users, use social networking sites such as
Facebook and Twitter. In Nigeria,
Facebook and WhatsApp have been found to be the most popular and widely used
social networking sites amongst students (Buhari, Ahmad & HadiAshara, 2014;
Musa, 2015; Popoola, 2014). In 2016,
Facebook announced that Nigeria had 16 million active users and that 7.2
million people visit Facebook each day (Financial Nigeria, February 2016;
Internet World Stats, 2017). Data on
WhatsApp usage in Nigeria reveals that 45% of mobile phone users utilize the
platform (Adika, 2014). These data indicate a high social media usage in
Nigeria and this signifies that the potentials of social media use for health
communication could be far reaching.
Health, no doubt, is crucial for the
development of human capital and productivity in a country. The health of a
nation’s population is intrinsically related to the development of that nation.
This is because it is when a nation’s work force is healthy that they can be
productive. Lawanson (2004) underscores this point noting that “Only a healthy
population can be fit enough to learn all the required skills for productive
purposes and have the stamina to engage in production of goods and services to
steer the economy of the country forward” (p. 132). Underscoring the importance of good health
and wellbeing, the United Nations in 2015 made health the third goal of the 17
Sustainable Development Goals (SDGs). Goal 3 is titled, ‘Ensure Healthy
Lives and promote Wellbeing for all at all age’.
The aim is to ensure that people live healthy lives that will increase life
expectancy and reduce the incidence of deaths occurring from diseases
(Aitsi-Selmi & Murray, 2015; Kumar, Kumar & Vivekadhish, 2016; United
Nations, 2016).
Social media though originally designed
for social relations and connections are being utilised for health-related
purposes and contexts. Social media
though originally designed for social relations and connections are being
utilised for health-related purposes and contexts. The integration of social media in health communication
activities is to leverage on the social dynamics, audience participation,
conversations and networks that the platforms offer in addition to their
capabilities for information and education (Adum,
Ekuwgha, Ojiakor, &Ndubuisi, 2016). Studies abound on how the general public,
patients, health caregivers, health professionals, hospitals, health
organisations are employing social media for healthcare and communication (Abramson,
Keefe & Chou, 2014; Al Mamun, Ibrahim &
Turin, 2015; Song, Omori, Kim, Tenzek, Hawkins, Lin & Kim, 2016; Uittenhout, 2012; Zhang, 2013). Increasingly, individuals use social media to
request and share health information, express health concerns, connect with
doctors, health experts and specialists, share experiences, raise funds and
provide support for disease sufferers.
Health professionals (doctor, nurses, public health officers) employ
them to communicate with patients and manage patients care. Public health
organisations use social media to amplify their health messages and for health
advocacy while health agencies and organisations use social media for health
awareness, fund raising, disease warning and monitoring campaigns/efforts.
Ventola (2014) reported that in the United
States, eight in ten Internet users search for health
information online, and 74% of these people use social media while
in the United Kingdom, Facebook is the fourth most popular source of health
information (Moorhead, Hazlett, Harrison, Carroll, Irown, & Hoving, 2013). In
Nigeria, social media are being employed for health communication purposes by
individuals, health professionals and organisations. One
successful example of the use of social media for health communication was
during the outbreak of Ebola Virus Disease (EVD) in Nigeria in 2014. The
findings of Adebimpe, Adeyemi, Faremi, Ojo and Efuntoye (2015) revealed
that social media was the first source of information for many people. Recognising the extensive use of social media
during the crisis in Nigeria, the World Health Organization acknowledged that
among other things, “social media played a big role in the successful
containment of EVD outbreak in Nigeria” (Nduka, Igwe-Omoke & Ogugua, 2014
p. 5).
Social media are highly utilised by youths
and students as channels for information, interaction and entertainment. Social
media provide access to variety of information including health information,
thereby fostering adequate health information and knowledge among users.
Utilising social media to disseminate health information means that young
people can easily get such information and these can help them make good health
decisions and adopt healthy practices which can reduce the occurrence of
lifestyle diseases. Drawing from the
capacity of social media to make health information easily available as well as having
established the high usage of social media in Nigeria, especially among youths
and the positive returns recorded when employed for health communication, this
study carried out health communication intervention using social media and
examined its effect on knowledge, attitude and intention to adopt
health-enhancing behaviour among students in Lead City University, Ibadan and
Tai Solarin University of Education, Ijebu-Ode.
1.2 Statement
of the Problem
The incidence of lifestyle diseases
(cancer, diabetes, cardiovascular disease) and deaths occurring from them is on
the increase in Nigeria as indicated by WHO (2014). There is thus the need for
individuals and communities to have adequate knowledge, the right attitude and
high adoption rate of health-enhancing behaviour as enshrined in NEWSTART in
order to reduce the prevalence of lifestyle diseases.
Findings indicate that nutritional intake
among Nigerians is poor and there is a shift to unhealthy nutrition with individuals
consuming more of processed foods with high calorie diets, carbonated drinks,
low or no intake of fruits and vegetables (Arulogun & Owolabi, 2011; Onyiriuka,
Umoru & Ibeawuchi, 2013; The Federal
Ministry of Health, 2014). As regards exercise, it is recorded that Nigerians
do not usually engage in regular exercises and individuals live sedentary
lifestyle which involves low physical activities (Olubayo-Fatiregun,
Ayodele, & Olorunisola, 2014; Shehu, Onasanya,
Onigbide, Ogunsakin & Bada, 2013).
Another health enhancing practice is drinking water in sufficient
quantity. Most illnesses are linked to limited water intake. Ibemere (2015)
reveals that many Nigerians generally do not seem to have accepted drinking
adequate water as a way of life. They do not take up to eight glasses of
water in a day and prefer drinking
beverages to water. In addition, the
quality of rest (sleep) is compromised among Nigerians. In the bid to make ends
meet, many people put in long hours of work thus reducing their sleep time and
this negatively impacts health (Diehl
and Ludington, 2011).
Considering the above problems, one
wonders what could be responsible for the low adherence to health-enhancing
behaviour among Nigerians. Could it be that information about health-enhancing
behaviour are not widely disseminated among Nigerians? Or Nigerians are just
indifferent to health-enhancing behaviour?
Perhaps it could be that more channels (like social media) need to be
incorporated to make health information widespread and positively influence
attitude on the subject?
Statistics show that social media usage in
Nigeria is very high (a record of 16 million Facebook users) (Financial
Nigeria, February 2016; Internet World Stats, 2017). Their use is evident in
the areas of politics, entertainment, sports, business and even religion. For
instance, the high level of political participation during the 2011 and 2015
elections were largely attributed to the intense use of social media for
political communication (Akande, 2016; Nwafor, Odoemelam, Orji-Egwu, Nwankwo
& Nweze, 2013). However, the use of
social media in the health sector and for health-related purposes seems limited
in Nigeria. Patients, health professionals, health institutions and agencies
are not adequately tapping into the social media resource for health
communication (Batta 2015; Thomas & Adeniyi, 2013). Presenting a picture of this, Thomas and
Adeniyi (2013) affirm that, “there hardly exits any visible Facebook or Twitter
page around entirely committed to healthcare delivery” (p. 134). The question
then arises that could it be that the low usage of social media for health
communication is a reason for the limited knowledge, poor attitude and low
adoption of health-enhancing behaviour among Nigerians thus leading to increase
in lifestyle diseases? In the light of this, this study conducted a health
communication intervention using social media (Facebook and WhatsApp) in order
to determine its effects on the knowledge, attitude and intention to adopt
health-enhancing behaviour among students in Lead City University, Ibadan and
Tai Solarin University of Education, Ogun State.
1.3 Objective of the Study
The main objective of this study was to
examine the effect of social media health communication on students’ knowledge,
attitude and intention to adopt health-enhancing behaviour in selected
universities. The specific objectives
are to:
- ascertain
students’ utilisation of social media for seeking health information;
- assess
students’ knowledge of health-enhancing behaviour before and after the
social media health communication intervention;
- find
out students’ attitude to health-enhancing behaviour before and after the
social media health communication intervention;
- determine students’ intention to adopt
health-enhancing behaviour before and after the social media health
communication intervention and
- establish ways social media platforms can be employed for health communication.
1.4 Research
Questions
This research set out to answer the
following questions:
- How
do students utilise social media for seeking health information?
- What
is students’ knowledge level of health-enhancing behaviour before and
after social media health communication intervention?
- What
is the attitude of students to health-enhancing behaviour before and after
social media health communication intervention?
- What is the intention of students to
adopt health-enhancing behaviour before and after social media health
communication intervention?
- In what ways can social media platforms be employed for health communication?
1.5
Hypotheses
The hypotheses were tested at 0.05 level of
significance.
H1 There is a significant difference in
students’ knowledge of health-enhancing behaviour
before and after the social media health communication intervention.
H2 There is a significant difference in
students’ attitude to health-enhancing behaviour before
and after the social media health
communication intervention.
H3 There is a significant difference in
students’ intention to adopt health-enhancing behaviour
before and after the social media health
communication intervention.
H4 Students’ intention to adopt health-enhancing
behaviour will be significantly predicted
by attitude, subjective norms and
perceived behaviour control as stated in the theory of
planned behaviour.
1.6 Scope of the Study
This study investigated the effect of
using social media for health communication on the knowledge, attitude and
intention to adopt health-enhancing behaviour among undergraduate students in
Lead City University, Ibadan and Tai Solarin University of Education, Ogun
State. The choice of students as participants for this study is hinged on the
fact that the usage of social media is popular among youths and college
students (Chu, 2011, Folorunso, Vincent, Adekoya & Ogunde, 2010). Materials (text, images and videos) on each
element of NEWSART was the content of the social media health communication
intervention. Two social media platforms, Facebook and WhatsApp were employed
as platforms to convey the health communication messages for this study. The health communication intervention ran on
the two social media platforms for 5 weeks; from December 2016 to January,
2017.
1.7
Significance of the Study
This study revealed the usefulness of
social media for health communication as well as forms in which they can be
utilised. The study would be of benefit
to members of the public (youths especially) as they would get to know that
social media should not be used only for social and entertainment purposes but
for health information, connecting with health specialists, developing health
support groups and other activities that can enhance their health and
wellbeing.
The findings of this study would provide
input for relevant government health agencies to formulate policies and
legislations that would make for the incorporation of social media in health
communication programmes in the country.
The use of social media by health
professionals (doctors, nurses) in Nigeria for health care and communication is
low, it is expected that this study would sensitize these professionals on the
need to include social media as part of the channels of communication with
individuals and patients in order to enhance self-management after face to face
consultations.
To public health organisations and
non-governmental organisation (NGOs), it is hoped that the results would
provide better knowledge on how social media can be employed to create
awareness, educate the public and promote healthy behaviours among the
populace.
This study would contribute to the existing
literature in the area of social media utilisation for health communication.
While studies have been carried out on social media and their role/impact in
different aspects of health care in some parts of the world, only few studies
use experimental research design in exploring social media and health
communication. This study would
therefore contribute to the body of knowledge in this field and serve as a good
base for future researchers.
1.8
Operational Definition of Terms
Key concepts and variables as used in
this work are defined thus:
Social Media:
are Internet communication platforms that enable users to generate contents and
connect with other users. In this study, social media refer to the Facebook and
WhatsApp accounts created for this study, called Health and Wholeness.
Social Media Health Communication:
refers to process involving the dissemination of health messages (NEWSTART) via
the Facebook and WhatsApp accounts for this study. It is the independent
variable of the study and its effect will be tested on participants’ knowledge,
attitude and intention to adopt the health-enhancing behaviour.
NEWSTART:
is an acronym for Nutrition, Exercise, Water, Sunlight, Temperance, Air, Rest
and Trust in God. It formed the content of the health communication
intervention disseminated to participants via Facebook and WhatsApp.
Knowledge of Health-enhancing Behaviour:
refers to participants’ understanding of health-enhancing behaviour advocated
in NEWSTART. This was ascertained by
respondents’ positive answer or otherwise to questions on NEWSTART. Knowledge
was measured using 16 statements on a 4-point Likert scale with options of
Highly Knowledgeable, Knowledgeable, Not Knowledgeable and Slightly
Knowledgeable. Where the mean score of participants’ responses was less than
1.49 = Not Knowledgeable, 1.5 to 2.49=Slightly Knowledgeable, 2.5 to
3.49=Knowledgeable and where it was 3.5 to 4= Highly Knowledgeable of
health-enhancing behaviour.
Attitude to Health-enhancing Behaviour:
means participants’ disposition towards NEWSTART message. Attitude was measured
with 16 statements on a 10-point interval scale. If the mean score of
participants’ responses was between 1 to 2.49= Low Attitude, 2.5 to
5.49=Moderate Attitude, 5.5 to 7.49 =High Attitude, 7.5 to 10 = Very High
Attitude
Intention to Adopt Health-enhancing Behaviour: refers to participants’ reported willingness
and readiness to practice the messages of NEWSTART communicated Facebook and
WhatsApp. Intention to adopt was measured with 14 statements on a 10-point
interval scale; and where themean
score of participants’ response was less or equal to 1.49
to 4.49 = Low Intention to Adopt, 4.5 to 5.49=Moderate Intention to Adopt, 5.5
to 6.59 = High Intention to Adopt, 7.0 to 10 = Very High Intention to Adopt
health-enhancing behaviour.
Subjective Norms:represent a participants’ perception of people
important to him or her (family and friends) beliefs that he or she should or
should not practice NEWSTART. Subjective norms was
measured with 16 statements on a 10-point interval scale with 1 being the
lowest and 10 being highest.
Perceived Behaviour Control:represents a participants’ perceived ease or
difficulty of practicing NEWSTART. Perceived behavioural control was measured
with 16 statements on a 10-point interval scale with 1 being the lowest
perceived behaviour control and 10 being highest perceived behaviour control.
Participants:
in this study were selected undergraduate students of Lead City University,
Ibadan and Tai Solarin University of Education, Ogun State.
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