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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 the mean 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.