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# Modeling Health Video Consumption Behaviors on Social Media: Activities,
Challenges, and Characteristics

Jiaying Liu<EMAIL_ADDRESS>School of Information, The University of
Texas at AustinUSA and  Yan Zhang<EMAIL_ADDRESS>School of Information, The
University of Texas at AustinUSA

(2023)

###### Abstract.

Many people now watch health videos, such as diet, exercise, mental health,
COVID-19, and chronic disease videos, on social media. Most existing studies
focused on video creators, leaving the motivations and practices of viewers
underexplored. We interviewed 18 participants, surveyed 121 respondents, and
derived a model characterizing consumers’ video consumption practices on
social media. The practices include five main activities: deciding to watch
videos driven by various motivations, accessing videos on social media through
a socio-technical ecosystem, watching videos to meet informational, emotional,
and entertainment needs, evaluating credibility and interestingness of videos,
and using videos to achieve health goals. The five activities do not
necessarily proceed in a linear fashion; rather, their arrangement is
situational, depending on individuals’ motivations and their social and
technological environments. We further identified challenges that consumers
face while consuming health videos on social media and discussed design
implications and directions for future research.

Health, video, qualitative method, social media

††copyright: acmcopyright††journalyear: 2023††doi:
XXXXXXX.XXXXXXX††conference: ; ; ††booktitle: ††ccs: Human-centered
computing††ccs: Human computer interaction (HCI)††ccs: Empirical studies in
HCI

Figure 1. Examples of health videos on social media (from left to right: a
mental health video on YouTube, a Gymhack exercise video on Instagram, a keto
diet video on TikTok, a physical injury video on Facebook, and a monkeypox
video on Twitter)

Examples of health videos on social media (from left to right: a mental health
video on YouTube, a Gymhack exercise video on Instagram, a keto diet video on
TikTok, a physical injury video on Facebook, a Monkeypox video on Twitter

##  1\. Introduction

Consuming online videos on social media is increasingly popular. A typical
user now spends two hours and twenty-five minutes on social media each day
(digital 2021, 2021), and 49% of social media users watch more than five
videos per day (McCue, 2020). Around 3.37 billion people consumed videos in
2022, reaching 91.8% Internet users. Consumers use multiple platforms for
video consumption. TikTok, YouTube, and Twitch are the three largest video-
sharing platforms (Bartolome and Niu, 2023) with rich video content. Platforms
that previously focused on text and pictures rolled out sections designated
for videos. Now, users spend more than half the time on Instagram Reels and
Facebook Watch watching videos (street journal, 2022), 82% Twitter users watch
videos and Snapchat users consume 10 billion videos every day (Villa, 2021).

Health videos are popular on social media, particularly after the COVID-19
pandemic. Health videos refer to online videos about health-related topics,
such as mental health, sexual health, and physical exercise. Fig 1 shows some
examples. Unlike live-streaming, online videos are not synchronized, thus
could afford more convenience and attract a larger audience (Rigby et al.,
2018).

Health videos on social media have a great potential to influence consumers’
knowledge, health decisions, and behaviors. Early evidence has shown that
health videos may have contributed to the exacerbation of eating disorders
(Jordan et al., 2021) and inaccurate self-diagnoses of mental disorders
(Jargon, 2021). Despite the impact on consumers, much of the existing research
on health videos has concentrated on understanding video creators’
motivations, such as disease management (Huh et al., 2014) and community
building (Liu et al., 2013), with limited attention given to consumer
practices. Gaining a thorough understanding of consumers’ experiences with
health videos is vital to guide the effective use of videos and social media
to promote positive health behaviors.

We aimed to contribute to the broader conceptual understanding of video
consumption. Video consumption is intrinsically connected with various fields
within HCI and CSCW, such as learning (Lee et al., 2021), online dating (He et
al., 2023), and e-commerce (Tolunay and Ekizler, 2021). However, these studies
predominantly centered on video consumption on a specific platform, failing to
provide a holistic understanding of user behaviors in the complex social and
technical environment. Further, these studies only revealed a subset of
viewers’ video consumption behaviors, such as viewers’ watching motivations or
their perception of videos’ characteristics (Lee et al., 2021). Thus, the
current research only offered a limited account for consumers’ overall video
consumption process.

Our study addresses these gaps by exploring consumers’ lived experiences of
health video consumption in the complicated socio-technical environment. We
endeavour to provide a comprehensive understanding of the various practices
and activities in relation to users’ health video consumption. Our research
questions are:

  * •

RQ1: What are consumers’ practices of consuming health videos on social media?

  * •

RQ2: What challenges do consumers face in consuming health videos on social
media?

We conducted a mixed-method study where we interviewed 18 participants with
diverse demographics and varying health goals and surveyed 121 respondents.
Our participants reported their experiences with watching health videos on a
wide range of topics, such as general wellness (e.g., diet and exercise),
chronic diseases (e.g., obesity and diabetes), and mental health. Based on the
analysis of the interviews, we identified five major activities involved in
consuming health videos on social media, including deciding, accessing,
watching, evaluating, and using.

Participants decide to watch health videos with motivations for health
improvement, emotional support, learning knowledge, social awareness,
entertainment. They access health videos cross topics, devices, platforms, and
channels including searching, browsing, and social recommendations. When
watching health videos, the video modality enable participants to acquire
information with greater clarity and efficiency, emotionally engage with the
content, and explore various genres. Participants evaluate health videos based
on the platform previews, content, and creators. Finally, participants use
health videos in four ways: guiding problem-solving, personalizing long-term
behavior change solutions, regulating emotions alone, and managing video
content. It should be noted that health video consumption behaviors are
dynamic; thus, the five activities are not linear; rather, they are iterative
in nature. For example, the evaluation and use of health videos might lead to
changes in consumption motivations and access platforms. Specifically, we
observed several prominent behavioral trends in the iterative consumption of
health videos, including developing stronger motivation, seeking better
accessibility, and navigating to in-depth and reliable content.  Further, we
summarized the challenges that participants encountered at each activity and
described how the barriers cascade.

This work is a timely response to the surge of health video consumption on
social media. We contribute to research on online videos and consumer health
behaviors by (1) demonstrating that health videos on social media are becoming
an important health information source that consumers actively use to satisfy
multiple needs; (2) depicting the cross-platform and iterative consumption
behaviors within the socio-technical ecosystem and indicating several crucial
health video consumption preferences; (3) identifying challenges of health
videos consumption and proposed corresponding design implications; (4)
providing a preliminary five-activity model of health video consumption
behaviors on social media, which could potentially characterize user video
consumption practices beyond the health context.

##  2\. Related Work

We reviewed prior research on online video research and specifically health
videos in HCI and identified several research gaps on the topic.

###  2.1. Online videos consumption behaviors

Online videos are gaining popularity (Bentley et al., 2019), and video
consumption behavior is now ubiquitous on a number of platforms, including TV
sites, social media platforms, and news websites (Bentley and Lottridge,
2019). Online videos provide ample resources to serve on-demand and cross-
device watching at varying times and locations (Rigby et al., 2018).

A large stream of research in CSCW concentrated on live video streaming in
various contexts such as gaming (Lessel et al., 2017; Sjöblom and Hamari,
2017), learning (Lee et al., 2021), cooking (Tang et al., 2016), eating
(Anjani et al., 2020), and traveling (Haimson and Tang, 2017). Studies
suggested that “live” nature of video streaming is key to attracting and
engaging viewers by having real-time conversations with the audience to
enhance interactivity. However, according to statistics, live streaming video
consumption only occupies 28.5% (Shepherd, 2023) of the Internet video
traffic, and online video consumption is more omnipresent because it offers
the convenience of flexible viewing and attracts a larger audience (Lu et al.,
2019). Thus, this study focused on the consumption of online videos to address
the lack of relevant studies.

Previous studies reported some features of online video regarding user
engagement. Although online videos are prepackaged and asynchronized, they
still create para-social interactions (PSI) (Horton and Richard Wohl, 1956).
For example, Niu et al. (Niu et al., 2021) summarized six social provisions of
#WithMe videos, including attachment, integration, reassurance, alliance,
guidance, and nurturance. These provisions facilitate and foster
contextualized disclosure, creator-viewer interactions, and community-
building. Creators’ techniques such as talking directly to the camera (Niu et
al., 2021) also play vital roles in cultivating a sense of intimacy and
connectedness (Anjani et al., 2020). Platform functions enable viewers to
respond to and interact directly with creators by commenting and liking (Wohn
et al., 2018).

Prior studies were mainly conducted in less serious scenarios (e.g., gaming
and traveling) which largely differ from the nature of health context. Despite
health topics constituting large part of online videos, little was known about
why and how people engage with health videos.

###  2.2. Health videos on social media

Social media play a vital role in people’s health information acquisition
(Carrotte et al., 2015; Goodyear et al., 2019) and health videos now pervade
social media platforms (Harris, 2019). Major public health agencies, such as
CDC, and many health non-profit organizations maintain video channels on
popular social media platforms such as YouTube and Facebook for public health
education and awareness raising. In the Web 2.0 era, user-generated health
videos that share illness experiences, disease management, or lifestyle videos
further enrich the diversity of health content. During the COVID-19 pandemic,
videos about health topics received even more attention and served as
resources for COVID-19 news (Li et al., 2021), companies to mitigate
loneliness (Niu et al., 2021), windows to peer into doctors’ life (Southerton,
2021), and facilitators to keep fit at home (Ibrahim et al., 2021).

However, the existing research mainly focused on video creators’ motivations
to produce heath videos on social media, such as managing chronic diseases
(Huh et al., 2014), building a supportive community (Liu et al., 2013),
disseminating educational materials (Poquet et al., 2018), keeping a personal
diary for fighting diseases (Noyes, 2004), and expanding visibility on social
media (Sakib et al., 2020). Researchers comprehensively surveyed the
challenges encountered by creators during video production and proposed design
implications to support their needs of engaging viewers (Fraser et al., 2019),
managing fans, improving workflow efficiency (Weber et al., 2021), and
promoting e-commerce activities (Haimson and Tang, 2017).

Only a limited number of studies explored viewers’ motivations for consuming
health videos on social media. For example, Harris (Harris, 2019) found young
people use YouTube health videos to learn about a wide range of health topics.
Song et al. (Song et al., 2021a) surveyed why people watch health videos on
TikTok and they identified three significant contributing affordances– social
presence, immersion, and credibility perception. However, prior studies
exclusively focused on a certain activity, namely, the motivation or
evaluation of health video consumption, and what other activities are included
in the consumption process are still unknown. Further, these studies were
mostly constrained to specific health topics (e.g., unhealthy food (Coates et
al., 2020) and sexual behavior (Levinson et al., 2020)) on a single platform
(e.g., TikTok or YouTube). Thus, they failed to uncover the complexity and
dynamics of the lived experiences of consumers’ health video consumption on
the socio-technical ecosystem of social media.

The pressing issue of low-quality health videos underscores the urgency of
delving into people’s experiences and challenges when engaging with such
content. Health videos on social media are increasingly used as decision aids
for the general public (Haslam et al., 2019). However, their quality remains a
significant concern. Various studies invited health professionals to assess
the quality of health videos, including those related to diabetes on TikTok
(Kong et al., 2021), meningioma treatment on YouTube (Śledzińska et al.,
2021), and cancer on Instagram (Xu et al., 2021). These investigations
revealed a substantial and alarming disparity in the quality of health videos.

Overall, the current studies are characterized by topic-specific, platform-
specific, and activity-specific inquiries, we aimed to extend the existing
research by holistically studying why and how people consume health videos on
social media.

###  2.3. Models of content consumption on social media

Another goal of the study is to achieve an improved conceptual understanding
of consumers’ video consumption behavior on social media. A number of models
and theories have been widely used to explain user behaviors on social media.
One of the most frequently used theories is the Use and Gratification Theory
(UGT) (Katz et al., 1973), which has been validated by much empirical research
and was constantly amended and renewed in response to the changing media
economy (Ruggiero, 2000). It is presumed that people use social media to
fulfill certain needs.

Kaplan and Haenlein (Kaplan and Haenlein, 2010) specifically classified two
types of behaviors on social media: content consumption and self-disclosure/
social interactions. Based on this, some HCI researchers conducted empirical
research and developed frameworks explaining self-disclosure behaviors on
social media in health-related contexts, such as LGBTQ identity (DeVito et
al., 2018) and chronic illnesses (Shamon and Berning, 2020). For example, Pyle
et al. (Pyle et al., 2021) provided a framework of why LGBTQ+ people decide to
disclose pregnancy loss on social media. However, there are no models that
capture how content consumption unfolds on social media.

Some information seeking and retrieval models can to some degree be used to
make sense of the content consumption process on social media. For example,
the berry-picking model (Bates, 1989) details people’s real-life information
search process like picking berries in bushes where the information seeker
learns from documents retrieved and moves from one source to the other to meet
information needs. The schematic model of information seeking (Savolainen,
2006) assumes that information seeking begins with information needs, which
lead them to identity and access information sources, then examine and
evaluate information, followed by using information.

However, these models tend to focus on active information search and do not
account for content consumption through browsing and encountering, which are
common on social media. Additionally, these models are developed and applied
mostly in studies that examine people’s search for text-based information and
thus do not account for the unique features and affordances of video modality.
A model that is specific to video consumption on social media is needed to
formalize our study results to guide future research on video consumption in
the context of social media.

##  3\. Methods

We used the mixed-method approach, incorporating semi-structured interviews
and surveys with two different sets of participants. The interviews allowed us
to elicit people’s narratives about their lived experience of consuming health
videos on social media, while the survey provided a general view of video
consumption behaviors and prevented us from losing sight of a broad picture
when interpreting the interviews. Specifically, we designed the survey after
we conducted and analyzed the first 12 interviews. The analysis of survey
results further informed the following theoretical sampling of new
interviewees. The research protocols were approved by the University’s
Institutional Review Board.

###  3.1. The semi-structured interview

We began with interviews to reveal contextualized and detailed consumers’
motivations, practices, and interactions with health videos.

####  3.1.1. Recruitment

Previous literature indicated that socioeconomic backgrounds significantly
influence people’s health behaviors (Schaefbauer et al., 2015). Thus, except
for our university listserv, we recruited participants from Reddit to bring in
hard-to-reach and low-economic-status participants (Topolovec-Vranic and
Natarajan, 2016). The included participants showed a wide diversity and
confirmed our recruitment efforts.

Interested participants completed a screening questionnaire reporting
demographics (e.g., age, gender, race, health condition) and health video
consumption experiences (e.g., topics, motivations, frequency, and platforms).
We adopted the theoretical sampling strategy (Charmaz, 2000), where we
intentionally chose participants to maximize the sample demographic diversity
and diversity in video-viewing behaviors. For example, we carefully selected
participants with different health goals and included those interested in
wellness topics and relatively severe conditions such as depression. We also
incorporated participants watching health videos for their own needs and
family or friends’ needs.

####  3.1.2. Participants

In total, 18 participants were interviewed (9 females and 9 males). Their age
ranged from 18 to 80, with the median age being 29. Most of them (16/18)
reported having mild or serious health concerns or conditions, ranging from
BMI control to depression and Parkinson’s. All reported using health videos on
social media to fulfill their health goals. Table 1 shows more details about
the participants.

Table 1. Participants Characteristics

ID | Sex | Age | Race | Education | Frequency | Platforms | Health status | Health goal
---|---|---|---|---|---|---|---|---
P01 | M | 39 | Asian | Graduate degree | Monthly | YT | Chalazion | Unachieved
P02 | F | 21 | Black | Undergraduate | Daily | TT, YT | Obesity | Achieved
P03 | F | 20 | Asian | Undergraduate | Daily | TT, YT, IN, RD | Knee pain, vegan lifestyle | Achieved
P04 | F | 20 | Asian | Undergraduate | Daily | TT, YT, IN | Obesity | Unachieved
P05 | M | 21 | White | Undergraduate | Daily | YT, RD | Depression | Unachieved
P06 | M | 21 | Asian | Undergraduate | Daily | TT, YT, TW, FB, IN, RD | No condition | Achieved
P07 | F | 24 | Asian | Graduate student | Daily | TT, YT, TW, FB, IN | BMI control, father’s high blood pressure | Achieved
P08 | M | 25 | Black | High school | Daily | TT, YT, TW, FB | Depression | Achieved
P09 | F | 25 | Hispanic | Graduate student | Daily | TT, YT, TW, FB, IN | Friends’ asthma | Achieved
P10 | F | 29 | Hispanic | Graduate degree | Weekly | YT, FB, IN, RD | No condition | Achieved
P11 | M | 18 | Multiple Races | Undergraduate | Daily | TT, YT, IN, RD | Prediabetes | Achieved
P12 | F | 18 | White | Undergraduate | Daily | TT, YT, IN | Obesity | Unachieved
P13 | M | 26 | Hispanic | Undergraduate | Weekly | YT | Asthma | Achieved
P14 | F | 46 | White | Graduate student | Daily | YT, IN | ADHD | Unachieved
Mobility issue | Achieved
P15 | M | 43 | Black | Graduate student | Daily | YT, IN | Obesity, uncle’s heart attack | Achieved
P16 | M | 35 | White | High school | Weekly | YT | ADHD, EDS | Achieved
P17 | M | 42 | Black | High school | Daily | YT, TT | Obesity, grandma’s diabetes | Achieved
P18 | F | 80 | White | Bachelor degree | Weekly | YT | Parkinson | Achieved

Note: In the column of platforms, YT=YouTube, TT=TikTok, IN=Instagram,
FB=Facebook, TW=Twitter, RD=Reddit. In the Health status column, BMI= Body
Mass Index, ADHD= Attention-deficit/hyperactivity disorder, and EDS= Ehlers-
Danlos syndrome.

####  3.1.3. Interview procedure

After getting participants’ consent, the first author interviewed all
participants on Zoom, a video conferencing platform, because of the quarantine
during the COVID-19 pandemic. All interviews were recorded and transcribed
using Zoom. The interviews lasted, on average, 1.5 hours. Each participant
received a $20 Amazon gift card at the end of the interview.

Each interview began with grand tour questions asking about participants’
general social media use and health video consumption practices. Example
questions include “In general, on which social media platforms do you watch
health videos? What topics do you usually watch? Why do you watch these
topics?”

With such background information in mind, then, to enhance data specificity
and quality, we used the critical incident (Flanagan, 1954) and the contextual
inquiry techniques (Beyer and Holtzblatt, 1999). We informed the participants
that “We want to learn more examples about how and why you watched health
videos on the platforms you mentioned earlier.” To help participants recall
more cases, we started with participants’ clearest memory and asked which was
the most recent or most impressive video they watched, and elicited more
detailed follow-up questions such as “How did you find this video? Did you
think this video helpful?” We utilized questions regarding this incident to
familiarize participants with the depth and scope of our interview and then
further prompted experiences with other incidents. The interviewer went over
every topics and platforms mentioned by each participant. Example questions
include, “Did you remember the first time you watched health videos [on a
certain platform/ about a certain topic]? Why did you stop/continue watching
such videos? After that, what other health videos do you watch?” We also asked
about the most satisfying and unsatisfying health videos they watched. We
evoked the contexts in these narratives to understand why they watched and
interacted with videos, how the health videos influenced them, how they
navigated multiple platforms, and what challenges they encountered.

The last part of the interview asked the participants to compare their
experiences with health information in different modalities (e.g., video,
text, radio, face-to-face) and on different platforms.

####  3.1.4. Data analysis and Model development

The interview data were analyzed using the iterative open coding and axial
coding method (Corbin and Strauss, 2014).

The first author wrote memos immediately after each interview and during the
analysis process. The analysis started when we completed the first five
interviews so emergent themes could be compared with previous literature and
further explored in subsequent interviews. For example, several participants
reported that accessing health videos often involved multiple platforms, and
their preference for platform changed after watching and comparing videos
across platforms; the theme of the iterative process was created to represent
this practice, and the theme was further explored and developed in subsequent
interviews. The first author developed an initial open coding schema based on
the five interviews that included themes and sub-themes related to
participants’ practices and motivations for consuming health videos on social
media, as well as the challenges they encountered.

This schema was constantly revised in weekly discussions between the two
authors based on the first author’s notes and debriefs of the interviews
conducted in the past week and the comparison of these interviews with prior
interviews. The two authors proceeded to axial coding by revisiting the open
codes and the corresponding transcripts to refine and conceptualize
reoccurring themes into categories. These codes were stabilized after the 12th
interview. For example, different motivations for watching health videos were
integrated into the deciding activity category. Five categories that
represented activities during the video consumption process emerged from the
analysis, including motivations, access channels, videos’ advantages during
watching, evaluation, and using videos.

We revisited the interviews and mapped the five categories according to the
chronological order of participants’ narratives. We revised the names of the
categories and built an initial model. This model was further developed in the
following interviews and analysis process. For example, the evaluation and use
activities were not adequately represented in the previous 12th interviews;
therefore, we selectively chose participants with behavioral change goals and
focused on eliciting their accounts of evaluating and using videos for the
following interviews. We also compared the activities with prior empirical
studies and models such as the Use and Gratification Theory (Katz et al.,
1973) and the schematic model of information seeking (Savolainen, 2006).

###  3.2. The Survey

We conducted a survey to reveal a broader picture of consumers’ health video
consumption practices to enrich the perspectives obtained from the interviews.

####  3.2.1. Participants

We collected survey responses from Amazon Mechanical Turk (AMT) and Reddit.
Studies indicated that the AMT pool has a similar demographic distribution as
the overall US population (Kittur et al., 2008). We retained 121 responses
from the 548 responses after excluding incomplete or irrelevant responses.
Among the respondents, 54 (44.6%) were female, 63 (52.1%) were male, three
(4.5%) were non-binary/third gender, and one (0.8%) preferred not to respond.
Their age ranged from 18-76, with the median age being 29. Regarding
education, 46 (38%) had high school/ vocational training degrees or less, 61
(50.4%) had Bachelor’s degrees, and 14 (11.6%) had Graduate degrees.

####  3.2.2. The survey instrument

The survey contained 33 questions and was launched on Qualtrics. The survey
instrument asked about respondents’ demographic information and video
consumption practices on social media. We designed a series of multiple-choice
questions based on the categories and themes identified in the qualitative
analysis. For example, the options for the question of motivation came from
subthemes that represented participants’ specific goals. All multiple-choice
questions included “others, please specify:” to gather other types of
activities. We validated and developed these new activities in the following
interviews.  To enhance data quality, we added one attention check question
(August and Reinecke, 2019; Shamon and Berning, 2020) and improved the wording
and visual design of the survey with two rounds of tests. The appendix A.1
includes more details about survey design.

####  3.2.3. Data analysis

We used the survey responses to corroborate and compare with the qualitative
findings. We conducted a descriptive analysis of survey respondents’ health
video consumption practices. The results shed light on the prevalence of the
five categories and their subcategories, namely, specific activities of health
video consumption.

###  3.3. Reflections on the research design

Utilizing virtual interviews turned out to be another strength of our study.
Interviewing participants via Zoom enabled us to reach out to low-resource
communities who can not afford the time and transportation for in-person
meetings. Among the participants, two had never used Zoom but were able to
complete the interviews successfully with the researchers’ assistance.

Nevertheless, our research design also has limitations. First, our recruitment
of survey and interview respondents only included people who have watched
health videos on social media while excluding those without such experiences.
Second, user-generated content (UGC) was inadvertently overrepresented in our
interviews. Most participants watched individual-created videos, while very
few participants accessed videos from non-profit organizations and government
agencies. This may limit our understanding of their access and evaluating
practices. Third, videos about more severe health conditions, such as cancer,
were not covered in the study, such that we could have missed some health
video consumption motivations and practices. Fourth, participants’
descriptions of experiences with health videos might deviate from their real
behaviors, especially for instances that happened years ago. Fifth, collecting
data via participants’ recall might overrepresent experiences on YouTube
because they may have forgotten many short health videos that they randomly
watched without a strong motivation on other platforms.

##  4\. RQ1: Modeling Consumer Health Video Consumption Practices on social
media

The model, shown in Fig 2 portrays that consumers’ health video consumption on
social media demonstrated five main activities: deciding to watch videos by
certain motivations, accessing health videos through a socio-technical
ecosystem, watching videos by engaging with information and emotions,
evaluating videos by features of access channels, content, and creators, and
using videos to influence behavior, knowledge, and emotions. These activities
do not necessarily proceed in a linear fashion; consumers might skip or return
to previous activities when performing one activity.

Figure 2. A model of video consumption on social media.

A model of video consumption on social media

###  4.1. Deciding to watch health videos to fulfill motivations

Deciding to watch health videos is often driven by specific motivations. Five
major categories of motivations were identified: health improvement, emotional
support, learning, social awareness, and entertainment. Figure 3 shows the
survey results concerning each category of motivations, demonstrating the
prevalence of the motivations among a larger sample than the interview
participants.

Figure 3. Survey results of motivations for consuming health videos on social
media

Survey results of motivations for watching health videos on social media

####  4.1.1. Health Improvement

Health improvement includes motivations to develop healthier lifestyles as a
preventative measure, address existing health concerns and provide care to
family and friends. This was a major motivation for consuming health videos.

Many people are proactive in preventing diseases. For example, P05 said “I
want to make sure I’m informed of mask usage, and I was almost constantly
waiting for videos about the fact. I’m not really at risk, but I don’t like
being sick and suffering.”

Under circumstances when formal medical treatment fails, is unaffordable, or
conditions are stigmatized, the accessibility of health videos on social media
motivates viewers to use them as a substitute for healthcare services. For
example, P05 suffered severe depression but did not turn to any family
members, friends, or professionals for help, because “I just think that mental
health was not something that was very open for discussion in my background.”
P08 relied only on videos produced by a YouTuber to cope with his depression
because he could not afford professional consultation.

Health video consumption was not limited to serving personal usage; it also
served as a resource to care for family and friends. For example, P14 had a
WhatsApp family group where he and his brother shared health videos weekly or
monthly because “we have family members from other states and countries.
Sharing the YouTube links to the group is the best way I tried to provide
healthcare to make sure that they’re aware that good health can be beneficial
to themselves.” P07 and P09 reported searching for videos about high blood
pressure and asthma respectively in order to take care of diagnosed family
members and hospitalized friends.

####  4.1.2. Emotional support

Seeking emotional support was another major motivation for consuming health
videos, particularly for sense of community, hope, and self-regulation.

Sense of community was described as feelings that [P10]you’re not the only
person. Participants wanted to find people who shared similar health
conditions or health beliefs. For example, P16 had Ehlers-Danlos syndrome
(EDS), a rare disease, which took him a long time to be officially diagnosed
and pressured him both physically and mentally. He described “it was quite
reassuring to me to find people talking about how long it took them to get a
diagnosis.” Another participant, P05, watched many commentary videos that
criticize anti-vaxxers because “I’m glad I’m not the only one who thinks
that’s what the people [anti-vaxxers] are saying is kind of crazy.”

Hope can emotionally support many participants to overcome challenges. P02
commented on health videos on YouTube that “Maybe I’m struggling with
something right now, but there are people who have gone through it and they
are offering solutions. The fact that I can have access to these videos makes
me a more hopeful person.” P16 was also inspired by videos about “real stories
on YouTube, examples of people who have lived with overweight” so that he “saw
the challenges they have gone through, but they managed to survive.”

Encouragement offers the emotional incentive to make efforts. Encouragement is
essential for them to maintain healthy activities, such as exercising
regularly and eating healthy. They went to TikTok and Instagram for
motivational health videos. For example, P03 explained that “watching these
motivates me to get out of bed and get working. I see other people doing
things that are healthy, and they’re working out, so to motivate me.”

####  4.1.3. Learning

All participants reported learning knowledge being one of the motives for
watching health videos. Much of such learning was informal with a focus on
problem-solving. However, several participants were serious about learning
knowledge from health videos and performed more structured and sustained
learning to build one’s knowledge repertoire on particular topics. For
example, P02 had a “Tactical Tuesday,” a time to watch videos that “are
focused on my mind, trying to build my brain, and developing emotional
intelligence because that’s something that you can continuously build.” P13
watched health videos on YouTube almost every day “because they are something
not only new but also very useful. Maybe not for yourself, maybe not for today
or tomorrow, but you never know in the future or someone else.” P01 also kept
watching videos of conference presentations, TED talks, and lectures to
acquire knowledge about psychology.

####  4.1.4. Social awareness

Social awareness represents the urges to keep up with recent social events and
social relationships. “Trends” and friends’ interests were mentioned as a
motivation frequently. For example, P04 mentioned her attention to an exercise
campaign on TikTok because “This is a really huge thing during the Covid-19
like all my friends and every girl is doing that.” Mental health was another
common content our participants encountered on Facebook and Instagram. Many
perceived that “Mental health is a huge thing recently.” During National
Bullying Month, P07 watched mental health videos because “there are at least
two friends shared [on Facebook]… I saw some friends commented and added a new
link, being like ‘Hey, check it out, this is also good stuff’. Then I just
take a quick look at it.” She watched not only the shared videos but also a
few other related videos recommended by YouTube.

####  4.1.5. Entertainment

Entertainment is another important motivation for watching health videos.
Several participants watched amusing videos, such as exercise challenges and
emergency room anecdotes, on Instagram, TikTok, and YouTube. For example, P05
watched commentary videos where the influencer played videos containing anti-
vaccine viewpoints and rebutted their claims because “he senses things very
humorously and his responses are very strong.” P06 subscribed to health
workers’ channels on YouTube and Instagram and watched videos about hospital
anecdotes to relax. P10 mentioned that she watched Doctor Mike, a YouTube
influencer who made many funny health videos during breaks and lunches, for
entertainment.

###  4.2. Accessing videos

After deciding to watch health videos, participants access videos,
characterised by cross-topic, cross-device, cross-platform, and cross-channel
behaviors. Figure 4 showed survey respondents’ health video access activity,
including access frequency, topics, platforms and devices, and channels.

Figure 4. Basic aspects of consumer video accessing activity on social media

Bar charts of devices, topics, frequencies, platforms, and access methods of
health video-watching practices. Nearly 84% of the survey respondents watched
health videos on social media at least one time a week. General health and
wellness topics (e.g., exercise, diet, sleep) were watched the most
frequently, followed by mental health, COVID-19, chronic disease, and sexual
and reproductive health. YouTube was the most widely used (69.7% of the
participants) platform, followed by Instagram, Facebook, Twitter, and TikTok.
The most widely used device for watching health videos was smartphone,
followed by laptop, tablet, desktop computer, and smart TV. Regarding access,
participants browsed health videos in feeds (51.6%) and “similar videos”
recommendations (48.4%), actively searched for them on social media (51.6%) or
search engines (mostly Google, 41.0%), or followed recommendations from
interpersonal communications with family and friends (26.2%) and health
professionals (22.1%).

####  4.2.1. Cross-topic.

Most participants reported consuming diverse topics of health videos because
[P09]It [health] is a big topic […] mental health, physical health, and all,
they are all connected. Overall, these topics were mostly related to mild
conditions. General wellness (e.g., exercise, diet, sleep) was watched the
most frequently, followed by mental health, COVID-19, chronic conditions, and
sexual and reproductive health. Participants accessed a wide range of topics
of health videos frequently with nearly 84% of the survey respondents (n=121)
accessed at least once a week.

####  4.2.2. Cross-device.

Participants also used multiple devices to access health videos depending on
the contexts, as commented by P04, between classes, I would use my phone, but
if I am doing follow-up exercises, I probably use the tablet or my laptop. The
most frequently used device was smartphone, followed by laptop, tablet,
desktop computer, and smart TV.

####  4.2.3. Cross-platform.

86% survey respondents and 14/18 interviewees accessed health videos through
multiple platforms. YouTube was the most widely used (69.7%) platform,
followed by Instagram, Facebook, Twitter, and TikTok. We further classified
social media as content communities and Social Networking Sites (SNS)
according to Kaplan and Haenlein (Kaplan and Haenlein, 2010). Content
communities highlight creating and curating content across broad topics (e.g.,
YouTube and TikTok), and SNS emphasize building connections and interaction
with social relationships (e.g., Facebook and Twitter). We recognized that
these two types sometimes overlap because nowadays many platforms have
approximately equal emphasis on content and social aspects. For example,
Instagram owns features of both types that users can access a huge amount of
videos and images while interacting with social relationships. Some
participants directly accessed health videos from SNS or content communities.
It was worth noting that participants also accessed health videos from SNS and
then consumed them on content communities. P06 shared “One of my friends likes
to post things from YouTube, Twitch […] from there, I can trace more videos on
YouTube.”

####  4.2.4. Cross-channel.

Searching, browsing, and social recommendations are the three main channels of
video access.

Participants both actively search for videos as well as passively browse
videos, and the two access methods have similar prevalence among the survey
respondents. Specifically, participants performed searches both on social
media (51.6%) and search engines (41.0%). Some participants searched on Google
while some participants directly used social media to search for videos, as
described by P05 I just went to YouTube. Participants also passively browsed
feeds (51.6%) and “similar videos” recommendations (48.4%) to access videos.
Passive encounters were more common when participants did not have a clear
need such as during leisure time, [P17]I just keep scrolling and watching
videos on TikTok.

Social recommendations are suggestions from interpersonal communications with
family and friends (26.2%) and health professionals (22.1%). Around one-fourth
of the participants reported accessing videos via social recommendations.
Social relationships recommended videos based on their knowledge of the
participants’ interests, as P07 commented “They are just like, try this out,
maybe you like it. I think I told them to help me learn certain things, and
they just share when they find something beneficial for me.” The
recommendations could be a platform, an account, or links to videos. For
example, P08’s friends directed him to YouTube to search for videos related to
coping with depression; P17’s doctor recommended to him a YouTube account
about diabetes; P18’s doctor sent her several links to videos about exercises
for Parkinson.

###  4.3. Watching videos

Once they had access to videos, participants watched them. Watching videos
involves multiple activities, including processing information, taking notes,
and experiencing emotions.

####  4.3.1. Processing information

Participants considered processing information in the video format easy,
efficient, and effective.

Understanding information with greater clarity. Combining visual
demonstrations and oral explanations, videos convey information in a clear
manner, particularly for learning procedural information about how to do
something. Videos also made it easier for visual learners to understand
information better. For example, P07 said“Visually seeing diagrams and
pictures helps to understand. I don’t like reading because I get lost in the
words sometimes.”

Obtaining information with higher efficiency. Videos were perceived to be more
efficient for obtaining information in terms of time and cognitive cost. For
example, P14 commented “[Video] is one of the most efficient ways to get
information because they are usually pretty short. They’re really efficient
versus long articles, which can be really boring with lots of ads […]” The
fast pace of videos also contributed to the perceived efficiency like P17
thought “Dr. Schmidt speaks so fast that you get so much content in a minute.”

Getting longer attention span. Many participants compared watching videos with
reading books and concluded that videos are effective in keeping their
attention. For example, P11 commented “[Videos] are able to deliver
information which is palatable to my brain. Otherwise, I would have to be in
some libraries […] with my attention span, I’d constantly scatterbrained all
over the place.” P10 compared videos with texts and images and commented that
“[On Instagram], maybe people don’t watch the whole video but they probably
will stay engaged to it longer […]”

####  4.3.2. Taking notes

Some participants reported taking notes while watching videos, particularly
those with a purpose to learn about a subject. For example, P02, with the
intention to open a podcast channel to propagate health knowledge about mental
health, said “I will watch mental health-related videos and take notes to
strengthen the learning effectiveness.” Figure 5 showed a screenshot of her
notes. Some participants expressed the need to take notes but did not resort
to external tools. For example, P07 said she took ”mental notes” and P13 tried
to ”memorize” the content.

Figure 5. Notes taken by P02 while watching health videos

Notes taken by P02 while watching health videos

####  4.3.3. Experiencing emotions

Participants reported emotional arousal while watching videos, including a
stronger sense of connection with creators, a sense of realness, and a sense
of fun.

Connecting with content creators. The perceived “face-to-face” communication
and the creators’ real voices and performances connect viewers to creators.
For example, P07 commented “I prefer them [creators] appearing [in videos]
because they are facing you directly like they are having a conversation with
you. That makes you connect to the information that they are trying to
portray.” P01 said that “the way that she was talking about her experience,
how she suffered, and nothing was working. That’s like, she knows what I’m
talking about and I know she’s talking about.”

Getting immersive experience. Some viewers developed a sense of realness by
being immersed in the contexts, environments, and lives of the vloggers. P03
commented on her experience of watching first-person shooting vlogs of vegans
“They follow them throughout the day, show what kind of stuff they do, so you
know they cook this kind of stuff in their breakfast. You see through their
eyes, the process, how they go shopping, how they cook, how they supplement.”
P05 said “I think being able to relate to somebody rather than just reading
plain text of an article was helpful. Videos talking about somebody who had
anxiety, […] the ethos, and rhetoric. [I felt] like they went through it and
they were able to thrive.”

Exploring diverse genres of content. Some viewers engaged with videos’
versatile genres, such as cartoons, imitations, commentary, interviews, talks,
and vlogs, which afford diverse and novel styles and make the content more
interesting, engaging, and fun to watch. For example, P10 remarked on a doctor
influencer whose videos featured imitation: “He’s always playing every
character. He’ll be this doctor, then he puts on a wig to be a nurse. It’s all
script-based to get you to think about some health topics that happen in the
hospital, and they’re really funny. I was like, oh my gosh he’s hilarious, and
I followed him.” P10 further commented “I think these videos are interesting
because every video is different. It’s not like the same setup or template.
Everyone is new and exciting.”

###  4.4. Evaluating videos

Participants formed evaluations of videos based on their watching and
engagement with videos. They assessed the credibility of videos from three
aspects: previews on platforms, video content, and video creators. We
extracted the specific indicators they used to in Tab 2.

Table 2. Evaluation of Video Credibility | Indicators | Definition
---|---|---
Platform previews | Covers | Covers with more information is more credible
| Metrics | Videos with more view numbers and like numbers are more credible
| Account type | Organizational and governmental accounts are more credible
Video content | Edits | Careful edits such as the design of visuals, voices, and background music indicate higher credibility
| Humors | Humorous elements are perceived to be more credible
Video creators | Appearance | Seeing the face of the presenter or creator is perceived more credible
| Credentials | Professional-created videos are more credible
| Tones | Enthusiastic tones suggest stronger motivation and higher credibility
| Personality | Creators with a stronger personality (e.g., vocal, rigorous) are more credible

##### Platform previews

When searching on Google or YouTube and selecting videos to view from the
results list, participants would form an initial evaluation based on video
features such as ranking, title, cover, and metrics. For example, P01 said, I
look at the video cover, the title of the video, the account name, and how
many views, like a million views is probably enough for me. Participants
acknowledged that they tended to click videos with visually appealing or
”attention-grabbing” covers. Five participants watched health videos produced
by non-profit organizations, patient communities, and medical students and
professionals. For example, P07, P11, P14, and P17 all watched mental health
videos on YouTube from Psych2Go, an organizational account, for its
professional and comprehensible content.

##### Video content

Viewers also valued video with careful edits, which entailed the selection of
appropriate background music, voices, and images. A human voice was preferred
to a machine-generated voice when explaining health knowledge. For example,
P06 said, ”I like a real person talking because narrated voice helps me focus
more and understand more.” Humorous elements and entertainment genres were
generally preferred by participants. P04 remarked ”I trust them [humorous
videos] more because I like the way they deliver the workout. Some YouTubers
are so boring.”

##### Video creators

15 out of the 18 participants watched user-created health videos. Many video
creators appeared and talked in the video. Some participants trusted video
creators who intensively self-disclose and show strong personalities. The
Credential of the creators was not limited to a professional certificate in
health-related areas but included shared experiences in a broader sense.

Some participants were in favor of passionate and enthusiastic tones as
reflected in their talking and they interpreted such tones as indicators of
good intention. For example, P13 liked a YouTuber who ”has a face very
enthusiastic about sharing the information,” and P02 trusted a YouTuber
because ”He’s a very excitable and vocal person that you can feel something he
says it. He seems earnest in his pursuit.”

The strong personality of the creator also plays a vital position in
reinforcing participants’ trustworthiness. Participants seemed to have diverse
expectations of and preferences for health video creators regarding different
topics. Some participants trusted creators who were precise and rigorous. P12
trusted a Korean vlogger who tests, presents, and explains the effects of
various skin care products. She commented that she”is not necessarily
professional but definitely does lots of research” and ”always shows the
factual information… brings in skincare curator sometimes.” However, four
participants were attracted to creators with distinct personalities compared
with others. P02 expressed appreciation for a creator who objected to and
satirized fitness influencers who promote quick weight loss methods. She
interpreted the aggressive words and sometimes exaggerated facial expressions
of this creator as signs of ”authenticity” because ”he doesn’t care about
whether you like him or not and he is just saying how he feels.”

###  4.5. Using health videos

Participants reported three main ways of using health videos: assisting
problem-solving, guiding long-term behavioral changes, regulating emotions
alone with positive videos, and managing content. 13 of the 18 participants
successfully achieved at least one goal, and they accredited the achievement
to health videos on social media, reporting that 50% to 90% of the success was
due to videos.

####  4.5.1. Assisting problem-solving

When participants searched health videos with clear and many times urgent
problems, such as treating eye problems, making healthy meals, and exercising,
they typically used the videos while or immediately after watching them. For
example, P01 tried six methods from YouTube videos after doctors failed to
treat his Chalazion, including washing his eyes, using vinegar, and massage.
He was anxious to be cured, as he commented “I wanted to try anything and
everything to pop it, although you’re not exactly sure how it works[…]”

####  4.5.2. Guiding long-term behavioral changes

Participants also used health videos to guide longer-term behavior changes. By
consistently following health videos, P08 overcame symptoms of depression and
four participants lost weight. To realize the weight loss goal, P10 applied
the knowledge that she learned from a variety of health videos and made an
exercise plan (as shown in Fig 6), specifying a workout routine over a week.
P18 reported performing two sets of Parkinson’s wellness recovery exercises
every day following videos from YouTube to get a “stronger body” and a “better
mood.”

Figure 6. Plans of made by P10 to guide weight loss

####  4.5.3. Regulating emotions alone with positive videos

Ten participants shared experiences of successfully getting emotional support
to varying extents. Being able to regulate emotions alone was appreciated by
participants because health videos afforded privacy, availability, and
easiness. Some participants found videos to be more useful than actual people.
P16 said “If it’s a physical problem, like pains, obviously I’ll go to a
doctor. But if it’s just stressful. I would turn to videos because it is more
of an emotional problem… it’s quite hard to have consultations with friends
and family about it.

Participants selected positive videos for use to inspire and encourage
positive behaviors. For example, P11 said ”They can get rid of carbs. That
would be a trigger for my mind. And that makes me know that I can [do it],
too.” P16 also said, ”If I’m struggling with pain or emotional aspects of
living with it [the disease], I’ll search out positive videos to help me with
dealing with pain.”

####  4.5.4. Managing content

Managing videos and/or associated information artifacts (e.g., notes and
links) is an integral part of using video information for some participants,
particularly when they plan to reuse the videos. For example, P18 saved the
email sent by her friend which contained the Parkinson’s recovery exercise
YouTube videos, and pulled out this email daily to do follow-up exercises.
Some participants manually created or designated one folder to “star” or
“collect” videos. The fact that there were no functions to support video
management led some participants to mix all videos into one folder. For
example, P11 had a playlist on YouTube called “’W’ where I just throw a whole
bunch of videos. If I’m ever on a diet and ideas, that’s still good for me to
keep,” but it troubled him that ”There are about 700 videos as you can see
(Fig 7), lots of them aren’t health-related. I have to go back through [this
folder] to see whatever I have watched.”

Figure 7. P11’s YouTube folder to collect videos

###  4.6. Iterations and dynamics among the five activities in the video
consumption model

Participants’ health video consumption is dynamic and iterative in nature. As
illustrated in Fig 2, participants may skip one activity or return to an
earlier activity in the consumption process. For example, after diciding to
watch videos to fulfill certain motivations (e.g., entertainment), some
participants iterated the accessing, watching, and evaluating activities.
After several iterations (i.e., consuming some health videos), they developed
new motivations (e.g., health improvement) and started to use the health
videos to guide behavioral changes. Later, they might also change access
channels based on the evaluation of videos across platforms.

We found that these dynamic consumer activities and technology environments
collectively co-constructed the socio-technological ecosystem (shown in Fig
8). Social media, including content communities and Social Networking Sites
(SNS), search engines, and participants’ social relationships comprise the
ecosystem. In this dynamic and iterative process, we observed several
tendencies of health video consumption, including seeking stronger motivation,
better accessibility, longer and in-depth content, and higher reliability.

Figure 8. Dynamics and Iterations in the Five Activities of Health Video
Consumption

Ecosystem of accessing health videos on social media. We classified social
media as content communities and social networking sites according to (Kaplan
and Haenlein, 2010), with content communities highlighting the content aspects
(e.g., YouTube and TikTok), and social networking sites emphasizing social
aspects (e.g., Facebook and Twitter).

####  4.6.1. Better accessibility: Search engine to social media

Directly accessing videos from social media offers better accessibility. For
example, P01 started searching for Chalazion related information on Google and
selected YouTube videos which were ranked at top positions on the result page
as illustrated by ①. After several iterations of redirection from Google to
YouTube, he experienced more convenience on YouTube. He accessed and watched
many recommended videos and he could easily modify queries on YouTube for
refined search results. He described I actually just went to YouTube and
searched the topic rather than on Google.

####  4.6.2. Higher reliability: Social recommendations and longer videos

Participants relied more on social recommendations after iterative consumption
of health videos from various channels, especially if they planed to use
health videos. The social recommendations could happen at offline
interpersonal communications (②) as well as interactions on SNS (③). Half of
the participants watched and used health videos recommended by their social
relationships. These videos were almost always relevant and credible because
they were recommended by doctors, family, and friends who knew better about
their needs. For example, P16 immediately trusted the YouTube account
”DIABETES CODE” recommended by his doctor and used it to learn how to prevent
diabetes. P17 and P18 were members of patient communities and they watched
health videos produced by these communities.

Participants also preferred longer and more in-depth videos for use after
several iterations as illustrated by ④. Many commented that YouTube is the
most suitable platform for accessing and watching in-depth health videos since
videos on YouTube were longer and more “reliable and “credible.”

####  4.6.3. Stronger motivations: entertainment to learning and behavioral
changes

Motivations that driven participants to decide to consume health videos may
develop over the iterative consumption process. Sometimes seeking social
awareness and entertainment might transform into learning and even trigger
behavior changes, reflecting that many participants got new ideas about
lifestyles from short video platforms and went to YouTube to learn more
(illustrated by ④). Some participants strategically accessed short videos to
encounter “new things” or look for “ideas” (e.g., food cleansing, keto diet)
and get motivated (e.g., gym hack) from the trending videos. Although
[P03]TikTok and Instagram are not the most reliable, but they’re very quick.
They turned to YouTube videos to support use activities. P17 gave an example
“I was scrolling on TikTok and something popped up, it’s about hypertension
and I found it interesting. But it did not go through deep content, so I went
to YouTube.”

##  5\. RQ2: Challenges of Health Video Consumption on Social Media

Participants encountered challenges in each health video consumption activity.
Small barriers at earlier activities can accumulate into big challenges later
(e.g., using). We summarized challenges associated with each activity in Tab 3
for clarity, but it should be noted that some problems in downstream
activities may be rooted in challenges from upstream activities.

Table 3. Challenges of Health Video Consumption on social media Activities | Challenges | Example quotes
---|---|---
Deciding | High expectations | “for some people, they are looking for overnight weight loss and they might end up falling victims of the viral videos in weight loss.” (P02)
Accessing | Lacking video content retrieval | ”it’s usually not the first thing that pops up on your result, and it is frustrating because I have to dig deeper for resources that I am looking for” (P03)
| Low professionality | “there are so many people talking while they are not qualified to talk” (P14)
Watching | Overwhelming recommendations | “For me, it’s very transactional and I don’t want them full of my feeds” (P01)
| Negative emotions | ”I don’t want to see these recommendations a lot, because I can easily empathize with their sufferings.” (P16)
Evaluating | Commercial intentions | “a lot of the market profit off the fact that people do not know the correct things and keep making mistakes.” (P02)
| Contradictory content | ”There are too many resources give you contradictory suggestions.” (P09)
| Low literacy | ”the green check on YouTube means this person is verified as a doctor or some professionals” (P15)
Using | Personalization | ”It’s really hard because everyone’s metabolism and how their body works is different, so you have to really learn how your body works”(P12)
| Failure | ”After a while, I got frustrated about not seeing the results you want, especially when I was working out so much and I don’t understand.” (P12)
| Integration with tracking apps | “but I didn’t write it down just because it’s hard for me to like completely type out but that like I do myself.” (P10)
| Lack of feedback | “I don’t know if I am making progress”. (P18)
| Content management | ”This is where I just throwing a whole bunch of videos right here, so I have like 700 videos as you can see.” (P11)

##### The over-expectation of health videos.

Four participants failed to accomplish their health goals, indicating a
misalignment between deciding and using activities. Some participants expected
to use health videos on social media as a substitution for professional
treatment. Such expectations are risky and often lead to disappointments. For
example, P11 shared her frustration when health videos failed to help her, it
was so discouraging. I got very frustrated because I felt like I was trying
everything but nothing was working.

##### Demanding efforts to find relevant videos.

The lack of sophisticated content filters and in-video retrieval demands extra
time and substantial effort for participants to go through videos. In some
cases, it only led to a finding that some videos are irrelevant.
Professionality of health videos is a dimension of relevance for some
participants. Many platforms only have limited search functions such as
ranking and filtering videos by metrics that are unhelpful for determining
content relevance. Participants had to rely on the title and cover to decide
whether or not to watch. Some platforms did not support search as P08
commented, ”[Facebook] was not designed for search, it will return a list of
people or groups.”

##### The uncontrollable algorithms.

Participants were exposed to overwhelming recommendations and potential
negative emotions that they did not expect. Although participants acknowledged
that recommendations could be helpful, sometimes participants felt they were
“annoying”. Many participants tried to control their interactions with videos
to avoid overload by using strategies such as intentionally not following or
subscribing to relevant accounts, particularly when they had problem-solving
goals. P16 was a highly ”sensitive” that ”I don’t want to see these
recommendations a lot, because I can easily empathize with their sufferings.”

##### Multifaceted difficulties of making an assessment.

Evaluation is a common challenge in health information consumption.
Participants considered the quality of health videos on social media varying,
causing difficulties in evaluating video credibility. Some participants
attributed this challenge to the fact that publishing health-related topics on
social media does not require a certificate. With the user-generated health
videos trending, the enhanced sense of closeness and interactivity curated by
creators’ communication techniques blur the boundary between credibility and
engagement. Participants also cited commercial or for-profit interests
involved in some videos. Insufficient knowledge about platforms is another
reason; for instance, P17 considered videos on YouTube more legitimate because
they could be retrieved by Google.

##### Obstacles of fitting information to personal needs.

Despite being relevant and helpful, solutions offered in health videos often
could not be directly applied to the participants and required
personalization. P03 was also bothered by an idiosyncratic joint problem that
“it’s like a black cartilage film… so my bones are closer together in there
and have less padding.” Thus, there were no ready-made solutions for her to
refer to. These difficulties sometimes originate from the accessing activity,
where the participants could not find the most relevant videos that suit their
needs; rather, they had to transform the knowledge learned from other videos
into self-experimented solutions. Difficulties in forming personalized
solutions can lead to failure to use health videos to guide behavior changes.

##### Low sustainability and efficiency for behavioral changes.

Even if participants have a plan for behavioral changes, solely using health
videos is not sustainable or efficient. Behavioral changes go hand-in-hand
with self-tracking, feedback, learning, and reflection spanning a long time.
However, video platforms can not be linked with other self-tracking apps. P12
had to monitor his calorie consumption by manual calculations using the
formula he learned from YouTube videos to cope with prediabetes. Participants
expressed the frustration of following the health videos but could not get any
feedback. P18 exercised every day following workout videos, but lamented that
“I don’t know if I am making progress.” Further, video platforms only support
the collection of videos but have less support for management functions, such
as recommending classifications of content.

##  6\. Discussion

Most existing studies about users’ consumption of health information on social
media mainly centered around text information. In response to the fast surging
of health videos on social media, we interviewed and surveyed consumers about
their health video consumption practice on social media with two purposes: to
enhance the conceptual understanding of health video consumption on social
media, and to shed light on implications for designing more effective socio-
technical environment to realize the potential of videos in promoting public
health and wellness and supporting individuals’ behavioral changes. In this
section, we first characterized video consumption practices based on the
health video consumption model that we developed and then discussed design
implications.

###  6.1. Characterizing video consumption

####  6.1.1. Deciding to watch videos: Social awareness and entertainment as
new motivations

The Use and Gratification Theory (UGT) postulates that people intentionally
(rather than passively) select media to satisfy certain social and
psychological needs (Katz et al., 1973). The deciding activity, particularly
the motivations outlined in our model, corresponds to the gratifications in
the UGT. It is not surprising that consumers chose to watch videos to improve
health (Huh and Ackerman, 2012; Mamykina et al., 2015), learn health knowledge
(De Choudhury et al., 2014; Hartzler et al., 2014), and regulate emotions
(Coulson, 2005; Grimes et al., 2008). These motivations or gratifications were
well documented in research on consumers’ health information-seeking behavior
on online health communities and social media platforms based primarily on
analyzing consumer health communication in text format (Zhang et al., 2013).
Our study indicated that they also apply to videos.

Our results also identified two additional motivations for accessing health
videos compared with text: obtaining social awareness of important others’
interests and seeking entertainment. This result is related to the affordances
of social media platforms where awareness of one’s social relationships is
possible and the affordances of video as an information-rich media (Daft and
Lengel, 1986) that can provide a more visual and immersive experience. It’s
worth noticing that motivations may change as consumers iteratively interact
with various health videos. Many participants’ curiosity transformed into
serious learning and sought reliable information from long videos. In our
study designated to health topics, a number of participants were well
motivated to learn and future research can investigate how to trigger
entertainment for learning purposes. However, in daily video consumption for
entertainment, this behavior is probably less prominent.

####  6.1.2. Accessing videos: Cross-platform information-seeking and
encountering

Research in HCI and information-seeking and retrieval typically focuses on
user behaviors on one information system or platform. Researchers have started
to note many information behaviors, such as sharing everyday activities (Zhao
et al., 2016) and disclosing sensitive personal information (Pyle et al.,
2021) and identity (DeVito et al., 2018) are cross-platform. The socio-
technical ecosystem of health video access consisting of search engines,
interpersonal communication, and different types of social media (i.e.,
content communities versus social networking sites and long-video platforms
versus short-video platforms) and the multiple access pathways that we
identified indicated that consumers’ health video access behavior is also
cross-platform.

Another noteworthy finding of the study is that actively seeking or searching
for health videos and passively encountering or receiving health videos on
social media share equal prevalence in enabling access to health videos. This
phenomenon was also reported by Sun’s study on college students’ social media
consumption behavior (Sun, 2022). In today’s technology environment, browsing
and encountering information are playing an increasingly important role as the
active seeking of video information is indicative of users’ interests and thus
leads social media platforms to push more relevant content to viewers. As a
result, the information environment is becoming increasingly responsive and
proactive such that users are subtly coerced to become more passive in
information seeking and consumption, raising concerns about the power of
social media algorithms and algorithmic biases.

####  6.1.3. Watching videos: Cognitive clarity, emotional engagement, and
genre-enabled sense of interestingness and novelty

We added to the existing knowledge that compared to text, videos allow
consumers to more effectively process information. Videos provide a powerful
platform for information understanding, excelling in their ability to convey
multimodal content (Mayer, 2002). They effectively combine visuals, audio, and
text, making complex ideas more accessible and engaging, while simultaneously
offering efficiency through succinct communication. Moreover, videos enhance
engagement and memory by capturing tone and facial expressions. Videos are
also readily accessible on mobile devices. The choice between text and video
depends on factors like audience, content nature, and communication
objectives. Some participants, particularly those with serious learning goals,
transform visual information into to text notes.

Previous literature reported that online videos afford immersion,
interactivity, and intimacy (Harris et al., 2021; Haimson and Tang, 2017) and
thus can enrich personal and contextual disclosure (Liu et al., 2013),
cultivate a sense of closeness (Southerton, 2021), and a sense of community
(Harris, 2019). Our participants also reported similar effects, pointing out
that videos cultivate a strong sense of connection with creators, a sense of
realness, and a sense of fun. Specifically, we identified that directly
talking to cameras and “in situ” shooting that showed details of experiences
are essential to cultivate effective social support without requiring direct
social interactions.

####  6.1.4. Evaluating videos: Importance of visual designs and creator
features

The quality of health videos on social media is problematic (Gabarron et al.,
2013; Krakowiak et al., 2021; Śledzińska et al., 2021), but few studies
examined how viewers evaluate online videos (Gamage et al., 2022). Our
analyses demonstrated that participants evaluated health videos on social
media from the access channel (i.e., how they get this information), video
content, creators, and some platform information such as ranking and user
engagement statistics. We also found that assessing videos is a complex
process involving not only credibility but also other dimensions such as
trustworthiness, interestingness, and visual attractiveness (Sun et al., 2019;
Liu et al., 2023). These findings are consistent with studies focusing on
users’ assessment of mainly textual health information (Liu et al., 2021;
Zhang et al., 2023). Nevertheless, we found that, compared to text
information, users relied more on affective measures to evaluate videos, such
as creators’ features, including their appearance, facial expressions, voices,
and personalities, whether or not they disclose personal information, and
whether or not they sound enthusiastic and authentic. These criteria seemed to
be related to parasocial interactions (PSI) (Horton and Richard Wohl, 1956)
viewers experience during video watching, where viewers develop one-sided
intimacy and emotional reliance towards the creators (Niu et al., 2021).

####  6.1.5. Using videos: Behavioral changes and personalization practices

Consistent with prior research on consumer health information behavior, our
study found that consumers use health videos to learn about health topics,
regulate emotions, and guide behaviors (Lambert and Loiselle, 2007). We
extended the understanding by revealing that consumers often go through a
personalization process to fit the information to their physical or life
constraints. This process requires additional work such as experimentation,
data collection (e.g., through self-tracking), reflection, and planning. We
also found that some consumers exerted efforts to manage the videos they found
for future access and use.

###  6.2. Design Implications

##### Creating engaging videos to motivate access.

The existence of different motivations for accessing videos suggests that
health educators, particularly healthcare providers, government agencies, and
non-profit health organizations, should consider creating video collections
that have multiple genres that use different styles to convey similar health
content. Imagine a generative AI system that may soon be able to generate
different genres of videos to accommodate different user needs and
motivations. This suggests that health educators should strategically create
links among their videos to maximize user access (Song et al., 2021b).

##### Broadening access channels.

The socio-technical ecosystem and multiple pathways of video access suggest
that health educators should work to provide multiple ways to promote access
to their videos. First, they should post their videos on social media to allow
them to be picked up by consumers while browsing their feeds. Second, health
educators should distribute their videos across platforms and tailor the
content to suit different platforms. For example, they may create short videos
to put on short video sites like TikTok or YouTube Short to serve as a lead to
or preview of more substantive videos on YouTube or their own websites to
increase the chance that the substantive educational videos will be accessed.
Third, health educators should also make use of the power of interpersonal
communications by distributing information directly to their customers through
methods such as emails or patient portals and making the content easily
sharable to family and friends.

##### Supporting learning.

Video designers may create innovative ways to provide structured information,
such as table of contents, section headings, and summaries, in videos to
better support some consumers’ needs for taking notes about the content.
Social media platforms may also provide tools to support note-taking, such as
generic note-taking functions and functions that allow viewers to extract
portions of the videos or transcripts and insert into their text notes.

##### Identifying high-quality videos.

Prior studies found that low-quality and misleading health videos on social
media had negative impacts such as self-doubt, anxiety, and disappointment
(Jordan et al., 2021). Common intervention strategies to support consumers’
evaluation of online health information include educational programs,
algorithms to automatically identify high-quality content, and interactive
interfaces giving real-time judgment assistance (Song et al., 2021a).
Considering the sheer amount of health videos on social media, deploying
algorithms such as deep learning (Al-Jefri et al., 2017), to be combined with
selective manual assessment, is needed to assess video quality and promote
high-quality videos. Interfaces could be developed to assist viewers as well,
such as making visible some effective quality indicators, such as video
sources. Given a wider use of affective criteria to evaluate videos in
comparison to text, educational materials should also be developed to help
people be aware of their behaviors and cautious about potential biases
involved, particularly for groups with comparatively lower technology
proficiency or information and health literacy.

##### Assisting consumers’ use of videos.

(1) Supporting personalization. Functions, such as templates to support the
creation of exercise and diet plans (for those who watch such videos) and
structured forms to support the recording of self-experimentation, could be
designed to support self-experimentation and planning. Content creators may
include in videos how viewers may observe progress, such as tracking and
reflecting on certain parameters. (2) Supporting content management. Platforms
could offer functions to help manage videos for re-finding and reuse, such as
creating categories and organizing collected content automatically after users
”star” the content, allowing viewers to indicate the importance of a video and
rank videos by importance, and allowing viewers to tag and annotate saved
videos. In addition, cross-platform content management should be supported
considering consumers’ access and use of videos are cross-platform (DeVito et
al., 2018).

##  7\. Conclusion

Health videos on social media are popular and widely consumed, but the
understanding of users’ practices of consuming health videos on social media
is limited. We interviewed and surveyed users and identified five main
activities involved in their health video consumption practices: deciding,
accessing, watching, evaluating, and using. We constructed a descriptive model
of video consumption on social media to demonstrate the general process of
health video consumption on social media, the socio-ecological systems that
enable and constrain the process, and the cognitive, emotional, and behavioral
actions involved. Future research may focus on detailing specific components
or processes in the model or relationships between different activities. For
example, how motivations, content, genre, and video affordances impact
consumers’ watching and evaluation of videos; how to support consumers to
integrate information from multiple videos and cross multiple platforms to
enable better personal health planning. Our study also generated a number of
design implications to enhance the video information ecosystem on social media
to better serve consumers’ health-related needs, such as diversifying genres
in delivering health content to meet differing motivations and video-watching
preferences and developing tools to support note-taking during video watching.

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##  Appendix A Survey details

####  A.0.1. Survey Design

The survey instrument consisted of three components: (1) respondents’ video-
watching practices on social media, including platforms and devices used,
frequency, topics of interest, video access, watching, sharing, and management
behaviors, and the use of information obtained from videos; (2) respondents’
motivations for watching health videos on social media. The motivation items
were derived from a review of prior literature and a preliminary analysis of
12 interviews that had been conducted when the survey was being designed ; and
(3) demographic information, such as age, gender, and education. We tested the
initial survey instrument with eight participants in two rounds. Feedbacks
included reducing number of options in multiple-choice questions, clarifying
wording of questions and answers, and improving mobile display interface,
were, incorporated into these iterations. To enhance data quality, we also
added one attention check question, asking respondents to select the number of
options they checked for a prior multiple-choice question (August and
Reinecke, 2019; Shamon and Berning, 2020). The final survey contained 33
questions and was launched on Qualtrics.

###  A.1. Data Exclusion

Before the data cleaning, there were 147 from MTurk, 41 from the university
listserv, and 360 from Reddit. We excluded responses that met any of the
following criteria: (1) incomplete; (2) completed in less than three minutes;
(3) failed the attention check question; and (4) gave irrelevant responses to
the open-ended questions. We also excluded responses submitted during a same
short time period and had the same email address patterns (we asked
participants’ emails to enter a random drawing of a $30 Amazon gift card).
There could be biases when determining whether a survey respondent should be
included. Survey responses collected via Reddit and MTurk demonstrated
features that could be related to bots, such as the number of responses
submitted during a short time span and similar email patterns (e.g., name plus
five random digits followed by @ and the domain name). The exclusion of such
data may have systematically excluded certain kinds of participants (cite Chen
et al.2023).