The impact of compliance with health literacy principles in Facebook posts on user engagement

BACKGROUND: Addressing health literacy in designing health messages can improve understanding and application of health information by the audience. However, the impact of health literacy-compliant social media posts on user engagement remains unclear. The aim of this study was to investigate the relationship between compliance with health literacy principles in Facebook posts and user engagement by governmental and non-governmental health organizations in Taiwan. METHODS: A total of 3,305 Facebook posts were collected from two governmental and four non-governmental health organizations. Using a proportional sampling method, 600 posts were selected for analysis. A quantitative content analysis was conducted. Compliance with health literacy principles was assessed using a Chinese tool adapted from the US CDC Clear Communication Index, which provided health literacy scores for the text and visual components of each post. User engagement was measured by the number of likes, shares, and comments. Non-parametric statistical methods were used for analysis. RESULTS: The use of pictures had a positive impact on the number of likes (z = 4.77, p < .001) and shares (z = 2.45, p = .014) received. Posts with higher health literacy scores in their text and visual components received more likes (Spearman's r = .21, p < .001 for text; r = .25, p < .001 for visual), shares (r = .24, p < .001; r = .24, p < .001), and comments (r = .12, p = .002; r = .13, p = .002). Posts with text components that fully corresponded to health literacy indicators received more likes (z = 3.78, p < .001), shares (z = 4.05, p < .001) and comments (z = 2.21, p = .027) than those that only partially corresponded to. The same trend was found in visual components (z = 4.95, p < .001 for likes; z = 4.92, p < .001 for shares; z = 2.73, p = .006 for comments). CONCLUSIONS: Compliance with health literacy principles and/or using pictures in Facebook posts positively affects user engagement for health organizations. KEY MESSAGES: • Health organizations should consider health literacy principles when creating social media posts to improve user engagement. • Applying visual aids on Facebook posts enhances user engagement for health organizations.