Are social networks effective in promoting healthy behaviors? A systematic review of evaluations of public health campaigns broadcast on Twitter

INTRODUCTION: While public health campaigns disseminated through Twitter have multiple theoretical advantages over other strategies (e.g., a high potential reach and low economic cost), the effectiveness of social networks as facilitators of attitudinal and behavioral changes in the population seems to remain weakly supported. Therefore, this systematic review was aimed to analyze the degree of impact of healthy behavior-related campaigns as documented in scientific literature. METHODS: Strictly following the PRISMA methodology, a total of 109 indexed articles were obtained, of which only 18 articles met the inclusion criteria. In addition to accessing the literature available on WOS, Scopus, BVS, Medline, Cochrane Library and PubMed, the quality of the existing studies was assessed through the Critical Appraisal Skills Programme (CASP) protocol. RESULTS: The results of this systematic review revealed a small number of evaluations of the effectiveness of social campaigns disseminated on Twitter, although the quality of these studies was considerably good. Most of the research used statistics and metrics for evaluation, with residual use of other measurement methodologies. However, their effectiveness and impact on public health-related behaviors remain arguable, in view of the existence of marked tendencies to: (i) not evaluate these campaigns; (ii) evaluate them through excessively brief, ambiguous, or potentially biased indicators; and (iii) not carry out systematic follow-ups over time. DISCUSSION: Although there is no strong evidence of the suitability of Twitter as a suitable medium for raising public health awareness on behavioral health affairs, the actual limitations identified in this review would help to optimize this paradigm and enhance the quality, reach, and effectiveness of such communication strategies.