Evaluation of Diet-Related Infographics on Pinterest for Use of Behavior Change Theories: A Content Analysis

Background There is increasing interest in Pinterest as a method of disseminating health information. However, it is unclear whether the health information promoted on Pinterest is evidence-based or incorporates behavior change theory. Objectives The objective of the study was to determine the presence of health behavior theory (HBT) constructs in pins found on Pinterest and assess the relationship between various pin characteristics and the likelihood of inclusion of HBT. Methods A content analysis was conducted on pins collected from Pinterest identified with the search terms “nutrition infographic” and “healthy eating infographic.” The coding rubric included HBT constructs, pin characteristics, and visual communication tools. Each HBT construct was coded as present or not present (yes=1, no=0). A total theory score was calculated by summing the values for each of the 9 constructs (range 0-9). Adjusted regression analysis was used to identify factors associated with the inclusion of health behavior change theory in pins (P<.05). Results The mean total theory score was 2.03 (SD 1.2). Perceived benefits were present most often (170/236, 72%), followed by behavioral capability (123/238, 51.7%) and perceived severity (79/236, 33.5%). The construct that appeared the least was self-regulation/self-control (2/237, 0.8%). Pin characteristics associated with the inclusion of HBT included a large amount of text (P=.01), photographs of real people (P=.001), cartoon pictures of food (P=.01), and the presence of references (P=.001). The number of repins (P=.04), likes (P=.01), and comments (P=.01) were positively associated with the inclusion of HBT. Conclusions These findings suggest that current Pinterest infographics targeting healthy eating contain few HBT elements. Health professionals and organizations should create and disseminate infographics that contain more elements of HBT to better influence healthy eating behavior. This may be accomplished by creating pins that use both text and images of people and food in order to portray elements of HBT and convey nutritional information.

[1]  Frances E. Thompson,et al.  Adults Meeting Fruit and Vegetable Intake Recommendations — United States, 2013 , 2015, MMWR. Morbidity and mortality weekly report.

[2]  L. Kantor,et al.  U.S. Per Capita Food Supply Trends: More Calories, Refined Carbohydrates, and Fats , 2002 .

[3]  B. Popkin,et al.  Patterns and trends in food portion sizes, 1977-1998. , 2003, JAMA.

[4]  Erik M Augustson,et al.  Portrayal of smokeless tobacco in YouTube videos. , 2012, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[5]  K. Glanz,et al.  Health behavior and health education : theory, research, and practice , 1991 .

[6]  P. Guenther,et al.  Diet Quality of Low-Income and Higher Income Americans in 2003-04 as Measured by the Healthy Eating Index-2005 , 2008 .

[7]  D. Black,et al.  Nutrition education worksite intervention for university staff: application of the health belief model. , 2003, Journal of nutrition education and behavior.

[8]  Karen A. Lee,et al.  A pilot study for plant the seed: A nutrition education program using local food environment to put theory into action , 2016 .

[9]  J. Stevenson,et al.  The extended health belief model applied to the experience of diabetes in young people. , 2006, British journal of health psychology.

[10]  Míriam Antón-Rodríguez,et al.  A content analysis of chronic diseases social groups on Facebook and Twitter. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[11]  A. Trichopoulou,et al.  Mediterranean diet and longevity , 2000, The British journal of nutrition.

[12]  David W. Grotto,et al.  The Standard American Diet and its relationship to the health status of Americans. , 2010, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[13]  Mahbubur Rahman,et al.  Level of Nutrition Knowledge and Its Association with Weight Loss Behaviors Among Low-Income Reproductive-Age Women , 2015, Journal of Community Health.

[14]  C. Stones,et al.  "If The Guardian can do it, we should be able to do it!" Examining Public Health Infographic Strategies used by Public Health Professionals , 2015 .

[15]  H. Payne,et al.  Use and Acceptance of Social Media among Community Health Workers , 2015 .

[16]  R. Winett,et al.  Self-regulation, self-efficacy, outcome expectations, and social support: Social cognitive theory and nutrition behavior , 2007, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[17]  Michael D. Barnes,et al.  The Laugh Model: Reframing and Rebranding Public Health Through Social Media. , 2015, American journal of public health.

[18]  Sunil Kripalani,et al.  Use of pictorial aids in medication instructions: a review of the literature. , 2006, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[19]  A. Pekosz,et al.  Mind the Gap: Social Media Engagement by Public Health Researchers , 2014, Journal of medical Internet research.

[20]  J. Beal.  Health education — Effectiveness, efficiency and equity, 2nd edition , 1996 .

[21]  S. Costanzo,et al.  Nutrition knowledge is associated with higher adherence to Mediterranean diet and lower prevalence of obesity. Results from the Moli-sani study , 2013, Appetite.

[22]  Joshua H. West,et al.  Health Behavior Theories in Diet Apps , 2013 .

[23]  Samantha R. Paige,et al.  Pinterest as a Resource for Health Information on Chronic Obstructive Pulmonary Disease (COPD): A Social Media Content Analysis , 2015 .

[24]  P. Briss,et al.  Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA , 2014, The Lancet.

[25]  R. Brownson,et al.  Evidence-based public health: a fundamental concept for public health practice. , 2009, Annual review of public health.

[26]  Judith Wylie-Rosett,et al.  Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. , 2009, Circulation.

[27]  P. Hajigeorgiou,et al.  Effects of diet and exercise in 337 overweight/obese adults. , 2012, Hippokratia.

[28]  K. Kondo,et al.  Quality and accuracy of Internet information concerning a healthy diet , 2013, International journal of food sciences and nutrition.

[29]  H. Korda,et al.  Harnessing Social Media for Health Promotion and Behavior Change , 2013, Health promotion practice.

[30]  Hannah E Payne,et al.  Health Behavior Theory in Physical Activity Game Apps: A Content Analysis , 2015, JMIR serious games.

[31]  L. B. Pierce,et al.  Efficacy of computer technology-based HIV prevention interventions: a meta-analysis , 2009, AIDS.

[32]  Simin Liu,et al.  Dietary intake of fruits and vegetables and risk of cardiovascular disease , 2003, Current atherosclerosis reports.

[33]  B. Vandermeer,et al.  Social media interventions for diet and exercise behaviours: a systematic review and meta-analysis of randomised controlled trials , 2014, BMJ Open.

[34]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[35]  David A Grimes,et al.  Theory-based interventions for contraception. , 2011, The Cochrane database of systematic reviews.

[36]  J. Carroll,et al.  A New Dimension of Health Care: Systematic Review of the Uses, Benefits, and Limitations of Social Media for Health Communication , 2013, Journal of medical Internet research.

[37]  M. Nestle,et al.  The contribution of expanding portion sizes to the US obesity epidemic. , 2002, American journal of public health.

[38]  K. Farrell,et al.  Chronic Disease Self-Management Improved with Enhanced Self-Efficacy , 2004, Clinical nursing research.

[39]  Sameer Deshpande,et al.  Factors Influencing Healthy Eating Habits Among College Students: An Application of the Health Belief Model , 2009, Health marketing quarterly.

[40]  C. Lister,et al.  It Gets Better: A Content Analysis of Health Behavior Theory in Anti-Bullying YouTube Videos , 2013 .

[41]  Joshua H. West,et al.  Apps of Steel: Are Exercise Apps Providing Consumers With Realistic Expectations? , 2013, Health education & behavior : the official publication of the Society for Public Health Education.

[42]  Xiaoli Nan,et al.  When Vaccines Go Viral: An Analysis of HPV Vaccine Coverage on YouTube , 2012, Health communication.

[43]  L. Miller,et al.  The effects of nutrition knowledge on food label use. A review of the literature , 2015, Appetite.

[44]  Buket Akkoyunlu,et al.  A New Approach to Equip Students with Visual Literacy Skills: Use of Infographics in Education , 2014, ECIL.

[45]  M. Perri,et al.  Prevalence of obesity among adults from rural and urban areas of the United States: findings from NHANES (2005-2008). , 2012, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[46]  Katherine M Flegal,et al.  Prevalence of Obesity Among Adults and Youth: United States, 2011-2014. , 2015, NCHS data brief.

[47]  K. Kattelmann,et al.  An Examination of Factors Associated With Self-Efficacy for Food Choice and Healthy Eating among Low-Income Adolescents in Three U.S. States , 2016, Front. Commun..

[48]  Marilyn Frenn,et al.  Changing the tide: an Internet/video exercise and low-fat diet intervention with middle-school students. , 2005, Applied nursing research : ANR.

[49]  R. Thackeray,et al.  Adoption and use of social media among public health departments , 2012, BMC Public Health.

[50]  Carla K. Miller,et al.  Is one theory better than another in nutrition education? A viewpoint: more is better. , 2004, Journal of nutrition education and behavior.

[51]  Matthew A. Silva,et al.  A Preliminary Study of Health Care Professionals’ Preferences for Infographics Versus Conventional Abstracts for Communicating the Results of Clinical Research , 2014 .

[52]  C. Lister,et al.  Share Videos, Not Pills: A Content Analysis of Prescription Drug Videos on YouTube for Presence of Behavior Change Theory , 2014 .

[53]  Gillian Nowlan,et al.  Pinterest as a Tool: Applications in Academic Libraries and Higher Education , 2012 .