Social media usage and health promoting lifestyle in profile related socio-demographic factors in Turkey

Introduction

Social relationships have been linked to positive health behaviours, good mental and physical health, and lower mortality risk. Adults who are more socially connected are healthier and live longer than their more isolated peers.^1-3 Therewithal, emotional support provided by social ties, such as being married, having children and religious involvement enhances positive health behaviours and reduces the risk of unhealthy behaviours.^4-7

An increasing fraction of today’s social interactions occur using online social media as communication channels.⁸ Social media users spend an average of 118 minutes worldwide and 181 minutes in Turkey using social media each day.^9,10 In Turkey 92% of internet users use Facebook.¹⁰

Researchers are interested in social media and health issues because they have become an important part of our everyday lives. Possible impacts of Facebook use on health, education, social life, consumption etc. reported in the previous literature. Studies on the health implications of Facebook use have generated many important results. Facebook use has been shown to be associated with many mental health domains such as Facebook addiction, psychological distress (i.e., depression, anxiety, etc.) and well-being (life satisfaction, positive mental health) anxiety, body image and disordered eating, drinking cognitions and alcohol use.^11,12 For all that, the heightened interpersonal connectivity afforded by social media was associated with an overall increase in psychological well-being. Ellison et al¹³ reported that intensive use of Facebook predicts social capital accumulation and is found to interact with measures of psychological well-being. In addition, some studies show that engagement with Facebook and number of Facebook friends has a positive association with subjective well-being,¹⁴ which predicts an array of mental and physical health consequences.^11,15

Facebook usage has been associated with many health outcomes, but little is known about the relationships between Facebook use and health-promoting behaviors. This article largely focuses on exploring the relationships between social media and the health-promoting lifestyle. We use Facebook as a research tool in order to determine the relationship. As of January 2017, Facebook, registered as having 1.871 billion active users all over the world, was the most popular online social networking application. This is also the case in Turkey, where it has 48 million active users.¹⁶ As a result, Facebook was determined to be a viable research tool both for its widespread use and its features that provide an invaluable resource for fulfilling the basic human need for social connection. It is hoped that the results of this study will provide information to policy makers for developing health promotion strategies and interventions.

The aim of this study was to analyse health promoting lifestyle in conjunction with socio-demographic conditions and Facebook usage and describe the complex links between these variables using non-linear canonical correlation analysis.

Materials and Methods

Results

This study included 423 participants and 51.1% of them were female, 48.9% were male. Single participants made up 53.9%, while 46.1% were married. In this study sample, 26.5% respondents were at less than high school level, 59.6% were at high school level and 13.9% were at more than high school level. 30.5% of all participants were in the age group of 18-34, 49% were in the age group of 35-64 and 20.5% were 65 of age or older.

Associations between health promoting lifestyles and sociodemographic factors are shown in Table 1. Health promoting lifestyles by gender were similar. There were no significant differences of health promoting lifestyle subscales in terms of gender categories.

We did not find significant differences at health promoting lifestyle scores in terms of age groups except for exercise subscale (P = 0.018). Younger groups engaged more in physical activity behaviors than did older group.

There were no significant differences of health promotion subscales according to level of education except for self-actualization subscale (P = 0.014). Respondents who had more education (more than high school degree) showed more positive self-actualization behaviour than those who had less education (high school degree or less).

There were no statistically significant differences in self-actualization, nutrition, interpersonal support, and stress management subscales according to marital status. Significant differences were revealed in the health responsibility (P = 0.004) and physical activity (P = 0.027) subscales. Singles engaged more in physical activity and health responsibility (39.5% and 41.2%, respectively) behaviors than did married persons (29.2% and 27.7%, respectively).

Table 2 represents associations between Facebook usage variables and sociodemographic factors. We found significant differences for number of Facebook friends, posts, and groups scores according to gender categories. There were significant differences for Facebook posts, groups, like rate, and comment rate scores in terms of age categories. There were also significant differences for some Facebook variables: friends, posts and like rate according to education levels. There were significant differences for Facebook posts and comment rate in terms of marital status.

The number of friends was higher in males and increases in proportion to education level. Posts were at the lowest level in young people (28.7%) and increased in proportion to age (52.7% and 72.4, respectively). As the education level increased, the like rate also increased. Posts were at a higher level in married people (56.9%) than singles (43%). Page likes were higher for males (55.6%) than females (44%). Groups were higher for males (50.2%) and significantly increased with age (33.3%, 48.3%, and 55.2, respectively). The like rate of users decreased with age (58.1%, 49.3%, and 39.1, respectively). Similarly, a high level of like rate increased dependent on their level of education (Low: 40.2%, graduated: 51.2%, post graduate: 62.7%; respectively). Middle-aged people had more comments (55.6%) than young and older people. The high rate of comments received by married couples (52.3%) was higher than that of singles.

Since all the data are non-numerical, OVERALS was applied to identify the relationships between three sets of variables, and a two-dimensional solution was found. Component loadings, loss values, eigenvalues and fit values that show the similarities between the sets obtained from the OVERALS are given in Table 3.

Of the relationship captured between the variables, 0.487/0.958 = 51% was explained by the first dimension and 0.472/0.958 = 49% was explained by the second. The canonical correlation coefficients which are the square roots of these eigenvalues were 0.70 and 0.69 for first and second dimensions, respectively. These values represented a positive and high relationship between the variable clusters discussed in both dimensions. The total fit measure was equal to 0.958 and explained 0.958/2 = 48% of the total variance when compared to the maximum fit (2), which is equal to the number of dimensions.

When looking at the graph of component loadings (Figure 1), it can be seen that the best discriminatory power belongs to education level, age group, number of friends, like rate, health responsibility and stress management variables, because these variables were located away from the origin. From the component loadings of Table 3; health responsibility, stress management, page likes, nutrition, and age group took high values in the first component. Page likes, like rate, friends, education, interpersonal support, and self-actualization had high component values in the second dimension.

Figure 1

Component loadings of OVERALS analysis.

Table 3 Component loadings, eigenvalues among the demographic, Facebook usage indicators and health promoting lifestyle.

A detailed demonstration of the compatibility among the categories is given in Figure 2. These point distributions provide us with the ability to identify key relationships between demographic variables, Facebook usage indicators and health-promoting lifestyle sub-dimensions.

Figure 2

Centroids plot for the OVERALS analysis of the relationship between basic demographics, healthy lifestyle factors and social media tools.

According to both the component loadings and centroid plot, there was a positive relationship between self-actualization, exercise, like rate, and nutrition. In the first coordinate, while the self-actualization, nutrition and exercise were positive, the like rate is high and the posts tended to be low. In contrast, in the third coordinate, it was noticed that those who had negative self-actualization, exercise and nutrition statuses had high levels of posts and low levels of like rates. This group mostly contained old men. In the second coordinate, it is seen that those whose number of friends and comment rate were high and who have had positive interpersonal supports had negative levels of health responsibility and stress management. It can be said that the self-actualization of this group, which was located in the second coordinate, was positive, and the level of education was concentrated in the graduated or post graduate level. In contrast, when the fourth coordinate is examined; those with a low level of friends, low like rates, and little group participation tended to be positive in stress management and health responsibility, although the interpersonal support was negative. Posts, groups and comment rate of young and single people were low, but their like rate was very high. On the other hand, married people had very high levels of posts and groups, whereas their like rate was low. While the self-actualization and interpersonal support of people with lower education levels were inclined to be negative, the number of friends was also low. However, as it is seen from the third coordinate, this group had a high number of posts. It was noteworthy that the people with the less than high school level had a higher number of friends, and their self-actualization and interpersonal support were more positive. At coordinates 2 and 3, the group of mostly middle-aged men with a high rate of group participation and high comment rate was found to be likely to be negative about exercise, nutrition and even health responsibility. On the first and fourth coordinates, the opposite of the previous ones, the group consisted mostly of single women with low group participation and low comment rate who tended to be positive in stress management, nutrition and exercise.

Discussion

This study is one of the first to emerge regarding the relationships between Facebook usage and a health promotion lifestyle, including health responsibility, nutrition, exercise, self-actualization, interpersonal support, and stress management. A strong aspect of the study is the use of the OVERALS analysis, which makes it possible to formally assess the relationship between people’s demographic characteristics, healthy lifestyle behaviours and social media use.

A monthly observation based on users’ sharing posts and receiving likes or comments on their posts shows that those who are positive in self-actualization, nutrition and exercise have a high level of like rate, while their number of posts is low. On the contrary, it is noted that those who have negative self-actualization, exercise and nutrition status have a high number of posts and a low level of like rates. In addition, females have better behaviours with respect to exercise and nutrition than males, and they get more likes on their posts even though they share fewer posts. This can be explained by the phenomenon of physical attractiveness. Because two important cues for female and male physical attractiveness are body mass index and shape,^22,23 and those people of higher physical attractiveness are perceived to possess more socially desirable traits.²⁴ On the other hand, those with high education levels are more positive in exercise, self-actualization and interpersonal support, while negative in health responsibility and stress management.

Some additional evidence was provided by our study on Facebook friend numbers and social support patterns. People with more friends on Facebook have more positive interpersonal support and self-actualization. This finding is similar to studies that reported that the number of Facebook friends emerged as a stronger predictor of perceived social support and may enhance a user’s subjective well-being.^16,25,26 Overall, independent from the number of Facebook posts, people who get more comments and likes on their posts and have more Facebook friends are worse off in stress management and health responsibility. This finding is in line with the study reported by Chen and Lee,²⁷which showed that more frequent Facebook interaction (including sharing photos and new stories, liking and commenting) is associated with greater distress. Therewithal, Campisi et al²⁸ suggested an association between Facebook use and psychological stress.

There were some limitations in the current study. This study assessed only Facebook users living in Ankara region. Our results could not be generalized to other social media tools users and other parts of the country. Replicated studies with other social media tools user groups residing in different geographical regions are needed to verify and compare the present results. Additionally, this study has been conducted with a sample from Ankara in Turkey, which is a part of a collective society. We also need more studies to be carried out in different cultural backgrounds in order to consider the results complete. Due to increasing time spent on social media in all societies, it is important for public health researchers and health policy makers to understand the relationship between social media usage and health behaviours.

In conclusion, our results highlight data showing that older people share significantly more posts than young people and have lower like rates. Additionally they have negative nutrition and exercise behaviors. We think that it is a result of social isolation, which is a common factor among the elderly population. Based on study findings it seems that there is a problem in health promoting behaviors of the older Facebook users. We recommend creating environments for older adults that are conductive to more social lifestyle. Additionally, at each clinic visit, the health provider should make suggestions for increasing physical activity. Also, educational programs encouraging healthy eating should be developed.

Ethical approval

This study was approved by Hacettepe University Ethics Commission (grant No. 35853172-900 ) and informed consent obtained from all participants.

Competing interests

The authors declare that they have no competing interests.

Funding

No funding was provided for this research.

Authors’ contributions

DG developed the framework, concept and design of the research project, collected the data. SYI performed analysis and had contribution in data entering phase. DG and SYI interpreted the data, wrote the results and revised the manuscript. DG approved the final version of the manuscript. EO has full supervision on the whole research project. All authors discussed and contributed to the final manuscript.

Acknowledgments

The authors greatly appreciate all the people who participated in the study for their support. This article was provided from PhD dissertation of Güleç.

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