Impact of Social Media on Health-Related Outcomes Among Older Adults in Singapore: Qualitative Study

Introduction

Background

Technological advances provide opportunities to meet the social needs of older adults and to educate and empower them on health-related matters. Social media refers to internet-based platforms that use an electronic means of communication to enable social interactions via the consumption, generation, sharing, and exchange of ideas and content by users within their virtual communities [1]. It includes social messaging apps (eg, WhatsApp), social networking sites (SNSs, eg, Facebook), and media-sharing apps (eg, Instagram). These platforms yield benefits over traditional communication modalities, such as telephones and regular text messaging, as real-time updates and communications are not bound by geographical distances [2]. The audiovisual functionalities of social media permit the sharing of pictures, videos, and audio recordings, which trigger the realism of depicted activities and increase feelings of being socially present [3]. In addition, the level of interactivity offered on SNSs is positively associated with greater social bonding with family members [4].

The internet is a preferred source of health information for older internet users [5,6], rendering it a potential tool to improve health communications for older adults. Health blogs and online support groups on SNSs could serve as useful resources for disease management in older adults [7,8], psychological well-being [9], and cognitive functioning [10,11]. However, there is limited research investigating the potential negative health impact of social media among older adults.

The feasibility of social media as a health promotion tool depends on the acceptance of technology. The traditional view is that a digital divide exists [12], with older adults typically being slower than younger adults in adopting new technology. Although research suggests that functional limitations such as cognitive impairment limit capacities to adapt to new technology, older adults are more likely to adopt the technology if they are personally interested and willing to invest in the effort to learn and use the technology [13-15], possess beliefs in self-efficacy [16], and are socially motivated to engage in intergenerational communication with family members [4,13,17]. Fears of privacy breaches [13,14,17,18], a lack of confidence [15,19], and perceptions that web-based communication is trivial [18,19] are some barriers to social media use. These findings indicate that social media use largely hinges on older adults’ own attitudes and beliefs, implying an artifactual digital divide that can potentially be overcome.

Objectives

One of the ways to access social media is the use of social media apps on smartphones. In Singapore, approximately 56% of those aged 60 years and above are smartphone users; 73% have used it to access internet-enabled platforms, including social media apps [20]. Furthermore, Singapore has actively pushed to become a Smart Nation with several initiatives to increase information technology literacy in seniors, including short courses to promote skills learning (eg, operating a smartphone) and becoming social media–savvy [21]. From a public health perspective, with the growing adoption of smartphones and Singapore’s move toward a Smart Nation, it appears that social media apps could be tapped on as useful platforms to promote health-related outcomes among older adults. An understanding of older adults’ perceptions of social media apps could also enable us to evaluate the utility of social media apps as health promotion tools in this age group.

However, despite the potential offered by social media apps, there seems to be scarce literature investigating older adults’ perceptions and attitudes specifically toward social media apps. Although a previous local study examined smartphone adoption and identified generally positive attitudes toward smartphone use among older adults [22], it is unclear whether smartphone use encompasses use of social media apps. Furthermore, much of the current research focuses on attitudes toward either SNSs only (eg, Facebook) [17] or technology acceptance in general [13]. Hence, this study seeks to extend the literature by (1) exploring the experiences of older adults in Singapore in their use of social media apps in enabling interactions and (2) understanding their perceptions of how social media app use influences health-related outcomes. As this was an exploratory study, no a priori hypotheses were made.

Methods

Study Design and Sampling

This study employed a qualitative research design with an interpretative approach. The study sample was recruited from the Community Health and Intergenerational (CHI) study of community-living older adults aged 60 years and above in Singapore [23]. The CHI study is an existing 3-year cohort study that aims to comprehensively investigate health profiles of 1000 older adults by looking at the biological, psychological, and social factors associated with the aging process [23].

The following inclusion criteria were established: (1) age between 60 and 80 years, (2) normal aging (established in neuropsychological tests in the CHI study), and (3) experience with use of internet-enabled technology (determined by smartphone ownership and ability to operate it). In addition to the above, maximum variation purposive sampling was used to ensure diversity of views and opinions. To this end, key participants from different genders, age groups, language of communication, and living arrangements were selected from the list of eligible participants who met the inclusion criteria.

Procedure

Written informed consent was obtained from all participants. At the start of each interview, participants were asked to list the social media apps they used and indicate the frequency of use of each app (to quantify use patterns). Semistructured, in-depth interviews were conducted with an interview guide (Textbox 1), which was developed from a systematic review of factors found to influence technology adoption to support aging-in-place [24]. Participants also answered additional questions on their social media use and its impact on health.