With billions of users, social media is a valuable tool for communicating public health information. What was already discernible several years ago has, with the emergence of the coronavirus, become obvious. The impact of social media in this public health context is heightened, unsurprisingly, when visuals are incorporated. In the article “The Role of Pictures in Improving Health Communication,” Peter S. Houts and his co-authors demonstrated how visuals are more likely to be remembered, for a longer period of time and more accurately. Further, Instagram has grown increasingly popular across the Arab world. The 2017 Arab Social Media Report, published by the Mohammed Bin Rashid School of Government, found that approximately 10.7% of survey respondents used Instagram. By 2019, the “Media Use in the Middle East” report published by Northwestern University in Qatar showed that, in nationally representative samples, approximately two-thirds of Qataris and Emiratis used Instagram. Social media, particularly Instagram, is reaching increasingly larger portions of the population and has been an effective public health messaging tool for Gulf states, particularly since the onset of the coronavirus pandemic.

Health Belief Model

The health belief model is a theoretical framework that has been used to examine health messages on various social media platforms. The model explains that individuals are more likely to adopt preventative health behaviors depending on six factors in communication messaging: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Scholars such as Lu Tang and Sung-Eun Park have used the model to examine positive health changes and the avoidance of negative health outcomes. The health belief model is a useful prism for examining the effectiveness of public-health-focused social media messaging in the Gulf. A brief look at each factor helps indicate the messaging strategies Gulf countries have used and the reasons these social media efforts have worked to enhance public health.

Perceived susceptibility refers to the extent to which a person feels vulnerable to a health condition or contracting a disease. For example, the Kuwaiti Ministry of Health posted a video on Instagram asking viewers: “Are you obese? Are you a smoker? Do you have a family history of cardiac disease? Are you over 40 years old?” By using personalized language, the post helps increase the feelings of perceived susceptibility to cardiac disease for those who may be at risk. It also includes a cue to action, directing people to a screening opportunity for lipids.

 

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Perceived severity refers to the extent to which a person feels an illness or health condition is threatening. For example, the Omani Ministry of Health posted an infographic on Instagram with figures on noninfectious illnesses. It describes such health conditions, including heart illnesses, diabetes, cancer, and chronic respiratory illnesses, as the leading causes of death on a global level. Along the same lines, the Bahraini Ministry of Health posted an infographic on Instagram indicating that transfats increase “bad cholesterol” and decrease “good cholesterol.”

 

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Perceived benefits refers to when individuals are more likely to take action on a public health recommendation if they feel they can prevent illness or improve health conditions by doing so. For example, the Omani Ministry of Health posted an Instagram video presenting the benefits of testing for sickle cell anemia and thalassemia when individuals intend on getting married. The video explains how having an awareness of genetic conditions they might pass down to their children can help couples plan, in efforts to help children live healthy lives.

Perceived barriers refers to when individuals are less likely to perform a recommended health action due to the obstacles preventing them from doing so. For example, to address concerns among Saudis of a scarcity of health-care appointments or difficulties with scheduling appointments, the Saudi Ministry of Health launched a campaign focused on the application Mawid to make scheduling easier. Similarly, the ministry posted information about a notification system to remind parents when to vaccinate their children, to reduce barriers related to demands on parents’ time, and scheduling. The United Arab Emirates’ Ministry of Health and Prevention also has an Instagram post showing a similar application developed to help mothers remember to vaccinate their children in a timely manner.

 

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Cues to action are direct calls to act on recommendations, such as “call your doctor.” For example, the Saudi Ministry of Health posted a video providing specific cues to action that help people dealing with insomnia, including avoiding stimulants, decreasing noise in the bedroom, refraining from using electronic devices, developing a sleep schedule, and consulting a doctor.

Self-efficacy deals with the belief in one’s ability to follow a recommendation. Posts incorporating self-efficacy use phrases such as “you can,” “make sure to,” and “be responsible to.” For example, one Saudi post empowers individuals, reminding them about their rights regarding their health care, including seeking a second opinion. Similarly, a Kuwaiti video encourages viewers not to neglect their heart health, to make sure they are using lipid screening services – stressing that lipid screenings aren’t difficult and take less than 10 minutes.

Health Messaging During a Pandemic

The health belief model helps to examine how Gulf governments have long been utilizing social media for important health messaging. These tools have become even more critical since the onset of the coronavirus pandemic.

The Gulf states have used social media to encourage people to wear masks, wash their hands, and remain socially distanced. These posts often include a cue to action or a perceived benefit, elements that improve the likelihood of the audience adopting favorable public health behaviors. One post by the Saudi Ministry of Health calls for all three behaviors, and it depicts a group of men praying communally while maintaining some distance between each person. Similarly, another Saudi post stresses the importance of washing hands, incorporating perceived benefits, that “we are all responsible” for preventing the spread of the coronavirus. Both posts show the collective nature of society, where individuals consider themselves part of the whole or are depicted in groups. These depictions include some of the components of the health belief model, which are necessary for effective health communication.

Other posts have acknowledged individual sacrifice by providing positive reinforcement or by providing safe alternatives. For example, one post by the UAE Ministry of Health and Prevention highlights the importance of the individual’s role in maintaining public health and expresses pride for those sacrificing for their nation and society. Meanwhile, a Kuwaiti Ministry of Health video encourages people only to leave their homes when necessary and remain distanced, though it acknowledges the social needs of Kuwaitis.

 

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After long periods of isolation, some posts have encouraged people to seek mental health support. One Omani post mentions that it is normal to feel sadness, anxiety, anger, or fear during crises and encourages people to seek others who they trust to talk to and to remain in touch with friends and family via cell phones and social media. An Emirati post provides a QR code, an email address, and a phone number for individuals who need psychological counseling. The post is in English and Arabic, noting the importance of reaching expatriates as well as nationals.

Many Gulf social media posts have specifically targeted children, noting the importance of this demographic as the majority of people in the Middle East and North Africa are under the age of 40, and have been posted in multiple languages to reach diverse populations. The Qatari Ministry of Public Health posted videos, in Arabic with English subtitles, with a child narrator teaching children how to properly wash their hands. Another video posted by Qatar’s ministry targeting children explains what the coronavirus is and attempts to reduce the anxiety children may experience during the pandemic. Again, it was posted in Arabic and English, demonstrating the importance of multilingual messages during public health crises. The Kuwaiti agency Bensirri Public Relations has long acknowledged the need for multilingual messaging in issues relating to public health as exemplified in its “Safe Food, Safe Family” campaign.

Posts have varied in terms of being informational and instructional. For example, a May 2020 post from the UAE differentiates between N95 respirators, surgical masks, and masks made of paper or cloth. In contrast, a May 2020 video from Kuwait’s Ministry of Health shows viewers how to fold a cloth to make a homemade mask, similar to an April 2020 instructional video from the U.S. surgeon general. Another Kuwaiti video shows how health-care workers can safely conduct testing.

Posts have incorporated religion and women in new ways. For example, a post from the Bahraini Ministry of Health recommends using social media to send Eid greetings and banking apps to send Eid money to relatives as well as restricting holiday celebrations to the nuclear family that shares a household. Meanwhile, an Emirati post shows female health-care professionals in the forefront of an image thanking the women “for being our first line of defense.” This is noteworthy as there has been a historical absence of women photographed in public life in the Gulf states.

 

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Other posts have addressed misinformation and disinformation. For instance, a post from the UAE urges its residents to protect their country from misinformation by relying on national health authorities. Even by 2018, the Saudi Ministry of Health had developed communication strategies to dispel health rumors. For example, the ministry created a post to address a rumor about how cholesterol tests are only necessary after the age of 40. To dispel the rumor, a cartoon doctor says that it is necessary to check cholesterol levels starting at age 20 and even at age 10 if there is a family history of the disease. The health misinformation campaign uses the hashtag #TheySay when a rumor is stated and debunked.

There are some universal trends in communication about the coronavirus pandemic. However, there are also some trends that speak specifically to the culture, religion, and history of the region. There is value in bridging the gap between the medical and social sciences for an interdisciplinary examination aimed at improving the effectiveness of health communication campaigns for the diverse residents of the Gulf region.