JMIR Publications

ABSTRACT

Background:

There is increasing concern around communities which promote eating disorders (Pro-ED) on social media sites through messages and images which encourage dangerous weight control behaviours. These communities share group identity formed through interactions between members and can involve the exchange of ‘tips’, restrictive dieting plans, extreme exercise plans and motivating imagery of thin bodies. Unlike Instagram, Facebook or Tumblr, the absence of adequate policy to moderate Pro-ED content on Twitter presents a unique space Pro-ED community to freely communicate. While recent research have identified terms, themes and common lexicon used within the Pro-ED online community very few have been longitudinal. It is important to focus upon the engagement of Pro-ED online communities over time to further understand how members interact and stay connected, which is currently lacking.

Objective:

The purpose of this study was to explore beyond the common messages of Pro-ED on Twitter to understand how Pro-ED communities get traction over time by using the hashtag considered to symbolise the Pro-ED movement, #proana. Our focus was to collect longitudinal data to gain further understanding on the engagement of Pro-ED communities on Twitter.

Methods:

Descriptive statistics were used to identify the preferred tweeting style of Twitter users (either as mentioning another user in a tweet, or as an individual tweet to oneself, commonly referred to as ‘self-directed’) as well as their most frequently used hashtag, in addition to #proana. A series of Mann Whitney U tests were then conducted to compare preferred posting style across number of followed, followers, tweets and favourites. This was followed by Linear models using a forward step-wise approach, were applied for Pro-ED Twitter users to examine the factors associated with their number of followers.

Results:

This study consisted of 11,620 Pro-ED Twitter accounts who posted using the hashtag #proana between September 2015 and July 2018. These profiles then underwent before a two-step inclusion / exclusion criteria screen to reach the final sample of 967 profiles. Over 90% (10,484) of the profiles were found to have less than 6 tweets within the 34 months period. Most of the users were identified as preferring a mentioning style of tweeting (74.3%) over self-directed styles (25.7%). Further, #proana and #thinspo were used interchangeably to propagate shared themes and there was a reciprocal effect between followers and followed.

Conclusions:

Our analysis showed that the number of accounts followed and number of Pro-ED tweets posted were significant predictors for the number of followers a user compared to likes. Our results could potentially be useful to social media platforms to understand which features could help or otherwise in curtailing spread of ED messages and activity. Our findings also show that Pro-ED communities are transient in nature engaging in superficial discussion threads but resilient, emulating cybersectarian behaviour.