JMIR Publications

ABSTRACT

Background:

Excessive sodium intake is a major concern for global public health. Despite multiple dietary guidelines, population sodium intakes are above recommended levels. Lack of health literacy could be one contributing issue and contemporary health literacy is largely shaped by social media.

Objective:

We aim to quantify the twittering behaviors on dietary sodium reduction by influencers in policy field on X (formerly Twitter) across time.

Methods:

We first identified X users with a scope of work related to dietary sodium and retrieved their posts (formerly Tweets) from 2006 to 2022. Users were categorized into the policy groups of outer-setting organization, inner-setting organization, or individual, based on their role in the conceptual policy field. Network analysis was used to analyze interactions among users and identify the top influencers in each policy group. A four-dimensional influence framework was applied to measure the overall influence, activity, priority, originality, and popularity scores. These measures were used to reveal the user-level, group-level, and temporal patterns of sodium-related influence.

Results:

We identified 78 users with content related to dietary sodium, with 1,099,605 posts in total and 14,732 dietary sodium posts. There was an increasing volume of sodium posts from 2010 to 2015; however, the trend has been decreasing since 2016, especially among outer-setting organizations. The top influencers from the three policy groups were the World Health Organization (WHO), American Heart Association (AHA), and Tom Frieden, with a total public engagement of 55,593, 26,395, and 12,672, respectively. At the group-level, inner-setting and outer-setting organizations generally had greater overall influence and tended to interact with more users in the network compared to users in the individual policy group; moreover, inner-setting organizations tended to receive more public attention per post than individuals followed by outer-setting organizations. At an user-level, the WHO and Simon Capewell ranked the highest in activity; WASSH and Action on Salt had the highest priority for dietary sodium content; General Mills, Tom Frieden, and Dariush Mozaffarian had the highest originality; and WHO, Tom Frieden, and Harvard University School of Medicinereceived the highest popularity. Monthly patterns show a significant peak in the number of sodium posts in March compared with other months.

Conclusions:

Despite the increased usage of social media, recent trends of sodium intake education on social media are decreasing and the priority of sodium among other health topics is low. To improve policy implementation effectiveness and meet recommended dietary targets, there is an increasing need for health leaders to consistently and collectively advocate for sodium intake reduction on social media.