Platform Effects on Public Health Communication: A Comparative and National Study of Message Design and Audience Engagement Across Twitter and Facebook.

Background: Public health agencies widely adopt social media for health and risk communication. Moreover, different platforms have different affordances, which may impact the quality and nature of the messaging and how the public engages with the content. However, these platform effects are not often compared in studies of health and risk communication and not previously for the COVID-19 pandemic. Objective: This study measures the potential media effects of Twitter and Facebook on public health message design and engagement by comparing message elements and audience engagement in COVID-19-related posts by local, state, and federal public health agencies in the United States during the pandemic, to advance theories of public health messaging on social media and provide recommendations for tailored social media communication strategies. Methods: We retrieved all COVID-19-related posts from major US federal agencies related to health and infectious disease, all major state public health agencies, and selected local public health departments on Twitter and Facebook. A total of 100,785 posts related to COVID-19, from 179 different accounts of 96 agencies, were retrieved for the entire year of 2020. We adopted a framework of social media message elements to analyze the posts across Facebook and Twitter. For manual content analysis, we subsampled 1677 posts. We calculated the prevalence of various message elements across the platforms and assessed the statistical significance of differences. We also calculated and assessed the association between message elements with normalized measures of shares and likes for both Facebook and Twitter. Results: Distributions of message elements were largely similar across both sites. However, political figures ( Conclusions: In general, we find a data and policy orientation for Twitter messages and users and a local and personal orientation for Facebook, although also many similarities across platforms. Message elements that impact engagement are similar across platforms but with some notable distinctions. This study provides novel evidence for differences in COVID-19 public health messaging across social media sites, advancing knowledge of public health communication on social media and recommendations for health and risk communication strategies on these online platforms.