Understanding Social Media Strategies to Improve Engagement in and Equitable Dissemination of Online Cancer Nutrition Information: Cross-Sectional Study.

Background: Social media is a common source of cancer information for patients, caregivers, and survivors. Factors influencing engagement with oncology nutrition content on social media are not well-defined, despite the high prevalence of social media use for health information. The impact of bilingual content strategies on that engagement is also poorly understood. Objective: This study aims to describe changes in postlevel engagement on a Facebook page used to disseminate evidence-based cancer nutrition information during the period before and after the implementation of a bilingual, multiformat content strategy and to identify creative and linguistic features associated with audience engagement at the post level. Methods: This cross-sectional study analyzed 306 Facebook posts from Cook for Your Life over 12 months, comprising 9 months before the strategy change (T1) and 3 months after (T2). Postlevel engagement metrics (likes, comments, shares, and link clicks) and aggregated user demographics were obtained from Meta Business Suite. Trained coders annotated visual and creative features, including branding, post shape, and infographics, as well as topical categories. Linguistic Inquiry and Word Count characterized language features. Group differences across time periods were tested using t tests and chi-square tests. Generalized linear models estimated associations between post characteristics and engagement, adjusting for the time period. Results: Users who engaged with oncology nutrition Facebook content (N=10,196) were mostly female (n=9500, 93.2%) participants, over 35 years of age (n=9311, 91.4%), based in the United States (n=6708, 71.4%), and English-language users (n=9419, 93.4%). Engagement tripled from T1 (mean 5.3, SD 4.2) to T2 (mean 17.7, SD 37.9; P<.001). Creative features such as branding and format were positively associated with engagement. Linguistically, there was a shift toward longer sentence structures, simplified vocabulary, increased analytical language, and a decline in emotionally charged and cognitive language in posts during T2. In models controlling for time period, posts that used bilingual content had 1.72-fold higher odds of audience engagement than English-only posts (95% CI 1.05-2.80). Conclusions: Implementing a bilingual, multiformat content strategy may promote engagement with oncology nutrition information on Facebook and enhance the equitable dissemination of health information. The use of creative visual design elements in combination with language that is more analytical and emotionally neutral was associated with higher engagement with educational public health content. Future research should test bilingual language presentation more directly and examine whether exposure to such content influences health beliefs and downstream behaviors across additional platforms.