Young peoples’ perceived benefits and barriers of sexual health promotion on social media - a literature review

ABSTRACT

Sexual behavior and related sexual health issues among young people present major public health concerns all over the world, and therefore, effective health promotion for younger age groups is needed. Social media is considered a promising platform to engage young people with sexual health. However, current research highlights not only the potential but also the concerns about the use of social media for sexual health-related topics. Therefore, the study reviewed the existing literature to identify young people’s perceived benefits and barriers. The review only included qualitative approaches to gain a deeper insight into the perspective of the target group. The search and selection process followed the PRISMA approach and resulted in eight studies that were included in the final analysis. In conclusion, all studies show that the use of social media is a new way of promoting sexual health and creates many opportunities to reach out to younger age groups. The most frequently reported benefits identified in this review are the use of entertainment, easy and fast access, interaction, and the use of platform-specific features. On the contrary, perceived barriers are privacy concerns, lack of control, unsuitability of social media for sexual health issues, and the rapid change of technologies. The results demonstrate the variety of perceived benefits and barriers of sexual health promotion on social media. This exploration of young people’s perspectives provides valuable insights for sexual health educators, future sexual health promotion on social media, and future research.

KEYWORDS:

• Sex education
• sexual health promotion
• social media
• young people
• adolescents

Introduction

Sexual health among younger age groups is a public health concern all over the world and they are at increased risk of many sexual health issues such as sexually transmitted infections (STI) (Agwu 2020). The term STI refers to a pathogen that causes infection through sexual contact (Divecha et al. 2012; Workowski et al. 2021). STIs like chlamydia, HIV or genital herpes have a direct impact on sexual and reproductive health through stigmatization, infertility, cancers and pregnancy complications (WHO 2022). According to the World Health Organization the highest rates are found among individuals aged 15–24 (World Health Organization 2022), and the Center for Disease and Control estimates that youth account for almost half of all new STIs (Center for Disease Control and Prevention, 2022), indicating the urgent need for sexual health promotion in this age group.

The rise of information and communication technologies in developed countries expanded the options for delivering all kinds of health interventions (Divecha et al. 2012). Social media is considered to be a particularly promising tool for sexual health promotion, especially for younger people who already use social media for other health purposes (Burns, Chakraborty, and Saint Arnault 2021; Kachur et al. 2013; Teadt et al. 2020). Social media platforms such as Instagram, TikTok or YouTube are particularly popular and used daily by younger target groups (DataReportal 2022b). In 2022, the average amount of time spent using social media worldwide was 147 minutes per day (DataReportal 2022a). Generally, those platforms allow individuals to create a profile, interact with other users, and reach large audiences (Boyd and Ellison 2007), which already indicates the major benefits for sexual health promotion: audience reach and interactive features (Pedrana et al. 2013). Despite the potential of social media platforms, there is an ongoing debate on privacy and data protection. To tackle this issue, the European Union published a General Data Protection Regulation in 2018 to unify data privacy laws across Europe (European Union 2023). Although users have some control over their data, keeping pace with the ever-changing and intricate privacy settings of social media platforms can prove to be a daunting task for users (Witzel et al. 2016).

Furthermore, the existing literature highlights both the benefits and potential negative impacts of social media on sexual health. On one hand, social media platforms offer easy and wide access, facilitating faster partner acquisition (Enomoto, Noor, and Widner 2017; Nadarzynski et al. 2019), which can increase the likelihood of engaging in unprotected sexual intercourse. Veinot et al. (2011) also reported that adolescents express concerns about the potential risks associated with acquiring sexual partners online, including the transmission of sexually transmitted infections (STIs). However, it is essential to note that the transmission of STIs can occur regardless of whether partners meet through social media or other means, if they are not using protection or have not undergone STI testing (Martin-Smith, Okpo, and Bull 2018). Contrary to these concerns, social media is considered a promising platform for providing information and positively influencing perception, knowledge, and behavior related to sexual health (Nadarzynski et al. 2019). Moreover, it holds the potential to contribute to the reduction of stigmas associated with sexual health (Burns, Chakraborty, and Saint Arnault 2021; Garett et al. 2016).

Although using social media for sexual health promotion is a promising approach young people also see the according challenges (Kesten et al. 2019; Olamijuwon and Odimegwu 2022; Patterson et al. 2019; Veinot et al. 2011). Social media has the potential for effective relationship and sex education (McKee et al. 2018) because of different aspects such as interaction, targeting, social support, audience reach and easy accessibility (Döring 2021; Khawaja, Ali, and Khan 2017; Ludwigs and Nöcker 2020; Olamijuwon and Odimegwu 2022). Another great opportunity is the aspect of learning through interactivity and therefore health professionals can explore ways to listen to and engage with young people to improve sexual health knowledge and promote behaviors such as condom use (Evers et al. 2013). However, there are also challenging aspects regarding the use of social media for sex education purposes such as privacy concerns (Stevens et al. 2017; Witzel et al. 2016). The interaction with sexual health content could be seen by others and result in unwanted reactions (e.g. stigma, rejection) from their friends, family or other persons on social media (Evers et al. 2013; Olamijuwon and Odimegwu 2022). Nevertheless, studies with young people show that they are interested in receiving health information online, particularly on sensitive topics such as sexual health (Olamijuwon and Odimegwu 2022; Ralph et al. 2011).

Only a few scoping reviews exist in the field of health promotion and social media (Brusse et al. 2014; Gabarron et al. 2012) or sexual health promotion in digital media in general (Döring 2017a, 2017b, 2017c; Gilliam, Chor, and Hill 2014; Sanz-Lorente et al. 2018). Furthermore, some systematic reviews examined existing sexual health promotion activities and interventions in digital media or social network platforms and aimed to evaluate their effectiveness on different sexual health outcomes and different target populations (Gold et al. 2011; Guse et al. 2012; Jawad, Jawad, and Alwan 2019; Jones et al. 2014; Martin et al. 2020; Wadham et al. 2019a). However, existing reviews do not specifically look at the benefits and barriers regarding sexual health promotion on social media and do not focus on the young people’s perspective. Thus, this review aims to bridge this gap by presenting a comprehensive overview of the current benefits and potentials of using social media for sexual health promotion, particularly from the perspective of younger people.

Objective

The effectiveness of the use of social media for sex education and sexual health promotion is dependent on different factors. Qualitative studies have shown that there are different perceived benefits and barriers to the use of social media for sexual health promotion targeting younger adults. This literature review will focus on primary qualitative studies to get a deeper insight into the perspective of the target group. Hereby, quantitative studies are omitted due to a lack of studies on this topic, by the time the review was conducted. Furthermore, this review will target all younger age groups including adolescents and young adults. Due to limited research on each individual age group, this review refers to younger people in general which includes people aged 15–25 (World Health Organization 2023).

Therefore, the aim of this literature review is to provide an overview of the qualitative literature, identifying the perceived benefits and barriers from young people in developed countries. This will enable a better understanding of this approach and inform professionals, as well as future studies and interventions.

Methodology

The study characteristics are based on the PEO approach (Richardson et al. 1995) and are displayed in Table 1. Therefore, the review includes studies focusing on younger people (Population) and the main interest is sexual health promotion and sex education through the use of social media (Exposure). This review focuses on social media’s role in promoting sexual health among young people, highlighting both benefits and barriers (Outcome).

Table 1. Study characteristics based on PEO.

PEO component	Characteristics
Population	Younger adults, youth, adolescents, teenager
Exposure	Sexual health promotion, sex education through the use of social media
Outcome	Benefits/potentials and barriers/risks

Eligibility criteria

The main criteria for inclusion were studies that focused on the use of social media for sexual health promotion. Furthermore, the review includes studies in English or German and studies published between 2010 and 2021 in developed countries. This review includes only qualitative approaches. Thus, secondary studies like meta-analyses or reviews were excluded as well as studies published in other languages than German or English, studies published before 2010 and studies that did not focus on the specific topic and target group (see Appendix A).

Search and selection process

Table 2 shows the search terms used in this review. Based on these, a search string was developed and adapted to the chosen databases (i.e. PubMed, PsycInfo, SAGE Journals, Communication Abstracts, and Google Scholar). The search was conducted on 8 May 2021. The results were saved to the reference management program Zotero and the analysis followed the PRISMA approach (Tricco et al. 2018).

Table 2. Keywords for literature search.

Social media	AND	Sexual health	AND	Adolescen*
Social network		Sex education		Youth
SNS		Contracept*		Young people
Instagram		Condom		Teen*
Facebook		Sex*		Younger adult
YouTube		Protect*
Twitter		Prevent*
Snapchat		Sexual behaviour
Social network site		Sexual health communication
		STD
		STI
		Sexually transmitted
		Sexual health information
		Sexual health promotion
		Sexual health education

Note. Example of search string for PubMed: (‘Social media’ OR ‘Social network*’ OR ‘Social networking site*’ OR Instagram OR YouTube OR Facebook OR SNS OR Twitter OR Snapchat) AND (‘Sexual health’ OR ‘Sexual health promotion*’ OR Sex OR ‘Sex education’ OR ‘Sexual Health communication’ OR Condom* OR”Sexual health education” OR Protect* OR ‘Prevent* Behav*’ OR ‘STI prevent*’ OR ‘STD prevent*’ OR STI OR STD OR ‘Sexually transmitted*’ OR ‘Sexual behavior’ OR ‘Sexual behaviour’ OR ‘Sexual health information’ OR Contracept*). The terms within column are connected with an ‘OR’. In the final search process, the third column was not included due to the small number of results. Therefore, the aspect of younger participants was later assessed during the screening of articles and assessing for eligibility criteria. Abbreviations: STD = Sexually transmitted disease, SNS = Social network site.

Data extraction and synthesis of results

Eight studies met the inclusion criteria. For the data extraction, tables were prepared, consisting of descriptive study characteristics, methodological aspects, and results of the studies. The extracted data were analyzed and used to inform the benefits and barriers of social media use for health promotion to reach the goal of this review.

Interrater reliability

This literature review was conducted and reported in line with best practices (Liberati et al. 2009). Although best practice guidelines recommend that literature searching and sifting should be conducted by two different reviewers, in practice this is often not the case or possible like in this review (e.g. due to time or source restrictions). Literature also suggests that a single individual can correctly conduct an extremely high-quality and publishable systematic review as well (Siddaway, Wood, and Hedges 2019). Considering that, it should be noted that this study was performed by one author and thus it is referred to as a literature review with a systematic approach (Grant and Booth 2009).

Results

Figure 1 presents the PRISMA flow diagram for selecting papers based on four phases: Identification, Screening, Eligibility, and Including. After removing duplicates, 309 potential studies remained. Subsequently, the studies were screened by title, based on the predefined eligibility criteria. Title screening excluded 121 studies, leaving 188 studies. Abstract screening led to the exclusion of 164 studies for reasons such as lack of access, focus on unrelated topics, or study type. Additionally, studies primarily focusing on correlating social media use with sexual health outcomes or implementing content analyses were excluded, as they didn’t align with the main interest of this research – meaning the perception of young people on benefits and barriers of the use of social media for sexual health promotion. After applying inclusion/exclusion criteria to the full-text articles, 12 studies were excluded, and eight studies met the criteria for data extraction and analysis.

Figure 1. PRISMA Flow Diagram – Study Selection Process.

Study characteristics

The detailed characteristics of each study are displayed in Table 3. Studies were in English and published between 2011 and 2021. The studies included in this review were conducted in Australia (n = 4) and the United States (n = 4). The studies used qualitative approaches, employing focus group or individual interviews. The studies were published in various journals, including Health Education & Behavior, Reproductive Health Matters, Sexual Health, Public Health Nursing, New Media & Society, Journal of Medical Internet Research, Sexuality Research and Social Policy, and American Journal of Health Education. The included studies primarily focused on younger adults or adolescents. Additionally, two studies explored not only the possible recipients but also the communicators of interventions such as adult stakeholders in sex education. Interestingly, some studies target gay men specifically. Sample sizes varied between 20 and 63 participants.

Table 3. Study characteristics.

Author	Year	Country	Methodology	Sample	Limitations
Burns et al.	2021	United States	9 group-depth interviews	N = 41 18–21 years African American males 63,4 % not in a relationship 68,3 % having sex in the past 6 months	−small sample size −optimal time to discuss sexual health prevention may be during the preadolescence phase of development
Byron et al.	2013	Australia	2 phases of focus group discussions −1.) divided into age groups (16–17 years and 18–22 years, school vs. post-school) −2.) mixed age and sex	N = 22 16–22 years Urban and regional males and females	−not mentioned
Ewert et al.	2016	Australia	Semi-structured interviews	N = 28Males 18–25 years Australian and international students Majority identifies as heterosexual	−data analysis is subjective and thus open to researcher bias
Jones et al.	2019	United States	8 focus groups (separated by gender) Facebook intervention	N = 63 15–23 years 57% female From a midwestern university, a large inner-city high school, and a rural high school	−self reported data may negatively affect validity −social desirability bias
McKee et al.	2018	Australia	7 focus groups Intervention: iPad App 7 Funny Guys, vulgar comedy videos featuring male comedians telling jokes about sexual health topics	N = 6groups with young people 15 males, 5 females 14–20 years	−not mentioned
Pedrana et al.	2013	Australia	4 focus groups Intervention: 2010 launched ‘Queer as F**k’ (QAF), an innovative and novel sexual health promotion intervention using SNS to target gay men	N = 27 21–46 years Gay men	−small number of participants and those who chose to participate may be fans more engaged with the Intervention
Ralph et al.	2011	United States	Mixed method approach: surveys and focus groups with teens	N = 58 Youth in low income communities 14–19 years	−participants were selected with the help of program staff and thus represent a convenience sample −socioeconomic data were not collected to confirm income status -findings be considered in the context of the time period in which the data were collected (2008)
Selkie et al.	2011	United States	Mixed method: survey and 5 focus groups	N = 29 14–19 years 65.5% female 61.1% heterosexual	−small sample size and thus limited generalizability −having both genders in each group may have inhibited communication

General Results

This review includes eight final studies to identify potentials and benefits as well as barriers or challenges of the use of social media for sexual health promotion for younger adults in developed countries (see Appendix B). The studies focus either on social media in general, social networking sites (SNSs), or specific platforms like Facebook, MySpace, or YouTube. The studies differ in the specific topic or outcome they focus on (e.g. specific sexual health topics like the prevention of STIs and the related protection behaviors such as condom use). Most studies reported both positive and negative aspects of the use of social media for sexual health promotion, but one study only presented benefits in their result section (Burns, Chakraborty, and Saint Arnault 2021). The following benefits and barriers are summarized from all included studies and exclusively reflect the aspects mentioned by the young people.

Benefits

All studies agree on the fact, that the use of social media is a new way of sexual health promotion, subsequently creating many opportunities for health educators and designs of interventions. Social media and SNSs are often described as fast, accessible, flexible as well as free, and shareable for everyone (Burns, Chakraborty, and Saint Arnault 2021; Byron, Albury, and Evers 2013; Jones et al. 2019; McKee et al. 2018).

The young people in the included studies reported, that the aspect of Entertainment appears to be one of the major potentials of the use of social media for sexual health promotion (Burns, Chakraborty, and Saint Arnault 2021; Byron, Albury, and Evers 2013; Jones et al. 2019; McKee et al. 2018; Pedrana et al. 2013). One study, for instance, reveals that young people perceive the use of humor as beneficial for delivering sexual health messages (Byron, Albury, and Evers 2013). They report that humor can help to avoid stigma and enable further distribution of sexual health information. However, finding an appropriate balance between education and entertainment is considered a challenge in the context of sex education (Pedrana et al. 2013).

Finding and having easy access to information is another identified benefit that supports the idea of using social media for sexual health promotion for younger people (Burns, Chakraborty, and Saint Arnault 2021; Byron, Albury, and Evers 2013; Jones et al. 2019; Ralph et al. 2011). In other words, the content is widely accessible across all forms of platforms that young people access. In addition, they report the benefit of algorithms of social media platforms to reach young people (McKee et al. 2018) and hard-to-reach groups such as gay men or other queer people (Jones et al. 2019; Pedrana et al. 2013; Ralph et al. 2011).

Additionally, Interaction is identified as an important advantage, because engagement and interaction with target groups increase message effectiveness and desirable outcomes (Burns, Chakraborty, and Saint Arnault 2021; Byron, Albury, and Evers 2013; Pedrana et al. 2013; Ralph et al. 2011; Selkie, Benson, and Moreno 2011). Participants in the studies also name the benefit of new forms of participation (McKee et al. 2018) such as the integration of interactive games (Jones et al. 2019). Additionally, young people can also become peer educators themselves by sharing information (Burns, Chakraborty, and Saint Arnault 2021; McKee et al. 2018).

Furthermore, two studies revealed the benefit of meeting young people in their own environments because they are already using social media for other (educational) purposes (Burns, Chakraborty, and Saint Arnault 2021; Ralph et al. 2011). The participants of two included studies also report the feasibility of delivering sexual health messages through famous personalities or others respected by young people (Burns, Chakraborty, and Saint Arnault 2021; Jones et al. 2019).

Other benefits identified are the combination of different platforms to spread messages (Burns, Chakraborty, and Saint Arnault 2021) or the opportunity of linking to other sources and additional information (Jones et al. 2019; Selkie, Benson, and Moreno 2011). The use of specific features and different formats such as videos or other visual presentation, was reported by three studies, in which young people perceived this as beneficial in the context of sex educational purposes (Jones et al. 2019; McKee et al. 2018; Pedrana et al. 2013).

Barriers

Besides the identified benefits, the spreading, receiving and sharing sexual health information through social media implies different risks and challenges. Most studies reported privacy concerns as the main disadvantage of using social media for sexual health promotion. Participants were aware of the danger of publicly expressing private matters (Byron, Albury, and Evers 2013; Ewert, Collyer, and Temple-Smith 2016) and criticised the lack of anonymity (Selkie, Benson, and Moreno 2011). Related to that, concerns about peer or parental reactions are mentioned as a barrier to the effectiveness of sexual health interventions and messages distributed over SNS (Ralph et al. 2011).

Another identified disadvantage of the use of social media for sexual health promotion is related stigmas to certain sexual health issues so that messages are unlikely to be shared by target groups. This is accompanied by the fact, that young people are afraid of embarrassment and drama in overt discussions about such sensitive and stigmatized topics (Byron, Albury, and Evers 2013).

The results of the studies also revealed that social media or specific social networking sites and platforms are simply not seen as suitable for sexual health, especially for detailed discussions about sexual health issues (Byron, Albury, and Evers 2013; Pedrana et al. 2013). Furthermore, sexual health messages on social media may be perceived as too negative, condescending or serious (Byron, Albury, and Evers 2013; Jones et al. 2019) and should avoid being preachy or lecturing (McKee et al. 2018). In contrast to being perceived as too serious, another study reported the concern that messages will not be taken seriously enough (Jones et al. 2019). Messages may also be overseen or ignored since there is a large number of advertisements and information and sexual health-related information could have a deterrent effect (Byron, Albury, and Evers 2013; Jones et al. 2019; Pedrana et al. 2013; Ralph et al. 2011).

Another challenge reported is the rapid development of technologies. Social media platforms change rapidly, and specific SNS are already seen as outdated by younger people (e.g. Facebook). This implies the risk that social networking sites can differ in efficacy depending on various age groups (Jones et al. 2019; Ralph et al. 2011).

Further perceived barriers to the use of social media for sex educational purposes are the challenge of the balance between education and entertainment (McKee et al. 2018) or the fact that some prefer to simply look at shared messages but not interact with them (Pedrana et al. 2013). Lastly, some studies reveal, that young adults highlight the importance of high-quality content and credibility of content and source (Pedrana et al. 2013) and also report concerns about inaccuracy (Ralph et al. 2011).

Discussion

This review aimed to provide an overview of studies on the perceived benefits and barriers of using social media for sexual health promotion among young people. Young people generally approve of this approach and other studies agree with this acceptance (Kesten et al. 2019; Olamijuwon and Odimegwu 2022). The most frequently reported benefits and potentials identified in this review are the use of entertainment, easy and fast access, interaction, reach of target groups, the use of platform-specific features, and lastly the combination of different platforms and links to other sources. The results of this review complement previous research. For instance, Wadham et al. (2019b) highlight several positive aspects in their systematic review, including rapid spread, low costs, great audience reach, targeting specific populations, interactivity, anonymity, and flexibility (Wadham et al. 2019b). However, the flip side of the coin of the wide reach of social media is also stated by prior research. Thus, sexual health messages might be seen by unintended target groups such as younger children, resulting in misunderstandings of the message or other undesirable and unintended effects (Döring 2021; Kesten et al. 2019; McKee et al. 2018).

On the other hand, the main identified barriers and challenges in this review are privacy concerns, lack of control, the unsuitability of social media for sexual health issues, the rapid change of technologies, and finding the right balance between education and entertainment. Privacy concerns appear to be a bigger concern and participants of similar studies also reported concerns about judgment and discrimination when interacting with sexual health content (Kesten et al. 2019).

Limitations and implications for future research

This review has some limitations. The studies assessed self-reported data, possibly affected by reporting biases (e.g. social desirability). Furthermore, there was an underrepresentation of women and a focus on specific target groups (e.g. gay men). Future research could explore other target groups based on sexuality or region (Bull et al. 2012; Kesten et al. 2019; Nguyen et al. 2019; Veinot et al. 2011). Geographically, the studies were limited to Australia and the US, and the restriction to English and German articles may have introduced biases by excluding other languages. Addressing these gaps is crucial for understanding young people’s perspectives. Additionally, the considered social media forms don’t encompass all existing platforms. As the social media landscape rapidly evolves with new platforms emerging, research should investigate their influence on perceived benefits and barriers for young people (Wadham et al. 2019b). This review provides new and in-depth insights into qualitative research on young people’s perceptions of providing sexual health information on social media. Based on this, future reviews could include quantitative studies in a mixed-method review or solely focus on quantitative studies in a systematic review.

The identified benefits and barriers also offer useful insights for sexual health educators and future interventions, aiming to promote effective sexual health promotion for younger people. Stakeholders and communicators of sexual health reported that they are aware of various risks and challenges and therefore are afraid of using social media, even if they know that the target group would prefer this way of health promotion (McKee et al. 2018). Consequently, it is necessary to inform stakeholders and highlight the benefits and potentials to reduce worries among young people and enable evidence-based decisions for designing, implementing, and evaluating sexual health promotion on social media for younger people.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

This research is supported by the Austrian Science Fund (Project P 35052-G).

Appendix A

Eligibility Criteria

Table

Inclusion Criteria	Exclusion Criteria
Published in English or German	Not published in English or German
Primary studies	Secondary studies (reviews or meta-analyses)
Focused on developed countries	Not focused on developed countries
Focused on young adults (10–24 years)	Not focused on young adults
Focused on Social Media or SNS	Not focused on Social Media or SNS
Referring to Benefits or Barriers of Social Media or SNS use for sexual health promotion	No references to Benefits or Barriers of Social Media or SNS use for sexual health promotion
Humans	Not humans
Published between 210–2021	Not published between 2010–2021
Qualitative approach (self-reported data, interviews, focus groups etc.)	Quantitative approach (content analyses, experiments etc.)

Appendix B

Summary of Findings

Table

Author	Year	Main Topic/Outcome	Form of Social Media	Theory	Benefits and Potentials	Barriers and Challenges
Burns et al.	2021	Condom use forSTI prevention	Social media in general	Theory of Planned Behaviour (TPB)	−social media already used for other educational purposes −straight forward −entertaining −easy to find information −to recruit for further face-to-face communication −messages can be delivered through leader/important personalities or other respected persons by the target group −interaction with target group −fast, accessible −meeting individuals in their own settings −use more than one platform to spread messages −young people can easily express themselves as well	−not mentioned
Byron et al.	2013	Sexual health topics in general	Social media in general and specifically Facebook	Not mentioned	−keeping up with current events −immediacy of engagement −rather generalized campaigns instead of explicit information −using humour −make sexual health information more accessible −use real/personal stories rather than facts	−potential for embarrassment and drama in overt discussions of sexual health in these spaces −unlikely to be shared due to stigma −public nature of SNS unsuitable for detailed discussion −disruption of social media practices (not suitable) −too negative or serious approach −many ways to use SNS −Facebook not suitable −privacy −acute awareness of the dangers of publicly expressing private matters −overseen or ignored like other ads
Ewert et al.	2016	Barriers to access for sexual health care & promotional strategies for sexual health for young men	Facebook	Not mentioned	−Facebook: novel way to communicate to young people	−Facebook: not the right place for this sort of information −concerned about being associated with it publicly
Jones et al.	2019	Educational Facebook intervention for STD prevention, knowledge and awareness	Internet, social media, Facebook (Intervention Caryn Forya)	Not mentioned	−versatility and flexibility −use of videos, attention grabbing images, and up-to date messaging −quick retrieval of information −links to other sources −entertainment aspect −integrate interactive games −use professional speakers -use of different forms together (i.e. sites and apps) −linked to other social media applications −create opportunities for improved parent-child communication −organized and easy to find information potential of reaching individuals seeking trustworthy sexual health information and affecting subsequent risky sexual behaviours −reach large amount of users	−may be received as condescending −Facebook might be outdated (also use other social media forms like Twitter, Tumblr, Snapchat or Instagram) −large amount of information can be deterrent −different effects in different age groups −privacy concerns (anonymity) −will not be taken seriously
McKee et al.	2018	Best way to reach young men with vulgar comedy videos that provide sexual health information	iPad App 7 Funny Guys vs. social media platforms	Van Dijck’s (2013) framework of ‘platformed sociality’ or ‘cultures of connectivity’	−use of videos −(mobile) social media is ideal way to deliver such information −free and sharable for everyone −new ways of participation −entertaining −young people can become peer educators by sharing the content −algorithmic capacities of social media platforms to ‘push’ educational content to target audiences	−entertainment vs. education −stakeholders are afraid of using social media even if they know that the target group would prefer this way of health promotion −avoid being preachy or lecturing -control is limited (distribution of the message etc.) −risk of making content shareable -> unpredictable outcome -might be seen by children who are too young and/or young people might misunderstand the messages
Pedrana et al.	2013	HIV prevention, sexual health promotion for gay men	Social networking sites (SNS), YouTube & Facebook	Not mentioned	−interactive web-based soap-opera style −opportunity for gay community to discuss sexual health content on Facebook with peers −good balance between education and entertainment (Edutainment approach) −target group can get/feels involved −format (video drama series)	−too many things on Facebook so the content may not be noticed −public nature of Facebook -> careful about commenting because it would show up in status updates (concerns of privacy) −Facebook not suitable/appropriate for discussing sexual health −preference to view the content but not to interact −high production quality is important −credibility of video content is important
Ralph et al.	2011	Use of SNS to connect youth to sexual health services	Social networking sites (SNS), MySpace	Not mentioned	−connecting with target populations in their own environments −privacy, anonymity and convenience −through a clinic’s SNS, teens can find information vetted by a reputable health provider −quickly accessible information −engage hard to reach youth -interaction/involvement	−concerns about the accuracy of the information available online −SNS more appropriate for social interaction −concerns about peer or parental reactions −prefer to connect with health professionals face-to-face -inaccuracy and “information overload −rapid development of new technologies
Selkie et al.	2011	Adolescents’ views how technologies could be used for sexual health education (SNS and text messaging)	SNS	Grounded Theory	−health education program run by other adolescents would be considered trustworthy −provide additional information −interaction −providing a ‘safe’ setting to interact with real people via technology	−lack of anonymity in SNSs