Norms-Shifting on Social Media: A Review of Strategies to Shift Health-Related Norms among Adolescents and Young Adults on Social Media

"By mapping the strategies onto our framework, social media strategies can be more systematically linked to the multi-level context in which they are applied, allowing future research to build towards a corpus of evidence."

Social media platforms (e.g., Facebook, YouTube, Instagram, TikTok) provide increasing opportunities for social and behaviour change (SBC) practitioners to understand and address health-related social norms among adolescents and young adults. This review provides an inventory of the numerous strategies that development organisations have used for norms-shifting among adolescents and young adults on social media - either as stand-alone interventions or in the wider context of multi-layered SBC programmes. The strategies are mapped onto a framework that distinguishes between intervention approaches and various levels of visibility on social media. The review identifies evidence gaps for the working mechanisms behind these strategies to be further unpacked in future research.

Opening sections of the paper introduce key concepts including social norms, which are perceptions of social expectations of typical and appropriate behaviour within a valued reference group that can dictate what people in a group believe is typical (normal) and appropriate (approved) to do. These ideas represent 2 types of social norms: (i) descriptive norms are expectations about what people do, and (ii) injunctive norms are expectations about what people should do, as well as perceived consequences of adhering to a norm or not.

There are many examples of public health programmes that have been effective in shifting social norms - for example, community-based, mass media, or social media initiatives. Peer influence, social interaction, and widening access to more available, shared, and tailored information have been identified as the main advantages of using social media for SBC. No matter what approach is used, effective norms-shifting programmes are often multi-level, informed by protective norms (those building on existing positive values) and rooted in contextual information.

For the review, the researchers examined literature describing qualitative, quantitative, and mixed-methods evaluations of programmes and interventions that included at least one component designed to address social norms or related constructs via social media, and in which the audience was primarily adolescents (10-19) and young adults (20-35). Ultimately, 18 peer-reviewed publications, 6 gray literature documents, and 9 projects were identified through a stakeholder survey.

The researchers mapped the strategies that were used in the selected programmes along 2 axes: (i) visibility (i.e., on which parts of social media interventions are visible: open or closed), and (ii) approach (i.e., whether the strategies are characterised by approaches to shift norms on the individual or community level). They categorised the selected programmes along these axes (see Table 2 in the paper), derived common strategies, and mapped them onto the framework presented in Figure 2.

More specifically, with regard to (i), norms-shifting across multiple levels of visibility, the common strategies that were identified are described here from most publicly visible to least:

• Public pages, comment sections, and open groups: The most open parts of social media (i.e., public pages and open groups) were leveraged to address community-level processes. Community-level processes on social media are interactions between individuals that social media users do not necessarily know personally but are visible to social media users belonging to online communities that have formed around, for example, a hashtag, specific YouTube accounts, or Facebook pages. At the community level, the identified strategies aimed to stimulate the circulation and/or creation of media content to shift descriptive norms (e.g., stimulating pledges that endorse condom use) and stimulate processes that reward the desired kind of behaviour to shift injunctive norms (e.g., stimulating reinforcement of pledges via comments). Addressing norms at the community level on social media is thought to make norms at that level more visible.
• Closed groups and group chats, which were leveraged to address interpersonal/group-level processes: interactions between peers within a contained group such as a Facebook group or a Telegram channel. Compared to public pages and comment sections, the more private character of closed groups and group chats (social media users have to actively join a group or group chat before being able to access the groups or chat content) allows programme developers to focus on this group more specifically and create a safe space. This approach was mostly leveraged to address sensitive topics to shift descriptive norms (e.g., asking group members if they carry condoms to stimulate affirmative comments) and by fostering peer support to shift injunctive norms (e.g., stimulating the exchange of experiences with condom use and fostering positive reinforcement).
• (Group) chats, which have been leveraged to introduce information and address issues in highly personalised ways (e.g., providing advice using chatbots or via one-on-one chats with frontline workers), aiming to shift individually held knowledge and/or beliefs. Such activities were undertaken with a view to further disseminate and reinforce norms at levels that are less publicly visible.

With regard to (ii), individual- vs. community-level norms-shifting strategies on social media:

• Individual level: Revolves around delivering media content or messages that are attuned to normative perceptions of individual audiences and/or audience groups to shift norms. Such messages can be designed manually, drawing from formative research, or automatically, drawing from data provided by the user via questionnaires, messaging, or user interfaces, which is also referred to as computer-aided message tailoring. Posting media content on social media to address norms is the most common strategy across the programmes selected for this review. An example is MTV Shuga: Alone Together (2020), a YouTube miniseries by the MTV Staying Alive Foundation that aimed to increase young people's knowledge, motivation, and actions to prevent COVID-19 and shape norms around public health. Analysis of 3,982 comments and 70 live chat conversations showed how the posting strategy stimulated followers to reinforce the episodes' key messages and complement them with their own views, experiences, and stories. In norms-shifting interventions, social advertising often plays a supportive role in reaching intended groups on open social media.
• Community level: Leverages social connectedness in online and/or offline communities to shift norms and reach priority audiences. Community-level norms-shifting strategies are designed to involve and empower intended groups to create (social media) content and to stimulate engagement, either through offline training and workshops or through online collaborative platforms or social media groups. Approaches include tagging and challenging, co-design and co-creation, peer support, and live events. An example of how pledges, co-created with members of the intended audience, are used to shift norms on social media is provided by Merci Mon Héros (meaning "thank you, my hero"), a programme in francophone Africa that spurred from a youth design challenge and that has been further developed under the guidance of Johns Hopkins Center for Communication Programs' Breakthrough ACTION and Breakthrough RESEARCH projects. As part of the effort to reduce the impact of norms that prevent youth from accessing family planning and reproductive health information and services, the stories in Merci Mon Héros are often drawn from (offline) community events, where the programme creators found young people to share their stories, editing them into a sharable format.

In discussing the review's findings, the researchers indicate: "there is no single 'winning formula': the activity of norms-shifting is context-dependent and needs to be carefully attuned to the target issue and audience while also considering the broader environment for shifting norms online and offline....Program developers need a good understanding of the role that social media plays in the daily lives of target audiences, who influences their behaviors, which social media behaviors they have in common, and the issues that programs aim to address."

That said, "a key factor seems to be that individuals are more likely to change their descriptive norms if they see the actual behavior occurring or being reinforced on the feeds of multiple peers in a closed social network....Stimulating engagement on personal timelines and in comments sections - either following an individual level or a community level approach and using various strategies - is an effective way to influence descriptive norms....A drawback of stimulating engagement is that program developers have limited control over the kind of engagement that is stimulated and the course the engagement takes."

In conclusion: "Aligning norms-shifting activities on social media with factors at the individual, family, community, and society levels, while also using digital research methods to better understand how to account for the influence of algorithms and other mechanisms of social media platforms in program design, makes norms-shifting on social media a complex, yet promising addition to the SBC media mix..."