The Importance of Engagement in the Dissemination of Audio-Visual Content by Spanish Health Influencers on Instagram

Abstract

Influencers are the main source of disseminated health-related content, and this content is also more accepted by the population compared to content disseminated by health institutions. The objective of this study is to determine the communication strategies and content that generate more engagement with users who follow health and pharmacy topics. We analysed six Instagram accounts of Spanish influencers related to science and health communication with more than 30,000 followers. We evaluated user interaction metrics, the type of content shared, and calculated the degree of engagement based on the number of followers and interaction with the content. The accounts with the highest degree of engagement, such as @Farmacia_enfurecida with 166,000 followers, an engagement of 3.7% of likes per publication and 0.91% in comments, are accounts with a smaller number of followers. Communication techniques such as health product sweepstakes are the most effective in achieving user interaction. Engagement is a determining variable in the impact of health-related content dissemination and is not necessarily linked to a greater number of followers; the profiles that use a greater number of reels and infographics are those with a higher engagement value.

1. Introduction

The participation of any person in the creation of information and audiovisual content in social media has led to a breakthrough in digital communication, which has led to a transformation of traditional communicative discourses in countless sectors such as politics, economics, and education, and also in areas related to health (Fuchs 2021; Torrado Morales et al. 2011). Particularly, communication in areas linked to health care is one of the most controversial issues, as it can have direct repercussions on the physical and psychological well-being of the people who access such information (Lavorgna et al. 2018).

Social media has great potential for the dissemination of information and audiovisual content aimed at promoting health and healthy habits. Influencers create digital content and make live broadcasts to share personal experiences on healthy living, advice on how to handle health problems, or promote health-related products, achieving very significant audiences (Juntiwasarakij 2018; Abidin 2020). Although these influencers often have adequate training, the question arises as to whether this content, and the information they share, should be supervised by health professionals and accredited institutions (Madathil et al. 2015; Almela-Baeza et al. 2021). Collaboration between health institutions and communicators or influencers who create health information and content is very important (Madathil et al. 2015). Several studies indicate that young people empathise with health influencers and create a relationship of empathy and trust with them and their audiovisual content (Harris et al. 2020; Fergie et al. 2013; Gray et al. 2005).

Currently, there are no mechanisms in place to moderate the flow and veracity of content circulating on networks. For this reason, educating users in critical thinking and skills to differentiate between reliable and unreliable sources is essential to prevent problems arising from fake news (Moravec et al. 2018; Livingstone et al. 2013).

According to the latest survey conducted by the Spanish Science and Technology Foundation (FECYT) on the public perception of science and technology in 2020, the evolution of the growth of the internet as a source of scientific information is exponential. More than 77% of people aged between 15 and 44 say that social networks are their main source of information about science and technology, surpassing television in this respect (Fundación Española para la Ciencia y la Tecnología 2021). According to Hütt Herrera, there is a generation gap when it comes to consuming information from different sources, which has a direct impact on determining consumer trends in the coming years (Hütt Herrera 2012).

1.1. Engagement in Social Media

Effective communication involves measuring the impact that information has on the audience. From a dissemination point of view, this aspect is key to understanding the topics or strategies that tend to have the greatest impact and to make communication more effective. By posting a picture on a social network such as Instagram, users can express their point of view on that information by selecting the “like” button, assuming that the content published there is of interest to them; replying to the post with a comment, which can be positive or negative; following the account of the author of the content; or simply viewing the information contained in the post. This resource has become essential in digital communication and allows profiles to be stratified according to their potential as communicators by the number of followers, number of likes, and views, among other quantifiable variables (Heller Baird and Parasnis 2011).

When measuring the impact generated by the information in a publication, many factors must be taken into account. One of the most objective tools is the measurement of engagement; this parameter is used to reference quantitative values (such as the number of likes or views) to the number of followers of the profile. In this way, comparisons can be made between profiles regardless of the number of followers, taking into account the real reach of each user (Brodie et al. 2013).

In this sense, in a study published by Cuevas-Molano et al., the authors developed a model to analyse the impact of 31 structural, semantic, and morphological content factors on engagement, measured by the number of likes and comments on 680 posts from 14 Instagram profiles in different sectors. The authors postulate that higher levels of activity on the profile correlate with more likes and comments, promoting interaction with users and that videos with sound tend to increase the number of likes (Cuevas-Molano et al. 2021).

Another study by Pérez-Escoda et al., analysed the relationship between the general public and digital media by measuring engagement during COVID-19. To this end, over a period of six months, they studied the traffic of information on three social networks, including Instagram, and the results point to a new communication model that provides space for any user to share content with the same engagement as people specialising in communication in health areas. This study also highlights that the pandemic accelerated the transformation of the communication sector, posing new challenges related to market demand (Pérez-Escoda et al. 2020).

1.2. Influencers in Social Media

The influencer is a figure that is emerging in a decisive way in the context of the digital world among users of social networks. Influencers can be defined as opinion leaders on social networks who transmit information to a huge audience (Gräve 2017). These digital opinion creators have the ability to influence the attitudes, decisions, and behaviour of their audience through the activity and content they share on their social networks (Watts and Dodds 2007; Lyons and Henderson 2005).

Although there is no established consensus on how many followers are needed for a profile to be considered an influencer, Rojas establishes the following groups based on the number of followers: nano-influencers (2000–5000 followers), micro-influencers (5000 to 100,000 followers), and even mega-influencers (100,000 to 500,000 followers), among others (Rojas 2022). However, the number of followers is not linked to the level of engagement between them, as profiles with fewer followers often achieve a higher level of engagement with their audience.

Although information from influencers has a greater impact and is better received by users than that of accredited professionals, (Madathil et al. 2015; Almela-Baeza et al. 2021), the growing demand for information due to SARS-CoV-2 has led to a growing trend of fake news through social media, which has questioned the work of health influencers (González Romo and Iriarte Aguirre 2020). Studies indicate that fake news is more likely to go viral, simply by reaffirming the beliefs of users with pre-established ideas about the topic (Moravec et al. 2018).

According to the theory of uses and gratification (UGT), individuals tend to make a utilitarian use of communication channels seeking to satisfy specific needs, a practice that has been used since the beginning of mass media, but has more importance than ever today with social networks (Ko et al. 2005). Applying UGT in this new media ecosystem reveals that the user not only wants to consume certain products, but also needs to interact with other users about the product and the environment. UGT directly influences the way in which influencers relate to their followers and the degree of engagement they produce (Dolan et al. 2016).

Influencers in the areas of pharmacy and health on Instagram have mainly focused on topics related to nutrition and cosmetics. One of the biggest challenges facing this type of profile is that, by promoting content linked to health issues, what they say can have a direct impact on the quality of life of their followers. For this reason, it is necessary to uphold the work of those who exercise this role in digitalised societies in order to try to ensure that their work is properly recognised and that they have the tools to perform it rigorously and effectively (González Romo and Iriarte Aguirre 2020).

The main objective of this study is to determine whether influencers in the areas of pharmacy and health on Instagram in Spain with more than 30,000 followers have a higher degree of engagement based on a higher number of followers, or whether users with a lower number of followers achieve a higher engagement rate. As specific objectives, we identify the communication techniques that generate a greater impact on the dissemination of the content of these influencers, as well as the type of content most used.

2. Materials and Methods

2.1. Study Population

The study population includes six Instagram profiles with relevance for health and pharmacy topics, selected on the basis of their impact in this thematic area. This group is made up of men and women aged between 18 and 65 with an account dedicated to scientific dissemination on the social network Instagram.

2.2. Sample Selection

For the selection of the study population, we used the online tool, Infludata (https://www.infludata.com), accessed on 1 April 2022. This application allows you to analyse the reach and other parameters on various Instagram and Tik Tok profiles.

The following variables were considered for the selection of these profiles:

• Having more than 30,000 followers;
• Using the profile to disseminate health and pharmacy related content;
• Being a resident in Spain and performing outreach work in Spanish;
• Having relevance in their subject area;
• Publishing with a high frequency (at least once a week).

The Instagram profiles selected for this study were:

• @Boticariagarcia;
• @Farmacia_enfuerecida;
• @FarmaciaTedin;
• @ElblogdePills;
• @Boticonsejo;
• @Medicadoo.

We also contrasted the results obtained on Infludata with three reference websites on pharmaceutical issues such as Portalfarma, the website of the General Council of Official Pharmacists’ Associations, Club de la Farmacia, a blog based on the experiences of Spanish pharmacists, and En Genérico, the website of the Spanish Association of Generic Medicines.

2.3. Study Design

Firstly, a qualitative study was carried out on the contents of the accounts of the study population, as well as a classification of the digital contents classified into the following variables:

• Images;
• Video;
• Infographics;
• News;
• Reels;
• Stories;
• Tweets.

Secondly, the impact of this content was determined during a six-month period, from October 2021 to March 2022. To obtain this impact, the user interaction metrics of each Instagram account were analysed using the following variables:

• Number of followers;
• Number of published posts;
• Number of users they follow;
• Number of likes per post;
• Number of comments per post.

In order to take into account the standardised impact of the publications, regardless of the number of followers, an engagement score was calculated for each profile, taking into account an average of likes and comments per publication divided by the number of followers. Using this score, it was possible to compare the frequency of the use of different communication strategies in order to objectively find the indicators with greatest reach.

2.4. Statistical Analysis

To determine the engagement of each profile, the metrics of the last ten publications from March 2022 were counted. In particular, we differentiated the “likes” and comments on these publications, which were then divided by the number of followers of that profile and multiplied by 1000. In this way, the engagement value was calculated for each variable under study.

$$Instagram engagement=\frac{likes+comments}{followers} \times 1000$$

The variables related to user interaction and the variables grouping the type of post published were obtained from the freely available data provided by the Instagram account of each influencer.

3. Results

Table 1. Instagram user interaction metrics from October 2021–March 2022.

Influencer	Followers	Posts	Followings
@Boticariagarcia	474,000	2882	864
@Farmacia_enfuerecida	152,000	2213	776
@FarmaciaTedin	49,000	444	953
@ElBlogdepills	45,800	918	755
@Boticonsejo	42,900	3329	826
@Medicadoo	41,700	500	3572

shows the number of followers, posts, and other profiles followed for each influencer from October 2021 to March 2022 (data extracted on 24 March 2022).

Table 2. Calculating engagement in likes and comments per influencer.

Influencer	Likes per Post	Engagement Likes	Comments per Publication	Engagement Comments
@Boticariagarcia	3.222	0.67%	97.4	0.02%
@Farmacia_enfuerecida	6.003	3.7%	145.6	0.91%
@FarmaciaTedin	1.012.3	2.14%	44.5	0.94%
@ElBlogdepills	529.3	1.08%	16.8	0.03%
@Boticonsejo	383.4	0.89%	13.2	0.03%
@Medicadoo	301.2	0.71%	99.9	0.23%

shows the engagement values calculated on the basis of the last ten posts of each profile, taking into account the comments and likes of each post.

Table 3. Comparison of content dissemination formats used by the different influencer profiles.

Influencer	Images	Video	Infographics	News	Reels	Stories	Tweets
@Boticariagarcia	49%	24%	3%	5%	1%	18%	-
@Farmacia_enfuerecida	12%	6%	1%	2%	49%	5%	25%
@FarmaciaTedin	6%	3%	-	-	91%	-	-
@ElBlogdepills	4%	1%	73%	-	3%	19%	-
@Boticonsejo	2%	-	78%	-	18%	2%	-
@Medicadoo	31%	-	37%	-	26%	6%	-

below shows the prevalence of the communication tools most used by each profile. Each graph shows the percentage of publications that use a certain communication tool out of the total number of publications in the study period.

4. Discussion

This study focused on profiles dedicated to scientific dissemination linked to aspects of pharmacy and health through social networks in Spain. The choice of this thematic group arose from the great impact they have on decision-making related to people’s health (Lavorgna et al. 2018; Juntiwasarakij 2018). Not only are they communicators, but they also have a responsibility to understand that what they post on their networks can have a direct impact on the well-being of the followers who rely on their expertise (Madathil et al. 2015; Almela-Baeza et al. 2021). This study analysed the type of content and the interaction that users have with influencers, which can help us to establish strategies to control the content and the impact of the health advice disseminated on health (Moravec et al. 2018; García Jiménez 2013).

There are clear preferences for each user when it comes to choosing a digital format on Instagram. In the case of @boticariagarica, images are the most used, followed by @Farmacia_enfurecida and @FarmaciaTedin, who show a differentiated use of Reels over other formats. In the profile of @elblogdepills, infographics are the most common, followed by @boticonsejo and @medicadoo, who also tend to use infographics over other resources. Based on this information, the predominant elements in the dissemination of pharmacy and health content by influencers in Spain are Reels, infographics, and images.

The value of engagement in media communication is of interest because it not only reflects the reach of a publication, but also the impact generated by user interaction metrics (Brodie et al. 2013; Aguado et al. 2011). Due to the lack of this type of analysis in the available literature, this paper aims to contribute to correlate theoretical knowledge about social media engagement with empirical evidence in the case of the dissemination of scientific content, given that most of the published studies focus on the figure of the influencer in the context of digital marketing (Cuevas-Molano et al. 2021).

The results obtained indicate that a greater number of followers is not associated with greater interaction with the user, as we can see in Table 2. The profile of @Boticariagarcía, which has the largest number of followers (477,000) (Table 1), achieves the lowest engagement compared to the other profiles, with 0.67% in likes per post and 0.02% in comments per post. On the other hand, the influencer @Farmacia_enfurecida, who has less than half of the followers (166,000), shows a higher engagement in their community of followers, with 3.7% of likes per post and 0.91% in comments.

This phenomenon is frequently observed in social media marketing studies, where nano- or micro-influencers, those with modest numbers of followers, tend to have more reach among their audience than the so-called mega-influencers (Cuevas-Molano et al. 2021). A resource widely used by influencers to encourage interaction with the public is evident in the case of @Medicadoo, whose publications include sweepstakes of pharmaceutical products, where users must click on the like button on the publication and comment on it in order to participate, behaviour that we associate with the UGT and that relates the user’s desire to obtain products or compensation and the need to share it (Dolan et al. 2016). This type of commercial strategy is commonly applied in different Instagram accounts with the intention of giving visibility to a product or service. It is worth noting that, in this study, the intention is to determine whether any communication strategy is more effective than the dissemination of informative and non-commercial content, so this aspect has not been included in the analysis.

From the trend observed, a higher number of followers does not correlate with a higher reach of the content, which may indicate that the loyalty of these followers to the profile is even more relevant. These results allow us to establish a distinction between groups of followers; on the one hand, “passive” followers or those who simply follow an account, but do not interact and, therefore, do not contribute directly to the engagement of the publication, and on the other hand, “active” followers who show quantifiable interest in what is published, increasing engagement. Taking this difference into account, one might think that the idea that a greater number of followers correlates with greater reach in publications is only possible if those followers are “active”.

The profile with the highest engagement among the cases under analysis is @farmacia_enfurecida which, together with @FarmaciaTedin, is the one that most frequently uses Reels as a communication tool. Reels are a good strategy for promoting a brief and attractive message to users. This type of format allows the use of various elements such as filters, music, images, and vignettes. Another aspect to consider about Reels is that they have a preferential section where only this type of content is shared in a loop, so their reproductions can be favoured with respect to the rest of the available formats.

Historically, the infographic format has been successful in the dissemination of information in the printed press, and it is no coincidence that it is also successful in the digital format. There are a large number of applications that allow infographics to be created quickly. Undoubtedly one of the most notable and limiting aspects when generating infographics is the selection of information and its summary without losing the rigour of what is intended to be told. The accounts @elBlogdePills, @Boticonsejos, and @medicadoo stand out for their use of infographics, and also have a great impact on their community of followers. This could be a good indicator that infographics offer an attractive format for communication.

In terms of the practical implications of the study, we can indicate that these results can help to establish an analysis method to determine the impact of individual posts and associate it with the format of the post. On the other hand, we can establish associations between the communication tools or strategies on Instagram, with the engagement of the audience that usually follows health-related social media accounts.

Study Limitation

The main limitation behind this study lies in the number of profiles analysed. The choice of dates on which the interactions are counted is also another limiting factor, because each profile has a different age and, therefore, they are compared in the same temporal space but not necessarily in the same period of development of each account. It is also a limitation of the study to have only taken the last ten publications and not to extend this range. To solve this, a longitudinal study that takes into account the evolution of the profiles over time could be considered. We have not differentiated between positive and negative comments and the influence this would have on engagement, nor have we determined whether the followers of each account are active or passive. As a future approach, the study could be extrapolated to the influencers of other social networks. It would also be possible to measure the level of engagement for each post in particular, as well as the frequency of publication of each type of post.

5. Conclusions

The main conclusion of this study is that engagement is a determining variable when it comes to disseminating health and pharmacy advice to the population. Accounts with a large number of users do not directly influence engagement if they are not active users. On the other hand, the most recurrent content used are Reels or infographics that generate greater engagement. Strategies such as raffles of products related to health and nutrition, where the user has to indicate like or make a comment to participate, are very effective and significantly increase engagement and, thus, the impact on the audience of the content.