Credibility, Authenticity and Communication Strategies of Multiple Sclerosis E-Patients on Social Media

Abstract

Social media has become a key space for health communication, fostering the emergence of the e-patient influencer, a figure capable of generating a support community around themselves. In the case of multiple sclerosis (MS), a complex disease with an uncertain prognosis, these profiles can influence the perception and management of the disease. Therefore, credibility and authenticity are identified as key constructs for truly understanding the effectiveness of their communication. Through content analysis, the main active profiles on Instagram and TikTok are examined to recognise narrative patterns, communication strategies and different levels of credibility and authenticity, as well as potential differences between those platforms involved. The results show, on both networks, a predominance of empathetic content focused on the daily management of this disease. Furthermore, a positive, albeit moderate, relationship between credibility and authenticity is found, confirming the importance of these two concepts in social media. Instagram shows slightly higher degrees of credibility, while authenticity is more predominant on TikTok, fostered by the spontaneity and transparency of its creators.

1. Introduction

Social media has transformed the media landscape, emerging as a key source of information (Wearesocial, 2025a). Digital News Report (Reuters Institute, 2025) also confirms a trend that has been evolving in recent years: the proliferation and social relevance of SMIs (Social Media Influencers), content creators who share their knowledge and expertise in a particular field and who prove to be able to influence the decisions of their community of followers (Nygård & Lindfors, 2025). Building a personal brand based on authenticity helps them stand out in a specific environment where capturing and holding attention is essential (Zhu & Wang, 2024).

From a health perspective, Jiang et al. (2022) remind us that a well-informed patient clearly becomes an empowered one, counting on the arguments to make decisions and being much more involved in their self-care (Willis & Friedel, 2026). However, the overabundance of online information, such as biased content, as well as harmful misinformation and fake news, leads to public distrust and underscores how paramount the value of credibility becomes in this context. According to Ohanian (1990), credibility is a three-dimensional construct upon which message acceptance depends, comprising trustworthiness, expertise and attractiveness. Han and Balabanis (2024) go even one step further, arguing that authenticity and credibility are interconnected: an authentic, namely natural, influencer on social media is perceived as more credible, thus increasing their influence on their audience’s attitudes and behaviours.

Our work contributes to the vast literature analysing credibility and authenticity in SMIs, with the novelty of applying it to e-patients, profiles proliferating on social media who, thanks to their specialised communication, facilitate understanding of the disease and its management (Ibáñez-Hernández & Carretón-Ballester, 2025; Lind & Wickström, 2023). Specifically, we monitored the narratives of the main Spanish-speaking e-patients with multiple sclerosis (MS), an incurable autoimmune disease diagnosed in 1200 people in Spain each year (EME, n.d.). MS is commonly known as the disease with a thousand faces, due to the high diversity of symptoms, manifestations and progression it presents, which makes its diagnosis difficult and actually worsens the level of uncertainty and helplessness of those who suffer from it.

The two theoretical constructs under study, credibility and authenticity, are multidimensional and measurable, as demonstrated by Barbosa and Añaña (2023) or Duffek et al. (2025). Therefore, this work reviews their components and adapts them to the specific characteristics of e-patients. Furthermore, we are guided by the request of Mansilla-Moreno et al. (2024), who advocate for increased research into social media content about MS, due to its clear value in helping manage the disease and providing patient support. This study also seeks to identify potential differences between two of the main platforms making use of short videos: Instagram and TikTok.

2. Theoretical Framework

2.1. Communication and Health: Social Networks as a Space for Information and Connection

Health is one of the main concerns among Spaniards (CIS, 2025). Furthermore, contemporary patterns of citizen consultation on health issues show a growing preference for the immediate, accessible and private response offered by digital technologies, such as mobile applications, social networking sites and electronic gaming, thus encouraging self-diagnosis (Wartella et al., 2016). This situation faces challenges such as the population’s lack of skills in identifying fake content or information overload, which often leads to contradictory messages (Langbecker & Catalán, 2023). Jiang et al.’s (2022) study demonstrates how online health information influences decisions made by adults, primarily based on the perceived quality of the arguments and the credibility of the source.

The COVID-19 pandemic marked a turning point and highlighted the potential of digital communication, specifically social networks, to establish new dynamics of participation, connectivity and citizen empowerment in health-related themes (Martínez-Sanz & Durántez-Stolle, 2024). Healthcare professionals, public institutions, specialised media outlets, patient associations, influencers and celebrities use these platforms to disseminate health-related content, significantly influencing their audience’s decisions (Mansilla-Moreno et al., 2024; Langbecker & Catalán, 2023). Currently, social media has over 5.6 billion users worldwide, with an average weekly usage of 18.5 h (Wearesocial, 2025a). This same agency indicates that 90% of people in Spain aged 16 to 24 and 85% of those aged 25 to 34 use them, with Instagram, boasting 24.8 million users, and TikTok, with 19 million users over the age of 18, being among the most popular (Wearesocial, 2025b).

However, attention economy demands from social media influencers (SMIs) the strategic management of algorithmic and interaction processes to achieve visibility, which actually mediates and redefines the health knowledge that is prioritised and disseminated (Hendry et al., 2021).

2.2. Credibility and Authenticity as Key Values of the E-Patient Influencer

The e-patient influencer is one who uses their expertise concerning the illness to build a community through which they can offer advice, provide information or simply share their daily life (Martín-García et al., 2024). Through their communication on social media, the e-patient can truly become a health promotion agent by encouraging self-management of the disease (Willis & Friedel, 2026), reducing the associated stigma (Lind & Wickström, 2023) or providing care guidelines (Ibáñez-Hernández & Carretón-Ballester, 2025).

When the social media influencer (SMI) makes their illness public, along with all of which it entails—pain, aftereffects or limitations—they appear vulnerable, which seemingly contradicts certain ideals always linked to this role, such as personal autonomy or constant happiness (Lind & Wickström, 2023). However, sharing first-person accounts of health-related expertise is perceived as a marker of authenticity. Y. H. Lee et al. (2021) find, through an online survey of 474 US residents, that participants define streamers who had revealed details about their anxiety or depression in their broadcasts as “more authentic.” Additionally, Gupta et al. (2022) identify the most decisive factors influencing user attitudes towards health content generated by social media influencers (SMIs) as the author’s credibility, the perception of a selfless purpose and the quality of the information shared.

In order to achieve success, content creators need to project a true-to-life image of themselves—that is, an authentic one—and one that aligns with their audience’s concerns and interests (J. A. Lee & Eastin, 2021), which can also foster a sense of community. SMIs are expected to be “people like us”—authentic and open—in a way that sharing their life experiences and expertise, including failures, fears and vulnerabilities, makes them more human (Y. H. Lee et al., 2021). Authenticity thus plays a fundamental role in how the public interprets the messages, while the perception of commercial or self-promotional intent can indeed reduce credibility and even provoke negative reactions (De Araujo et al., 2025).

In relation to the above, the SMI needs to win the audience’s trust (Djafarova & Rushworth, 2017). According to the Ohanian Model of source credibility, factors such as attractiveness, trustworthiness and expertise can influence audience attitudes and behaviours (Ohanian, 1990). De Araujo et al. (2025) confirm these dimensions as applied to health content and emphasise the idea that attractiveness remains relevant on image-based platforms like Instagram. Regarding expertise, Han and Balabanis (2024) explain that it depends on the source’s perceived knowledge, skills and expertise, influenced by factors such as education and achievements. These researchers remind us that, although the SMI’s expertise should explore their qualifications and competencies, these are not an automatic guarantee of credibility.

Both the works by De Araujo et al. (2025) and Y. H. Lee et al. (2021) stress the importance of SMIs being able to establish parasocial relationships, understood as one-way emotional connections. This contact generates a sense of intimacy and closeness that strengthens the relationship and identification with the other person. This explains the intensive use of interactive strategies by many content creators, such as directly addressing the audience by looking at the camera, verbally using mainly the pronoun “you” or asking followers to participate (Nygård & Lindfors, 2025). Interaction has been proven as empowering for users, especially those undergoing the same illness, by means of improving their perceived knowledge and social self-efficacy—that is, their self-confidence in carrying out actions or coping with a situation (Wasike, 2023).

On social networks where the audiovisual format predominates, parasocial relationships not only intensify the sense of closeness but also shape cognitive appraisals. Mulcahy et al. (2025) demonstrate that, when content on TikTok and Instagram contains misinformation, high virality tends to reduce perceived deception and increase the intention to share, whereas visible critical comments on highly viral posts raised perceived deception, thereby dampening its spread. Within follower communities of influencer e-patients, parasocial relationships—beyond providing socio-emotional support and guidance—can operate as a brake on misinformation by channelling trust towards competent sources (Menéndez-Signorini et al., 2025).

Regarding the themes covered, Willis and Friedel’s (2026) research investigates the issues that yielded the best results in terms of strengthening self-management behaviours in chronically ill patients through communication on e-patient networks. The most effective strategies are representing the disease, providing valuable information and offering healthy advice. However, Mansilla-Moreno et al. (2024) explore the content most consumed by MS patients on Instagram, one of the main findings being that research advances on the disease and testimonials were the most in demand.

Taking all of that into consideration, our empirical study delves deeper into the figure of the multiple sclerosis (MS) e-patient, a chronic autoimmune disease that affects the central nervous system, to identify their posting patterns and effects on the audience. Our work aims to contribute to the comprehension of the theoretical constructs of credibility and authenticity present in the communicative work of SMIs (Barbosa & Añaña, 2023; Zhu & Wang, 2024) and scarcely explored in e-patient profiles.

3. Methodology

This work starts from the premise that for the communication sciences, it is fundamental to study how health messages are constructed, circulated and interpreted in digital environments (Sánchez-Castillo et al., 2025). More specifically, it seeks to assess the credibility, purpose and authenticity of the narratives of multiple sclerosis (MS) influencer e-patients on Instagram and TikTok, as well as to determine the differences between the platforms. For greater clarity, we detail the specific objectives derived from the main one.

SO1. 

To observe the purpose of the messages published by e-patients in order to identify the predominant orientation, themes and biases.

SO2. 

To determine if there are recurring posting patterns among the analysed e-patients.

SO3. 

To quantify the degree of credibility and authenticity of the influencers and to determine whether there is a relationship of dependence between these two constructs.

SO4. 

To analyse the impact of credibility and authenticity on the support received from the community.

SO5. 

To determine which variables show the greatest influence on the authenticity and credibility constructs of those SMI who address multiple sclerosis.

The methodological design was based on content analysis (Piñeiro-Naval, 2020), consisting of a rigorous, precise and systematic examination of the profiles of the most followed MS e-patients on Instagram and TikTok, two of the fastest-growing social media platforms in Spain (Wearesocial, 2025b). Profile selection was carried out in July of 2025, and the requirement was that the account should be in the Spanish language and belong to an MS patient with demonstrated activity in the previous six weeks. The search for profiles began with the preferences indicated by a group of 224 MS patients in the research by Mansilla-Moreno et al. (2024) and continued with searches within the applications themselves using the hashtags #Esclerosismultiple and #Esclerosis, until reaching the outcomes’ redundancy.

The final sample consisted of 20 profiles (

Table 1. Sample: ID, social network and number of followers.

Instagram		TikTok
ID-1. 136K followers	ID-6. 4733 followers	ID-11. 437K followers	ID-16. 6748 followers
ID-2. 9951 followers	ID-7. 4328 followers	ID-12. 296K followers	ID-17. 5833 followers
ID-3. 6701 followers	ID-8. 4168 followers	ID-13. 9816 followers	ID-18. 5136 followers
ID-4. 6189 followers	ID-9. 1988 followers	ID-14. 7472 followers	ID-19. 1054 followers
ID-5. 5949 followers	ID-10. 1970 followers	ID-15. 7008 followers	ID-20. 1010 followers

). The analysis of these profiles considered the header description and the first ten visible posts on the timeline (pinned and most recent) that directly mentioned the disease, totalling 200 posts.

An analytical instrument was developed to identify the different communication strategies used by e-patients and quantify their credibility and authenticity, as has been performed in previous similar studies, using dichotomous variables (presence = 1, absence = 0) (see

Table 2. Analytical instrument.

Identification data of

Profiles: Profile name; Social network; Number of followers; Type of influencer

Posts: Identifying number for the post; Encoder code; Profile name; Link to access the post; Social network; Number of likes; Number of comments

Credibility

Expertise: Professional; Links to access other sites; Predominance of MS

Trustworthiness: Medical environment; Quality sources; Frequency of publication

Attractiveness: Recognisable profile; Active community; Timeline

Source: Own elaboration from Barbosa and Añaña (2023), De Araujo et al. (2025), Han and Balabanis (2024) and Ohanian (1990)

Authenticity

Transparency: Self-disclosure; Visibility

Spontaneity: Spontaneity at editing; Spontaneity at talk

Everyday life: Private environment; Colloquial language

Connection: Addressing; Response

Source: Own elaboration from Duffek et al. (2025), J. A. Lee and Eastin (2021), Zhu and Wang (2024) and Zhu (2025)

Communicative strategies

Orientation: Informing or divulging; Empathy; Persuasion; Normalising; Entertainment; Gratitude; Promoting; Proposing; Inspiring; Others

Theme: MS manifestations; Aftereffects; Service offered; Disease management; Others

Priority: Presence

Bias: Positive; Negative; Neutral

Format: Image(s); Video

Intellectual ownership: Own elaboration; Shared elaboration

Source: Own elaboration from Ibáñez-Hernández and Carretón-Ballester (2025), Mansilla-Moreno et al. (2024) and Martín-García et al. (2024)

). The information contained in the header and posts was used to address the variables that comprise credibility, whereas the posts and the interaction regarding those comments they generated certainly tackle the issues of authenticity and communication strategies.

Before coding the main sample, a brief pilot study was conducted to allow the coders to adjust the observation criteria for the variables. Two of the authors analysed 20 publications outside the corpus to calculate Krippendorff’s alpha (Krippendorff, 2011) for each item using the Kalpha macro for SPSS (version 30) (Hayes & Krippendorff, 2007; Goyanes & Piñeiro-Naval, 2024). The average reliability of the preliminary test reached M (αk) = 0.95.

The final coding of the 20 profiles and 200 publications was carried out during the fall of 2025. For the calculation of inter-coder reliability, a random subsample of 30 publications (15%) was used, with a truly satisfactory overall result: M (αk) = 0.94.

4. Results

4.1. Purpose of the Publications

The variables orientation, theme and bias allow us to analyse the overall purpose of the posts by multiple sclerosis patients. Regarding orientation, the empathy objective stands out as predominant (38% of the total), compared with others such as inspiring (15%), proposing (12%) or informing (10.5%). However, when breaking down the results by social network, a statistically significant association between orientation and network is observed [χ² (9, n = 200) = 35.35, p < 0.001, v = 0.42]: TikTok shows an absolute predominance of the empathy-centred orientation (56 of its 100 posts), while Instagram presents a greater variety of results, with percentages almost as high for empathy (20%) as for inspiring (19%), proposing (16%), informing (15%) and, to a lesser extent, promoting (10%), as shown in Figure 1.

Regarding the theme, the overall results indicate a preference for content that addresses disease management (44.5%) compared with content that explains its aftereffects (25.5%) or its manifestations (14%). Only very rarely does content focus on offering the influencer’s own services (5%). In this case, there is also a statistically significant, though less intense, association with the platform [χ² (4, n = 200) = 14.44, p = 0.006, v = 0.27], with Instagram being more focused on management and services than TikTok (Figure 2).

Furthermore, when evaluating a cross-section relating the overall data on orientation and theme, we can observe a statistically significant association between the two [χ² (36, n = 200) = 217.84, p < 0.001, v = 0.52]. In this regard, posts addressing the disease manifestations primarily aim at informing, those discussing its aftereffects have an empathetic orientation, and those focusing on its management are built in terms of inspiring and proposing (Figure 3). Finally, much less frequently within the sample are posts offering services, whose main orientation is promoting, and those focusing on others, which tend to aim for entertainment (Figure 4).

Regarding bias, the posts are mostly positive (52.5%), followed by negative (32.5%) and neutral (15%). Here, too, there are significant differences between the two networks [t (198) = 5.94, p < 0.001, d = 0.83], as Instagram (M = 0.55, SD = 0.73) has a much more positive tone than TikTok (M = −0.15, SD = 0.92). The negative bias is primarily linked to the author’s low state of mood (Figure 4) and their complaints about situations stemming from their illness, such as the lack of understanding from those who do not suffer from it, or limitations of the healthcare system concerning its real capacity to provide diagnoses or even offer an empathetic medical care.

4.2. Patterns in Content Creation

Besides the correlations observed in the previous section, the analysis results allowed us to identify other patterns in message construction. When assessing the data cross-section regarding orientation with the dichotomous variable “narrative from personal expertise,” a statistically significant association is observed [χ² (9, n = 200) = 40.56, p < 0.001, v = 0.45]. When there is self-disclosure in the post, its orientation tends to be empathy (44.7% of cases) or inspiring (19.3%); while when a personal experience is not shared, the post aims at proposing (26%), informing (20%) or entertaining (14%). This relationship is reflected in both networks when viewed separately. On Instagram [χ² (9, n = 100) = 31.02, p < 0.001, v = 0.56], when that expertise is shared, the post is more empathy-centred and inspiring, and when it is not shared, it just proposes or informs. On TikTok [χ² (8, n = 100) = 18.59, p = 0.017, v = 0.43], when there is self-disclosure, the post’s orientation is more empathetic, and when that is not the case, it aims to entertain.

In the overall data, although possible links were observed between orientation and the creator’s appearance in the post (that is, their visibility in the publication), no statistically significant association was found [χ² (9, n = 200) = 13.49, p = 0.142]. Neither could we observe a statistically remarkable connection between orientation and the inclusion of a private or intimate environment for the author [χ² (9, n = 200) = 13.9, p = 0.126]. However, when data are broken down by social networks, it certainly leads to the statement that within Instagram, there is a relation between orientation and the influencer’s presence in the post [χ² (9, n = 100) = 24.75, p = 0.007, v = 0.48]. When the influencer appears, the post has a primarily inspiring tone (24%), whereas, whenever they do not, the empathy (36%) or informing objective (28%) becomes revealed. In contrast, on TikTok, the data does not show an association between orientation and the appearance of the influencer. Finally, there is no significant association between orientation and the display of a private environment for the author on the mentioned platforms.

4.3. Credibility and Authenticity of Those SMIs on MS, and Correlation Between Both Indicators

Credibility is calculated from the sum of nine binary variables associated with each profile (see Table 2 in the Materials and Methods section), hence the range here is 0–9. In this case, the descriptive values for the entire sample are M = 5.65, SD = 1.56. Authenticity, on the other hand, is calculated from eight binary variables associated with each post, allowing for the creation of the mean value for each profile. Its specific values are in the range 0–8, M = 5.36, SD = 1.51. Then, there is a statistically significant and positive, though not very strong, correlation (Cohen, 1988; Johnson et al., 2008) between both indicators [r (198) = 0.25, p < 0.001], suggesting that when credibility increases, authenticity also increases (and vice versa).

As shown in

Table 3. Average credibility and authenticity of profiles on both networks.

Id_Profile	1	2	3	4	5	6	7	8	9	10	Instagram Profiles
Credibility	5	6	9	8	4	5	7	7	3	4	5.8
Authenticity	5.8	6.2	6.1	4.9	6.1	3.7	5.8	4.9	1.9	4.6	5
Id_Profile	11	12	13	14	15	16	17	18	19	20	TikTok Profiles
Credibility	4	5	4	6	5	7	6	5	8	5	5.5
Authenticity	5.1	6.1	4.8	5.7	7	6.7	4.7	6	5.1	6	5.72

, when comparing the totals for each profile across networks, a slightly higher credibility value is observed on Instagram, compared with a higher average authenticity value on TikTok.

Figure 5 shows the differences in the configuration of each indicator on each platform. The differences in credibility between networks are hardly statistically relevant [t (198) = 1.36, p = 0.088], with Instagram being slightly superior to TikTok (M = 5.5, SD = 1.21). On Instagram, credibility relies more on the use of scientific sources (0.6 on average, compared with 0.2 on TikTok), links to other websites by the same creator (0.7 versus 0.3) and mentions of their profession (0.6 on average, compared with 0.3). Conversely, TikTok stands out for the attractiveness of its follower community, which is more active than Instagram’s in terms of engagement (M = 0.5 versus M = 0.1). As shown in Figure 3, both platforms have very similar averages for the other variables that make up credibility: the attractiveness of the timeline, profile personalisation, the predominance and frequency of posts about multiple sclerosis (MS) and the presence of medical environments.

On the other hand, the differences in authenticity are more significant [t (198) = −3.47, p < 0.001, d = 1.46], as Instagram remains quite far behind TikTok (M = 5.72, SD = 1.32). This may be due to the fact that certain factors that make up the indicator and prove more relevant, such as the spontaneity of the creation and the transparency of the author, are more present in TikTok profiles due to the characteristics of the social network itself (shorter creations in video format). For example, TikTok stands out for its higher scores in the spontaneity of speech (0.61 on average compared with 0.36 on Instagram) and editing (0.75 compared with 0.47). In contrast, Instagram profiles clearly show more variety, including here some authors prioritising the focus on informing and promoting creations that lack spontaneity and colloquial language, while others prefer image-based content without revealing the author or their expertise.

On Instagram, creators strive for greater interaction through engagement and frequent responses to comments, while MS patients on TikTok tend towards transparency, self-promoting and showcasing their online spaces, as well as sharing personal stories (Figure 6). These data are related to the lower engagement received on the former platform, which leads to a necessary greater effort from its creators, and to the empathy-centred orientation and negative bias predominant in those posts by the latter.

4.4. Impact of Credibility and Authenticity on Profile Success

The calculation of the correlation between credibility and authenticity with different parameters that express the support received from users is shown in

Table 4. Correlation between credibility and authenticity with support received.

Support Parameters	M	SD	Credibility	Authenticity
Followers	8965	10,015	−0.251 ***	0.114
Likes	852	3110	−0.002	−0.021
Comments	44.5	84.23	0.129 +	0.225 **
Total interactions 1	896.5	3157	0.001	−0.015

¹ Total interactions = likes + comments. *** p < 0.001, ** p < 0.01, + p > 0.05 < 0.10.

.

Credibility correlates significantly, albeit negatively, with the number of followers [r (198) = −0.251, p < 0.001], meaning that as the number of followers increases, credibility decreases (and vice versa). This suggests that, in the case of multiple sclerosis e-patients, the follower community is less interested in this factor than in authenticity itself, among others, since these are personal profiles whose profession is not relevant and whose primary objective is not informing or disseminating, but rather promoting empathy and inspiring. For example, most of the profiles analysed showcase personal experiences and opinions, compared with a minority that builds up their posts by means of data from medical or specialised sources. Credibility, however, does correlate positively, although only as a mere tendency [r (198) = 0.129, p = 0.069], with comments: that is, those influencers who strive to demonstrate credibility in their profile and content generate a higher amount of conversation on their posts.

Authenticity, on the other hand, is also associated with the volume of positive comments [r (198) = 0.225, p < 0.01], which is linked to the most active communities seen on TikTok and this, in turn, to those posts showing more transparency, empathy and a negative bias.

4.5. Impact of Each Variable on the Main Indicators

The analysis of the correlation between profile credibility and its component variables shows that those with the greatest impact on the indicator are the mention of the influencer’s profession in their profile description [r_pb (18) = 0.59, p < 0.01], links to other websites belonging to the author [r_pb (18) = 0.481, p < 0.05] and the general attractiveness of their feed [r_pb (18) = 0.463, p < 0.05]. Regarding the first two, it is worth noting that mentioning the influencer’s profession in their profile is more frequent on Instagram. Furthermore, a relationship is observed between the profession and the type of content shared. For example, posts from professional athletes like ID1 or ID8 are mostly inspiring, or promote empathy, while a communicator’s profile like ID4 prioritises the labour of informing, and therapists like ID6 or ID7 have posts promoting their own services or proposing recommendations for illness management.

Analysis of the variables that comprise authenticity shows that the creator’s appearance in the post is the most influential factor [r_pb (198) = 0.542, p < 0.001], followed by both images [r_pb (198) = 0.519, p < 0.001] and language that remain spontaneous [r_pb (198) = 0.5, p < 0.001], as well as narration based on their expertise [r_pb (198) = 0.499, p < 0.001]. Conversely, the factors with the least correlation are the author’s reaction or response to comments [r_pb (198) = 0.252, p < 0.001], directly addressing the audience [r_pb (198) = 0.317, p < 0.001] and the presence of a private environment in the post [r_pb (198) = 0.36, p < 0.001].

5. Discussion and Conclusions

This study has allowed us to evaluate the credibility and authenticity of multiple sclerosis (MS) e-patients on Instagram and TikTok, as well as the qualities of their narratives, and to identify differences between the two networks. The conclusions related to the specific objectives and their connection to previous literature are summarised below.

SO1. 

To observe the purpose of the messages published by e-patients in order to identify the predominant orientation, themes and biases.

MS e-patients’ posts are primarily aimed at fostering empathy (38%), and to a lesser extent, at inspiring other patients (15%), proposing for improvement (12%) or informing (10%), which aligns with the results of research on other types of e-patient influencers (Martín-García et al., 2024; Willis & Friedel, 2026). Differences between platforms are evident, as Instagram shows a minor extent of empathy than TikTok does, besides a higher level of promoting their own services, and less entertainment.

Overall, the themes typically revolve around disease management (44.5%), its aftereffects (25.5%) or its manifestations (14%). At this point, a significant difference between networks is also observed, with greater emphasis on management and service on Instagram and greater importance on aftereffects and manifestations on TikTok.

Influencers focused on multiple sclerosis, a multifaceted autoimmune disease and an uncertain course in each case, mostly create positive content (52.5%) that helps people cope with symptoms, manifestations and social aftereffects, inspiring and normalising life with MS. However, a significant portion of posts (32.5%) also have a negative bias, especially on TikTok, highlighting the lack of support they receive, the difficulties of living through this disease and the fact of not counting on adequate medical care.

SO2. 

To determine if there are recurring posting patterns among the analysed e-patients.

At this point, statistical relationships have been established between the different variables of the study, revealing important trends in the construction of these influencers’ messages. Firstly, posts about disease manifestations tend to show the aim of informing, those dealing with aftereffects seek to evoke empathy in the audience and those related to symptom and manifestations’ management are mainly shaped as both inspiring and proposing communication. Second, the post’s orientation is also associated with narration based on expertise: when there is self-disclosure, the objective is usually empathy (44.7%) or inspiring (19.3%). When there is no self-disclosure, the focus is on proposing (26%), informing (20%) or entertainment (14%). This type of relationship is observed on both platforms. On Instagram, another tendency is also found: inspiring posts feature the e-patient, while they are less present in empathy or informing posts.

SO3. 

To quantify the degree of credibility and authenticity of the influencers and to determine whether there is a relationship of dependence between these two constructs.

Through the analysis sheet, which adapts the references of authors such as Barbosa and Añaña (2023), Duffek et al. (2025), J. A. Lee and Eastin (2021), Ohanian (1990) or Zhu and Wang (2024) to the object of study, a matrix of variables was constructed for each of the main indicators (Table 2). Credibility is obtained from nine binary variables evaluated on each profile, with questions about expertise, trustworthiness and attractiveness. Authenticity, on the other hand, is observed from the sum of eight variables related to transparency, spontaneity, everyday life and connection reflected in each author’s posts. As a whole, credibility and authenticity have a similar mean value (5.65 vs. 5.36), although comparatively, TikTok achieves higher values in authenticity (5.72 vs. 5) due to a greater presence of the author and their private environments and stories, usually with an approach that seeks identification and is less positive than Instagram. In contrast, Instagram stands out slightly in profile credibility (5.8 on average compared with 5.5), especially in areas such as the use of scientific sources, references to the e-patient’s profession and links to other websites.

Furthermore, the overall data has revealed a positive correlation between both indicators: higher credibility correlates with greater authenticity, and vice versa, thus supporting the fact of interdependence of these two concepts on social media (Han & Balabanis, 2024).

SO4. 

To analyse the impact of credibility and authenticity on the support received from the community.

The credibility of the profiles has correlated significantly, albeit negatively, with the number of followers, suggesting that followers of these types of influencers are not as interested in their credibility as they are in their authenticity. This may also be explained by the fact that these are personal profiles, not medical or scientific references, and that their primary focus is on promoting empathy and inspiring, rather than informing or disseminating information. In other words, credibility does not seem particularly relevant to the audience, which could pose a risk if they implement their proposed disease management strategies and other health-related decisions (Ibáñez-Hernández & Carretón-Ballester, 2025; Willis & Friedel, 2026). However, these findings should be considered within the context of the user’s multimedia consumption (Wartella et al., 2016), since in addition to personal profiles, they are likely to follow institutional accounts of a scientific or healthcare nature, as well as other media outlets. In any case, the establishment of parasocial relationships with influencer e-patients contributes to curbing misinformation by modulating cognitive appraisals (Mulcahy et al., 2025).

The degree of authenticity does show a particularly significant positive relationship with the volume of comments, a fact further confirmed by the observation that social media influencers about multiple sclerosis (MS) on TikTok, which are more transparent and spontaneous, achieve more active communities than those on Instagram. These findings validate the results of previous research such as that by Y. H. Lee et al. (2021) and Nygård and Lindfors (2025). Another relevant conclusion demonstrated here is that profiles with promoting content or content about their own services—more predominant on Instagram—elicit more rejection and therefore receive less support (Gupta et al., 2022; Zhu, 2025).

SO5. 

To determine which variables show the greatest influence on the authenticity and credibility constructs of those SMI who address multiple sclerosis.

The most important factors in establishing credibility are the mention of the profession in the influencer’s description, links to the author’s other websites and the general attractiveness of the feed. Instagram stands out in the first two, where a relationship can also be highlighted between the influencer’s profession and the type of content shared: athletes prove to be inspiring, and promote empathy, while therapists propose ways to manage and deal with the disease or offer services.

Finally, the creator’s presence in the post, the spontaneity of the images and language and first-person narration are key to building authenticity—aspects in which e-patients on TikTok excel.

This work contributes to the understanding of the e-patient, a relevant figure in the current media landscape given prevailing information and content consumption preferences (Reuters Institute, 2025). We focus on influencers diagnosed with MS, given the severity and impact of the disease (EME, n.d.). However, since each illness has its own unique characteristics, it is necessary to replicate the work on e-patients for other diseases, especially less common ones, as the limited information available about the disease is likely to increase the level of credibility demanded by users. Future research could even include comparisons between personal profiles of MS patients, organisations linked to the disease and medical or scientific sources specialised in the theme.

This research also sheds light on the communication strategies developed by successful MS profiles on Instagram and TikTok, which can serve as a reference for institutional or profiles more oriented to informing, seeking to connect with users. Martín-García et al. (2024) observed significant shortcomings in the management of original content on Instagram for patient association profiles, suggesting that collaboration between organisations and personal profiles is advisable here as well, since, to paraphrase Mansilla-Moreno et al. (2024, p. 208), “there is still much work to be done.”

Furthermore, the study reinforces the relationship of dependence between authenticity and credibility applied to MS and defended by Han and Balabanis (2024). Finally, we highlight the work of e-patients, whose spontaneity and approachability contribute to improving the physical, psychological and social management of complex diseases such as multiple sclerosis.