Background: Online social networking platforms such as Facebook and Twitter have grown rapidly in popularity,
with opportunities for interaction enhancing their health promotion potential. Such platforms are being used for
sexual health promotion but with varying success in reaching and engaging users. We aimed to identify Facebook
and Twitter profiles that were able to engage large numbers of users, and to identify strategies used to successfully
attract and engage users in sexual health promotion on these platforms.
Methods: We identified active Facebook (n = 60) and Twitter (n = 40) profiles undertaking sexual health promotion
through a previous systematic review, and assessed profile activity over a one-month period. Quantitative measures
of numbers of friends and followers (reach) and social media interactions were assessed, and composite scores used
to give profiles an ‘engagement success’ ranking. Associations between host activity, reach and interaction metrics were
explored. Content of the top ten ranked Facebook and Twitter profiles was analysed using a thematic framework and
compared with five poorly performing profiles to identify strategies for successful user engagement.
Results: Profiles that were able to successfully engage large numbers of users were more active and had higher levels
of interaction per user than lower-ranked profiles. Strategies used by the top ten ranked profiles included:
making regular posts/tweets (median 46 posts or 124 tweets/month for top-ranked profiles versus six posts or
six tweets for poorly-performing profiles); individualised interaction with users (85% of top-ranked profiles versus
0% for poorly-performing profiles); and encouraging interaction and conversation by posing questions (100% versus 40%).
Uploading multimedia material (80% versus 30%) and highlighting celebrity involvement (70% versus 10%) were also
Conclusion: Successful online engagement on social networking platforms can be measured through quantitative
(user numbers and interactions) and basic qualitative content analysis. We identified the amount and type of host
activity as key strategies for success, and in particular, regular individualised interaction with users, encouraging
conversation, uploading multimedia and relevant links, and highlighting celebrity involvement. These findings provide
valuable insight for achieving a high level of online engagement through social networking platforms to support
successful health promotion initiatives.