This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Cardio, is properly cited. The complete bibliographic information, a link to the original publication on https://cardio.jmir.org, as well as this copyright and license information must be included.
Heart disease continues to be the leading cause of death in men and women in the United States. The COVID-19 pandemic has further led to increases in various long-term cardiovascular complications.
This study analyzed public conversations related to heart disease and heart health on Facebook in terms of their thematic topics and sentiments. In addition, it provided in-depth analyses of 2 subtopics with important practical implications: heart health for women and heart health during the COVID-19 pandemic.
We collected 34,885 posts and 51,835 comments spanning from June 2016 to June 2021 that were related to heart disease and health from public Facebook pages and groups. We used latent Dirichlet allocation topic modeling to extract discussion topics illuminating the public’s interests and concerns regarding heart disease and heart health. We also used Linguistic Inquiry and Word Count (Pennebaker Conglomerates, Inc) to identify public sentiments regarding heart health.
We observed an increase in discussions related to heart health on Facebook. Posts and comments increased from 3102 and 3632 in 2016 to 8550 (176% increase) and 14,617 (302% increase) in 2021, respectively. Overall, 35.37% (12,340/34,885) of the posts were created after January 2020, the start of the COVID-19 pandemic. In total, 39.21% (13,677/34,885) of the posts were by nonprofit health organizations. We identified 6 topics in the posts (heart health promotion, personal experiences, risk-reduction education, heart health promotion for women, educational information, and physicians’ live discussion sessions). We identified 6 topics in the comments (personal experiences, survivor stories, risk reduction, religion, medical questions, and appreciation of physicians and information on heart health). During the pandemic (from January 2020 to June 2021), risk reduction was a major topic in both posts and comments. Unverified information on alternative treatments and promotional content was also prevalent. Among all posts, 14.91% (5200/34,885) were specifically about heart health for women centering on local event promotion and distinctive symptoms of heart diseases for women.
Our results tracked the public’s ongoing discussions on heart disease and heart health on one prominent social media platform, Facebook. The public’s discussions and information sharing on heart health increased over time, especially since the start of the COVID-19 pandemic. Various levels of health organizations on Facebook actively promoted heart health information and engaged a large number of users. Facebook presents opportunities for more targeted heart health interventions that can reach and engage diverse populations.
Heart disease continues to be the leading cause of death in men and women in the United States [
Researchers and health care providers have increasingly embraced social media data to understand and engage in public conversations regarding various public health issues, including cardiovascular diseases and heart health. Social media provides a great opportunity to observe and understand the information environment related to heart diseases and health. We based our research inquiries on 2 theoretical backgrounds.
First, we drew on the Health Belief Model, which theorizes how perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy work together to influence health behaviors and decisions [
Second, health-related conversations on social media can affect one’s perceived susceptibility to and severity of heart diseases [
Finally, social media provides a platform for the public to not only obtain access to health information but also connect with each other [
Facebook is the most popular social media platform worldwide [
The primary aim of this study was to analyze public Facebook posts and comments related to heart disease and heart health over the past 5 years in the United States. We used Linguistic Inquiry and Word Count (LIWC; Pennebaker Conglomerates, Inc) [
In this retrospective observational study, we collected US posts and comments in English related to heart disease and heart health from Facebook using the
This study was approved by the University of California, San Francisco Institutional Review Board (21-34235).
Flow diagram of data extraction and collection processes from public Facebook pages and groups.
As a robustness check, 2 trained research assistants screened for the relevance of the resulting pages and groups. Pages and groups were excluded if they were (1) private or closed (ie, not public), (2) not related to heart disease or heart health, (3) not in English, (4) about pets or animals (eg, animal vaccination), or (5) in a specified foreign location. The 2 research assistants coded a random 10% (100/1334, 7.5% of pages and 48/473, 10.1% of groups) sample of the list. They achieved a 94% agreement rate for page coding and 89% for group coding. Finally, we included 216 public pages and 40 public groups for data collection and analysis.
Next, we searched within the Facebook pages and groups and collected posts related to heart health and heart disease using CrowdTangle [
We first used LIWC [
We then performed topic modeling on the data using LDA [
To examine the discussion of heart disease and heart health for women specifically, we delved into posts and comments that were analyzed as belonging to the one special topic on heart health for women from the topic analysis results. This included posts (5200/34,885, 14.91%) and their attached comments (9501/51,835, 18.33%) that received a higher topic weight for the one topic on heart health for women than for all other topics.
To discern differences in the discussions before and during the COVID-19 pandemic, we separated the data set into pre–COVID-19 posts and comments (before January 1, 2020; 22,545/34,885, 64.63% of posts and 32,774/51,835, 63.23% of comments) and post–COVID-19 posts and comments (after January 1, 2020; 12,340/34,885, 35.37% of posts and 19,061/51,835, 36.77% of comments). Although the first case of COVID-19 in the United States was confirmed on January 21, 2020 [
To analyze and compare the level of emotions in posts and comments, we used 2-tailed 2-sample
We obtained 34,885 Facebook posts and 51,835 comments (attached to 8885 unique posts) for analysis.
The number of Facebook posts and comments in the United States regarding heart health from June 1, 2016, to June 30, 2021.
We obtained the level of positive and negative emotions with LIWC for posts and comments and used 2-sample
Regarding specific negative emotions, LIWC only reported scores for anxiety, anger, and sadness. Posts contained more anxiety (
For the post data set, we extracted 6 thematic topics.
Latent Dirichlet allocation topic modeling for all Facebook posts, showing topic keywords and weights, topic interpretation, and example posts (N=34,885).
Topic number | Topic name | Top 10 keywords and weightsa | Interpretation by authors | Example of Facebook posts (paraphrased) |
1 | Heart health promotion |
0.052*heart 0.022*health 0.018*disease 0.013*american 0.012*stroke 0.011*association 0.011*thank 0.011*join 0.010*live 0.009*support |
Heart health–, heart disease–, and stroke-related events and support by organizations (eg, the American Heart Association) | The Heart Walk is how the American Heart Association mainly raises funds to prevent heart disease and stroke. It promotes physical activity and healthy heart living, and creates a family-friendly environment. On April 1st, a Saturday, the AHA is holding their annual Franklin County Heart Walk at the Washington City Fairgrounds Swine Pavilion at 9 a.m., with the walking starting at 10. |
2 | Sharing personal experiences |
0.043*heart 0.018*attack 0.009*know 0.009*life 0.008*time 0.008*day 0.008*go 0.007*years 0.007*feel 0.007*family |
Sharing personal and family stories related to heart disease and encouraging people to share their stories to increase public awareness | It's been 5 years since I had my heart attack. I waited for about 15 hours with symptoms coming and going before I decided to drive myself to the hospital. After my heart attack, I was traumatized by the fear of death, and I started to exercise and eat healthier. It’s important it is to know the symptoms and listen to your body because one day it could save your life. |
3 | Risk-reduction education |
0.052*heart 0.027*disease 0.024*risk 0.023*blood 0.015*health 0.013*pressure 0.011*high 0.010*stroke 0.009*cholesterol 0.008*study |
Risk reduction (eg, blood pressure and cholesterol) and lifestyle modification for heart health and disease and stroke | Eat something healthy and delicious in Barbecued salmon, sauteed zucchini, sweet potatoes, and asparagus. Control your heart health by lowering cholesterol and salt intake. |
4 | Heart disease and heart health promotion for women |
0.053*women 0.048*heart 0.040*red 0.028*disease 0.012*attack 0.010*wear 0.008*available 0.008*symptoms 0.008*awareness 0.007*abstract |
Promoting awareness of myocardial infarction symptoms for women and emphasizing characteristics of women’s myocardial infarction by the Go Red for Women Campaign | #GoRedForWomen today. We're bringing attention to women’s heart disease. Women have different warning signs for heart attacks. |
5 | Educational information sharing |
0.050*article 0.047*video 0.042*content 0.035*presentation 0.023*information 0.021*health 0.013*heart 0.012*purpose 0.012*attack 0.012*general |
Presenting articles and videos related to heart health and myocardial infarction information | Dr. A, Consulting Physical, discusses heart attack prevention. |
6 | Physicians’ live discussion sessions |
0.065*dr 0.036*heart 0.027*cardiology 0.026*attack 0.023*discuss 0.020*page 0.018*cardiologist 0.018*facebook 0.016*pm 0.014*live |
Live Facebook sessions by physicians to discuss myocardial infarctions | Dr. B discussed how to reduce cardiovascular events in a Facebook LIVE session. |
aThe asterisk (*) shows the weight of each keyword.
Latent Dirichlet allocation topic modeling for all posts, showing the topics’ post distribution, Facebook metrics, and sentiments from Linguistic Inquiry and Word Count (LIWC; N=34,885).
Topic number | Topic name | Posts, n (%) | Facebook metricsa | Sentiments from LIWCb | |||||
|
|
|
Number of likes, mean (SD) | Number of comments, mean (SD) | Number of shares, mean (SD) | Word count, mean (SD) | Positive emotion percentage, mean (SD) | Negative emotion percentage, mean (SD) | |
1 | Heart health promotion | 10,912 (31.3) | 37.67 (264.95) | 2.31 (14.51) | 8.81 (50.78) | 47.64 (36.70) | 5.26 (5.16) | 1.12 (2.05) | |
2 | Sharing personal experiences | 8094 (23.2) | 48.37 (205.55) | 8.04 (26.47) | 15.14 (113.92) | 59.02 (77.90) | 4.84 (5.58) | 3.02 (4.12) | |
3 | Risk-reduction education | 8557 (24.5) | 49.63 (217.25) | 2.82 (17.36) | 18.85 (108.32) | 43.04 (57.96) | 4.87 (8.56) | 4.14 (4.54) | |
4 | Heart disease and heart health promotion for women | 5200 (14.9) | 68.65 (276.00) | 5.56 (24.39) | 33.36 (166.07) | 44.41 (53.66) | 2.53 (3.57) | 2.62 (4.03) | |
5 | Educational information sharing | 1208 (3.5) | 63.65 (114.14) | 10.43 (18.39) | 5.77 (18.25) | 137.98 (40.63) | 3.02 (7.25) | 2.78 (1.37) | |
6 | Physicians’ live discussion sessions | 924 (2.6) | 58.21 (152.55) | 11.97 (32.09) | 14.03 (46.10) | 49.2 (34.61) | 1.38 (2.10) | 3.19 (3.00) |
aData collected in November 2021.
bPositive and negative emotions represent the percentage of words in a post that appear in the dictionary indicating positive and negative emotions.
We extracted 6 topics from the comments. These topics centered on personal experience sharing and social interactions.
Latent Dirichlet allocation topic modeling for all Facebook comments, showing topic keywords and weights, topic interpretation, and example comments (N=51,835).
Topic number | Topic name | Top 10 keywords and weightsa | Interpretation by authors | Example of Facebook comments (paraphrased) |
1 | Sharing personal experiences |
0.013*go 0.011*heart 0.010*time 0.010*like 0.009*think 0.009*tell 0.009*doctor 0.009*know 0.009*pain 0.009*get |
People shared personal stories related to heart disease, physicians, and insurance. | The cardiologist never explained what was going on, and the ER doctors also never said except they needed more tests to make money from you. [I] am afflicted with cardiomyopathy and afib, making my hands and feet cold from poor circulation. |
2 | Survivor stories |
0.065*heart 0.031*years 0.026*surgery 0.022*valve 0.017*ago 0.017*old 0.016*attack 0.014*year 0.013*open 0.012*dr |
Survivors shared personal experiences with congenital heart disease when they were young. | Heart Warrior! Had pulmonary valve stenosis, subvalvular stenosis, and artery stenoses all surgically helped in 1993. Another surgery down the line. Fundraised and walked for CHD, grateful for those who also support current and future heart warriors! |
3 | Risk-reduction discussion |
0.042*heart 0.026*disease 0.016*eat 0.016*healthy 0.014*red 0.012*diet 0.012*health 0.011*smoke 0.010*exercise 0.010*risk |
Discussion on risk factors and risk reduction to prevent heart disease and improve health (eg, diet, exercise, and smoking cessation) | A healthy lifestyle helps! Water over sweetened beverages and being active keeps the heart healthy! My family has a high BP history, and I need to reduce the sodium in eating, as well as walk more. |
4 | Religious content |
0.061*thank 0.031*god 0.029*good 0.020*bless 0.018*love 0.017*share 0.013*great 0.011*family 0.010*happy 0.010*amaze |
Religious content—thanks to God and others | H is beautiful in the pictures, I wish [H] luck. [H] is amazing and kind, Peace with God. It calmed me, and I prayed. I'm doing well after 5 hospital visits, thank you Jesus. Blessed and at home with family. |
5 | Asking medical questions |
0.121*heart 0.097*attack 0.017*congratulations 0.017*women 0.013*symptoms 0.012*sir 0.012*sign 0.008*cause 0.007*patient 0.006*patients |
People ask physicians about heart diseases and risk reduction. | What are the precautions for a silent heart attack? Can it be removed? Women’s symptoms are different from mens (not as widely known) |
6 | Sharing appreciation and information |
0.031*great 0.031*love 0.028*information 0.024*nice 0.023*awesome 0.019*sir 0.018*good 0.017*dr 0.011*job 0.011*pressure |
People appreciate good information shared by others and organizations and share with their Facebook friends by tagging their names in the comments. | Dr. W, Dr. M; they listened and respected me. Good information in understandable language. |
aThe asterisk (*) shows the weight of each keyword.
Latent Dirichlet allocation topic modeling for all comments, showing comment distribution, Facebook metrics, and sentiments from Linguistic Inquiry and Word Count (LIWC; N=51,835).
Topic number | Topic name | Facebook metricsa—comments, n (%) | Sentiments from LIWCb | ||
|
|
|
Word count, mean (SD) | Positive emotion percentage, mean (SD) | Negative emotion percentage, mean (SD) |
1 | Sharing personal experiences | 14,000 (27) | 33.72 (46.15) | 4.29 (11.34) | 3.41 (7.40) |
2 | Survivor stories | 7026 (13.6) | 18.95 (22.61) | 5.93 (13.98) | 2.18 (4.49) |
3 | Risk-reduction discussion | 7080 (13.7) | 16.39 (25.26) | 4.94 (10.93) | 3.39 (6.24) |
4 | Religious content | 11,254 (21.7) | 10.03 (13.90) | 23.44 (22.05) | 0.91 (5.12) |
5 | Asking medical questions | 5964 (11.5) | 9.33 (9.21) | 4.87 (15.11) | 6.93 (9.37) |
6 | Sharing appreciation and information | 6511 (12.6) | 5.71 (10.08) | 23.87 (26.99) | 0.89 (4.11) |
aData collected in November 2021.
bPositive and negative emotions represent the percentage of words in a post that appear in the dictionary indicating positive and negative emotions.
We identified 5 topics for pre–COVID-19 posts and comments (Table S3 in
Of all topics, topic 4 was the most popular, with the highest number of shares (mean 70.99, SD 264.09) and likes (mean 36.73, SD 174.07), which indicated that people with heart health concerns cared about the warning signs and symptoms of myocardial infarctions (see Table S4 in
In the comments (see Table S5 in
The public expressed the least positive emotions (mean 2.37, SD 4.74) and the most negative emotions (mean 4.01, SD 6.35) in comments on topic 1, where people shared negative emotions, symptoms, and experiences (Table S6 in
We discovered 5 topics in post–COVID-19 posts (see Table S7 in
Furthermore, during the pandemic, the public liked (mean 61.55, SD 112.25) and commented (mean 10.08, SD 18.12) on posts related to topic 1 the most (see Table S8 in
A total of 4 topics were identified in the post–COVID-19 comments (Table S9 in
In addition, sentiments in posts and comments also changed during the COVID-19 pandemic. Compared with positive (mean 4.55, SD 6.43) and negative (mean 2.70, SD 3.98) emotions before the COVID-19 pandemic, posts became less emotional during the pandemic, with significantly less positive (mean 4.34, SD 5.78;
To summarize, there were specific discussions related to COVID-19, pandemic situations, and risks of heart disease in posts and comments published during the pandemic. The post–COVID-19 topics and comments highlighted the urgency for people to seek web-based information, connect with physicians, and share risk-reduction tips while people were enduring lockdowns, limited health care access, and restricted physical movements and social connection.
A total of 4 topics were identified in posts about heart health for women (Table S11 in
We extracted 4 topics from comments related to heart health for women (Table S13 in
This study analyzed heart health– and heart disease–related conversations on Facebook from 2016 to 2021. First, we observed an increase in heart health–related discussions on Facebook from 2016 to 2021. Second, health organizations were major contributors to heart disease and health–related discussions, especially in terms of information dissemination and heart health promotion. Third, the public was concerned about heart health during the COVID-19 pandemic, which was addressed by organizations and physicians. Fourth, we observed an extensive discussion on heart health for women. Finally, we observed some promotional or misleading content on alternative treatments that need to be effectively addressed by health care professionals in the web-based space or the platform. In the following sections, we discuss these findings in more detail.
Social media has become a popular platform for health information exchange, especially for organizations to communicate information related to heart health, promote events, and address the public’s concerns directly on social media [
The discussions related to heart health and heart disease on Facebook are mostly contributed to by health organizations such as the American Heart Association. These organizations have used social media to educate the public on heart disease prevention, risk reduction, and treatment [
The comparison of the conversations before and during the COVID-19 pandemic informed us of the impact of COVID-19 on individuals with preexisting cardiovascular conditions. Posts during the pandemic specifically focused on risk-reduction practices in diet and exercise as social isolation forced people to live with a different daily routine where securing healthy foods and engaging with sufficient physical activity became very challenging, which posed elevated risks to already vulnerable individuals. Health organizations promptly provided information on COVID-19 and heart health and engaged them in preventive care for heart health during the pandemic [
A prominent conversation was related to heart disease and heart health in women. Women-specific posts accounted for 14.91% (5200/34,885) of all posts. These contents centered on (1) women-specific promotional events as a part of the Go Red for Women campaign to promote the awareness of heart health and heart disease for women and (2) information related to the differences between women and men in warning signs, symptoms, treatments, and prevention. As an old myth goes, heart disease is a “man’s disease” [
Finally, we observed a few promotional comments during the pandemic and women-related posts, such as the promotion of alternative treatments for heart disease, cancer, and other major diseases and the specific promotion of physicians with unverified patient narratives and contact information. Although this kind of unverified information accounted for a small portion of the heart health community on Facebook, some individuals may still fall for it. Although our findings generally support the positive role that Facebook has played in promoting public awareness and education on heart health, we still acknowledge that identifying and managing unverified information on the platform is urgently needed as unverified misinformation can affect the public’s health-related attitudes and behaviors. So far, Facebook has not published rules or policies for general or heart health–specific information. A practical route may be for health organizations to maintain their pages or groups to actively monitor and address shared unverified information.
There are a few limitations noted in this research. First, this study focused on Facebook conversations related to heart health. Although it filled a research gap in examining Facebook data, we acknowledge that other social media platforms also support and engage the public on heart health. Data from platforms such as Instagram and Reddit are worth investigating. Second, within the scope of Facebook data, because of platform policies and ethical considerations, we did not obtain data from private groups or comments from public groups. Such data may add more insights into how individual users discuss, relate to, and understand heart diseases in more private web-based interaction settings. Third, we were unable to eliminate the factor of time in the comparison between before and during the COVID-19 pandemic. Although we observed differences in sentiments and thematic topics before and during the COVID-19 pandemic, these differences might not be fully attributable to the COVID-19 pandemic. Finally, this study was observational in nature, and we cannot draw any causal conclusions from this study. Although this study presented public discussions on heart health, we cannot draw any conclusions on how heart health information from organizations may have affected public discussions on heart health.
On the basis of a 5-year data set of public Facebook groups and pages, we observed informative and interactive conversations on Facebook related to heart health and heart disease for the general public, specifically women and individuals with preexisting cardiovascular conditions. The active participation by health organizations, physicians, and the public at both the national and local levels contributed to a diverse discussion with information, resources, experience sharing, and social support.
This study has implications for heart health organizations to engage in two-way communication with the public given the interactive nature of social media platforms [
This study provides an overview of heart health discussions on social media, especially in terms of thematic topics and public sentiments. Future studies are needed to analyze heart health discussions on other social media platforms, public forums, and discussion boards to provide a more comprehensive examination of the public discourse on social media. In addition, future studies may investigate how demographic differences play a role in shaping the public discourse on heart health. Disparities in heart health knowledge and health behaviors among different racial and ethnic groups can be examined. We only investigated the distinctive discussions on heart health for women; other demographic characteristics such as age and ethnicity should be further explored. Finally, given the increasing public communication on heart health, studies should be conducted to develop effective communication strategies leveraging social media such as Facebook for more effective health promotion and education.
Supplementary information for study procedure and results.
latent Dirichlet allocation
Linguistic Inquiry and Word Count
This project was supported by a grant (K24NR015812) from the National Institute of Nursing Research and the University of California, San Francisco Initiative for Digital Transformation in Computational Biology and Health. The study sponsors had no role in the study design; collection, analysis, or interpretation of the data; writing of the report; or decision to submit the report for publication. The authors would like to thank Valerie Moua for her assistance in data extraction and cleaning.
Data sharing was not applicable to this study as we used Facebook data that were available to the public and did not generate new data.
YF, JZ, and KS contributed to the conception and design of the study. HX conducted data extraction and analyses; BN assisted in data extraction and cleaning; and KS supervised the data analyses. HX, YF, JZ, and KS wrote the first manuscript, and all authors contributed to the manuscript revision and read and approved the submitted version.
None declared.