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Published on Authors of this article:. Background: Many interventions find that social media engagement with health promotion materials can translate into behavioral changes. However, only a few studies have examined the ways in which specific actions on various social media platforms are correlated with health behaviors. Objective: The objective of this study was to examine the association between social media use and HIV testing behaviors among Chinese men who have sex with men MSM. Data on sociodemographic variables, social media use platforms and behaviors, sexual behaviors, and HIV testing histories were collected.

HIV testing—related social media use was defined as having ever engaged with HIV testing content on social media, which was further divided into observing ie, receivingendorsing eg, liking and sharingand contributing eg, posting or commenting on HIV testing materials. Confirmatory factor analysis CFA was conducted to determine the best division of HIV testing—related social media use. Univariate and multivariable logistic regressions were used to examine the association between HIV testing—related social media use and HIV testing behaviors.

: A total of individuals participated in the survey. Among them, More than half of the respondents Additionally, HIV testing—related social media use, especially on multifunctional platforms such as WeChat, was found to be associated with recent HIV testing adjusted odds ratio [aOR] 2. Conclusions: Our data suggest that social media use, particularly on multifunctional platforms such as WeChat and with contributing behaviors, is correlated with HIV testing among MSM in China.

Campaigns that promote active participant contribution on social media beyond passive observation and endorsement of promotional materials are needed. This study has implications for the de and implementation of social media interventions to promote HIV testing. Social media components are increasingly being integrated into public health interventions.

Web-based engagement with social media health promotion campaigns can translate into offline behavioral changes [ 12 ]. Mobile phone apps and related social media provide opportunities for men to locate potential sex partners in their vicinity; according to recent statistical data, men report opening such apps approximately times per week [ 3 ].

Healthcare professionals are increasingly using social media to develop health promotion materials, distribute information, and establish peer-mentored education programs [ 4 ]. A wide range of social media interventions have been successfully implemented to improve health worldwide [ 5 - 7 ]. Although the effectiveness of social media interventions is well established, the relationship between social media engagement and relevant behavioral outcomes has not been fully explored [ 89 ].

In particular, detailed examination of the ways in which participants engage with social media platforms in public health interventions is scarce [ 10 - 12 ]. Functions and features vary between different social media platforms, with different platforms encouraging specific types of engagement sharing, liking, commenting, etc. Identifying the effects of specific social media platforms and behaviors on health outcomes and taking advantage of them can help optimize health-related intervention effects [ 13 ].

A large subgroup of men who have sex with men MSM and engage in high-risk sexual behaviors has never tested for HIV [ 16 ], thereby resulting in a sizable population of HIV-positive men who do not know their status [ 1718 ]. Studies on MSM in the United States, the United Kingdom, and Thailand using social and sexual networking sites have demonstrated that social media interventions for HIV testing promotion are both feasible and effective [ 19 - 21 ].

Social media platforms, which are used by MSM across the world to expand social circles, help build community, find sexual partners [ 2223 ], and allow public health practitioners to implement HIV testing promotion among MSM [ 122124 ].

In China, the rise in popularity of Web-based social and sexual networking sites has coincided with an increase in the prevalence of HIV infection among MSM in recent decades [ 25 ]. Social media Sex chat mobile bi latino China such as Weibo, WeChat, QQ, and gay apps are providing men with social and sexual networking opportunities and mediums for learning new information. InWeChat, a multifunctional social media platform based in China, reported million monthly active users [ 26 ]. As social media platforms are increasingly being integrated into Chinese daily life and public health interventions, there is a clear need for greater analysis of the specific effects of various forms of social media use on offline HIV testing behaviors [ 2728 ].

This study uses data from a cross-sectional Web-based survey to Sex chat mobile bi latino China the association between social media use by Chinese MSM and HIV testing behaviors. This was a baseline survey of an intervention study to evaluate the promotion of HIV testing among MSM in China, and these 8 cities were chosen because they were urban cities with relatively high rates of HIV prevalence [ 27 ].

Protocol of the study was registered in the Clinical Trials.

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We followed the Checklist for Reporting of Internet E-Surveys for reporting the development and findings of Web-based surveys [ 29 ]. The pretest survey was field tested by 30 MSM in Apriland their feedback was taken into to finalize the survey questionnaire. Private short messages containing the survey link were sent to the registered Blued users in the 8 cities. The study used cellphone s to prevent multiple entries from the same individual. Duplicated responses were excluded from the analysis. The eligible participants included those who were born biologically male, had ever engaged in anal sex with a man, were at least 16 years of age, were currently living in one of the deated 8 cities, were willing to provide their cell phoneand were willing to complete an informed consent procedure.

Sociodemographic information collected in the survey full survey attached as Multimedia Appendix 1 included age, education, income, and marital status. Questions on sexual orientation and disclosure of sexual orientation to others were also included. Participants were asked about their sexual histories and behaviors, including the of sex partners and condom use practices in the past 3 months.

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We focused on HIV testing in the past 3 months as outcome to reduce recall bias and to remain consistent with questions about social media use within the past 3 months. The survey included a section on social media use, in which participants were asked whether they had ever engaged with any content related to HIV testing on social media in the past and, specifically, whether they had done so in the past 3 months.

In this study, we defined HIV testing—related social media use as having ever engaged on a social media platform with any information or materials that mention or promote HIV testing. Men who reported HIV testing—related social media use were further asked about specific behaviors on 4 social and sexual networking platforms: Weibo, QQ, WeChat, and gay-specific dating apps.

Weibo is a Chinese microblogging platform, similar to Twitter, where users can publicly broadcast short messages under Chinese characters to their friends and followers [ 32 ]. Both QQ and WeChat are Chinese instant messaging platforms that provide multiple functions, including communication, information, entertainment, and financial services [ 33 ].

Whereas QQ is optimized for desktop use [ 34 ], WeChat is optimized for mobile phone use [ 26 ]. Gay-specific dating and networking apps mainly refer to Blued, a Chinese app with 27 million registered users. Other gay apps included Hornet, Grindr, and Zank, which are all available on mobile phones and allow participants to meet new sexual partners [ 35 ]. In addition, men who reported HIV testing—related social media use in the past 3 months were asked whether they had ever received, liked, or commented on information related to HIV testing or whether they had ever shared materials on their own timelines, forwarded them to others, or discussed them in one-on-one or group messages on various social and sexual networking platforms.

These of social media activities were adopted and revised from studies, which distinguish behaviors based on the differing levels of time investment and effort required [ 3637 ]. Bivariate analysis was used to examine factors associated with HIV testing—related social media use. Confirmatory factor analysis CFA was conducted to confirm the division of social media use into more specific. The GFI is a measure of fit between the hypothesized model and the observed covariance matrix; the AGFI corrects GFI, which is affected by the of indicators of each latent variable.

The NFI analyzes the discrepancy between the chi-squared value of the hypothesized model and the chi-squared value of the null model. Values for the NFI should range between 0 and 1, with a cutoff of. The CFI analyzes the model fit by examining the discrepancy between the data and the hypothesized model while adjusting for the issues of sample size. The CFI values range from 0 to 1, with larger values indicating a better fit. A CFI value of. The RMSEA examines the discrepancy between the hypothesized model with optimally chosen parameter estimates and the population covariance matrix.

A value of. Logistic regressions univariate and multivariable were used to examine the relationship between HIV testing—related social media use and HIV testing behaviors. Multivariable logistic regression models were adjusted for potential confounding variables, including age, education, income, marital status, sexual orientation, disclosure of sexual orientation to others, partner status primary partner, multiple partners, etc and past HIV testing before the recent 3 months.

As social media platforms are deed for and encourage different actions and behaviors, this study controlled for platforms while examining the effect of specific Web-based actions on offline behavior [ 4041 ]. The survey link distributed on Blued was clicked 36, times in 3 days, with 25, unique Internet Protocol addresses automatically collected by the survey tool.

Of these clicks, individuals met the study eligibility criteria and completed the questionnaire in its entirety. Seven responses were deleted as duplicates. Overall, eligible men from the 8 deated cities were included in the final analysis. Of the men who participated in the survey, Most men Nearly three-fourths Over one-third Nearly one-third Among respondents, Of the three social media useobserving occurred most frequently on gay mobile apps Endorsing occurred most frequently on WeChat: Contributing was a common behavior on both WeChat and QQ.

In bivariate analyses, age, education, income, and marital status were not correlated with HIV testing—related social media use. Self-identified gay men reported HIV testing—related social media use in the past 3 months more frequently than heterosexual and bisexual men Men who had ever disclosed sexual orientation to others Sex chat mobile bi latino China more likely to report HIV testing—related social media use Men who had main partners in the past 3 months were more likely to report HIV testing—related social media use Compared with men without HIV testing—related social media use, men with HIV testing—related social media use were more likely to have had multiple sexual partners in the past 3 months Multivariable logistic analysis showed that HIV testing—related social media use was ificantly associated with the of sexual partners adjusted odds ratio [aOR]1.

Multivariable analysis controlled for age, education, income, marital status, sexual orientation, disclosure status, main partner in Sex chat mobile bi latino China past 3 months, and past HIV testing before the recent 3 months. There was a platform-linked variation in the relationship between HIV testing—related social media use and HIV testing behaviors in the past 3 months Table 5.

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Table 5 also indicated the relationship between specific HIV testing—related social media use and recent HIV testing behaviors. Multivariable analysis controlled for age, education, income, marital status, sexual orientation, disclosure status, main partner in the past 3 months, and past HIV testing. The rise of social media has created a set of promising tools for HIV prevention [ 21221 ]. This study examines the relationship between specific social media engagement and HIV testing behavior, providing information necessary to optimize public health efforts on social media.

In particular, this study expands the literature by examining associations between social media use and HIV testing, dividing social media use into specific platforms and behaviors, and examining MSM in a middle-income country. Although several studies have treated social media as a generic platform [ 642 ], this study acknowledges the important versatility of social media platforms and specifically focuses on the ways in which social media use is related to HIV testing. This is consistent with past studies that have found that MSM commonly use social media to obtain information about HIV testing [ 2342 - 44 ].

Additionally, ongoing public health interventions use social media to provide information about HIV testing sites, counseling, and self-testing kits [ 74546 ]. As health interventions increasingly seek to integrate technology into healthcare services, there would be more chances for MSM to get engaged with HIV testing on social media [ 47 ].

This finding supports the positive association between Web-based engagement with offline health Sex chat mobile bi latino China [ 48 - 50 ]. It is consistent with the literature from other fields eg, smoking cessation showing that social media use is related to offline behaviors [ 51 - 53 ]. Social media has several key advantages, which encourage this link between Web-based engagement and offline behavior.

In particular, social media platforms allow public health campaigns to reach more diverse audiences, reduce overall cost, provide opportunities for repeated exposure to messaging, collect real-time feedback, and encourage direct engagement with messaging materials [ 13 ]. Men who engage in HIV testing—related social media use may receive detailed information about the testing location, hours of operation, and available services, thus potentially encouraging HIV testing [ 54 ]. Certain social media platforms and behaviors are strongly linked to recent HIV testing.

WeChat use, in particular, was strongly correlated with recent HIV testing in this study. This is consistent with research showing that instant messaging platforms promote HIV testing in China [ 55 ] and the United States [ 56 ]. On average, an adult in China spends more than 40 min per day on WeChat, and more than half of all users open WeChat more than 10 times per day [ 57 ].

The high-frequency use and constant engagement creates many opportunities for target audiences to be exposed to the messaging. An ongoing randomized controlled trial is examining the effectiveness of using WeChat to promote HIV testing [ 60 ]. Contributing on social media was strongly correlated with recent HIV testing as compared with observing and endorsing. Among the three specific behaviors, observing represents a type of passive involvement that allows men to encounter information without directly engaging [ 61 ].

Although receiving information about HIV testing on social media is commonly reported, studies have not found this to be associated with HIV testing [ 62 ]. Endorsing represents greater engagement, as individuals must consciously present a position of approval or support to certain persons, information, or actions. These public displays of pseudo-engagement may not be conducive to behavioral change, and in fact, may represent detachment from actual behavior by making participants believe that they have already made some ificant effort [ 64 ].

Compared with observing and endorsing, contributing on social media requires a higher level of cognitive engagement, as individuals need to develop some original perspectives or responses to the issue [ 65 ]. Contributing on social media may lead to positive health-related outcomes and influence behavior change [ 50 ]. When contributing on social media, men must think through the challenge and cognitively respond to the situation. This finding is consistent with the theory that social, participatory, and interactive aspects of social media can promote healthy behavior change Sex chat mobile bi latino China 1167 ].

This study is particularly relevant for policymakers and researchers who seek to use social media to promote behavior change.

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Although additional randomized controlled studies are needed to further examine the relationship between social media engagement and offline behavior, this study supports the integration of multifunctional platforms, such as WeChat, into public health interventions. Additionally, researchers and policymakers should encourage authentic input from MSM when deing social media interventions. The active engagement of MSM on social media is preferable to top-down, one-sided health communication [ 68 ].

Interactive activities, such as community crowdsourcing contests [ 69 ] that encourage higher levels of participation, can be organized in part through social media [ 70 ]. This study also has limitations. First, men were recruited from a gay-specific social media platform, likely resulting in overestimation of the rate of social media use. Second, it is a cross-sectional survey, so causal relationships were not established.

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