9. Adherence to Public Health Recommendations in TikTok Content During the Early Days of the SARS-CoV-2 Pandemic

Abstract

At the beginning of the SARS-CoV-2 pandemic, the Centers for Disease Control and Prevention (CDC) recommended widespread shutdowns of schools, businesses, and other activities. Internet use increased dramatically, with the short-form video social media platform TikTok gaining popularity among adolescents and young adults (AYA). Displays of health behaviors on social media have been shown to impact actual health behaviors in AYA, yet the scope of prevention behaviors related to the current global pandemic is unprecedented. Therefore, the objective of this study was to evaluate adherence to CDC infection prevention guidelines and information about COVID-19 as represented by TikTok content creators, or influencers, at the beginning of the pandemic in the United States. The study sample included content posted by the 150 most-followed influencers on TikTok between March 1, 2020 and April 27, 2020. Study team members identified and extracted all posts within the specified dates that referenced COVID-19 and/or pandemic precautions (e.g., social distancing, school closures). A codebook was developed based on the CDC Guidelines for COVID-19 prevention as of March 1, 2020 and included displays of behavior that either followed (e.g., staying home, washing hands) or did not follow (e.g., wearing a mask incorrectly) the guidelines at the time. Posts were also coded for the presence or absence of TikTok’s “learn the facts about COVID-19” banner, which had been implemented by the platform to combat misinformation. Rounds of 20-40 posts were used to train coders against a master coder, and coders began reviewing posts independently once agreement was over 80%. We performed descriptive statistics on content metadata and code frequency. Of 11,063 posts made during the study dates, 1,305 (11.7%) posts were COVID-related, with an average of 9.2 COVID-related posts per influencer. Each influencer’s combined COVID-related content had an average of 44.4 million views and over 8 million likes. Most (81.5%, n=1,064) posts contained behaviors that could be coded for CDC guidelines. Of these posts, 79.4% solely demonstrated behavior following CDC guidelines, with the most frequent being staying at home (n=805) and handwashing (n=50). 7.1% of posts solely demonstrated behavior that did not follow CDC guidelines, with the most frequent being not wearing face cover in public (n=41) or having contact with others outside the household (n=33). Posts that contained a combination of behaviors that followed or did not follow the guidelines comprised 10.3% of the sample. The COVID facts banner was only present in 3% of COVID-related posts. At the beginning of the pandemic, AYA were felt to be at low risk for severe COVID-19 disease, but were encouraged to follow infection control measures to protect at-risk populations like the elderly. We found that the most popular US TikTok influencers created COVID-related content that reached millions of users on a platform mainly used by AYA. This content usually demonstrated adherence to public health guidance at the time, suggesting positive implications for future health messaging on social media platforms.