Utiliting Social Media as a Health Promotion Tool to Engage

Millenials : A Systematic Review

Aisyah Nur Izzati, Zakiyatul ‘Ulya, Idam Choliq, and S. Tauriana

Faculty of Nursing Airlangga University, Mulyorejo, Surabaya, East Java, Indonesia
Email : aisyah.nur.izzati-2108@fkp.unair.ac.id

Keywords: social media, social networking, health promotion, behaviour, prevention, awareness

Abstract: Background: Social media has become the most important component of everyone’s life in this digital era.
It can’t be denied that social media has changed the ways people seek about health information. The aim of
this study was to assess the effectiveness of health promotion using social to change health behaviour and
health outcome. Scopus, ProQuest, NCBI, SAGE database was searched for existing literature on social
media development to delivering health promotion. The search returned 423 journals, and 15 journals met
the eligibility criteria following review of full-text documents literature result. Studies shown social media
is effective in increasing health knowledge, awareness, and prevention behaviour. Furthermore, other
studies stated social media can enhance their sense of community among patients with chronic disease and
thus help people attain healthier lifestyles.This review highlights that social media has a lot of roles in
changing people’s perception and behaviour, it a useful yet cost effective strategy that have to be considered
by health workers especially nurse to use it as health promotion tool and engange millennials people

1 BACKGROUND report of Europan Citizen’s Digital Health Literacy

Social media has been growing explosively
over the past decade. The popularity of social media
made itself become something everyone reading
everyday and likely to take it for granted. This
transition of technology has created an environment
in which everyones have the ability to comment,
participate, and contribute for sharing information.
Social media is a gathering place, people gather
together to share things, learn, and engange in
conversations regarding things that are important for
them (Barnes, 2015).
Published in 2014, over 60% of Europans reported
using Internet to looking up health information.
From all of these phenomena above, it can be
defined that it may be worthwhile for healthcare
professionals to find ways to engage millenials.
Social media is an efficient platform for their
user to access information, access for help, advice,
and information from another users. Health
promotions in social media enable users to have a
great control over, awareness, and improve the
health outcome through behaviour changes.

Global Digital 2018 reports during the past 12 In this review, we aim to assess the
months the number of social media users in each effectiveness of health promotion using social to
country has increased by almost 1 million new users change health behaviour and health outcome
everyday. Astonishingly, each person are spending
around two hours on social media everyday.
Although they use it as social interactions, self-
actualization, but social media platforms seem to be
used for seeking information (Kim et al., 2013). 2 METHODS
It is unsuprisingly that nowadays health 2.1 Literature search strategy
information seeking plays an increasingly important
role in use’s online activities. According to the
Three-step strategy is used for the collection of
literature study materials. Initial phase by searching
literature study with systematic review format on
chocrane, but suitable theme not found and year of
publication which is too old. The second step
searches the literature with the type of randomize
control trial design (RCT). The third stage includes
keywords according to selected topics in Scopus,
EBSCO, PubMed, Science direct, ProQuest. Articles
identified by the search terms or keywords
('massage' AND 'reflexology' AND 'anxiety' AND
'preoperative') published in the last 5 years (2013 -
2017) (Figure 1).
2.2 Inclusion and exclusion criteria
2.2.1 Study design
The literature completed by randomized controlled
trial published in peer-reviewed journals written in
English.
2.2.2 Population
Participants in the study were women and men older
than 18 years of age who will undergo surgery.
Operative measures include major or minor surgery
using local and general anesthesia.
2.3 Interventions
3 RESULTS
3.1 Literature search and study
selection
Three-step strategy is used fo The initial phase
of literature search with the specified keywords then
obtained a number of 88 literature. The second stage
is by limiting the design of research on the type of
randomize control trial (RCT) and the inclusion
criteria relevant to the topic, it is found that there are
10 selected literature (Mahmoudirad et al., 2013;
Heidari et al., 2017; Mei et all, 2015; Peng et al.,
2015; Brand et al., 2013; Bagheri-nesami et al.,
2014; Shahsavari et al., 2017; Ayik and Özden,
2018; Hudson, et al., 2015; Rosen et al., 2013). No
other literature is selected because of language or
letters such as Iranian or Arabic writing, intervention
methods that do not fit the criteria (Figure 1).
3.2 Population
The number of population involved between 60
to 100 participants. Participants involved are limited
by several criteria such as age, clinical examination
before action, experience related to medical action.
There is only one literature that requires certain
sexes as participants in the study subjects (Heidari et
al., 2017).

In the treatment group, the action given to the

preoperative patient was massage therapy and
reflection on the hands and feet. The control group is
not given massage therapy and reflexology or is
given massage therapy without reflection.

2.4 Clinical outcomes

The result of the intervention measured after the
action is the level of client anxiety by using
measuring tools such as Spielberger State-Trait
Anxiety Inventory (STAI), numerical rating scale
(NRS), Hamilton Anxiety Rating Scale (HAMA),
and Visual Analogue Scale Anxiey (VAS).

2.5 Study Selection

The compilation of the review system follows the
guidelines of the literature (Hoof et al., 2018)
obtained from Cochrane.
 Records identified through database
Identification searching
(n = 153)
Ebsco : N = 12 , Science Direct : N = 54,
PubMed : N = 6 , Scopus : N = 72,
Proquest : N =9
Records after duplicates removed
(n = 121)
Eligibility
Full-text articles assessed for eligibility
(n = 88)
RCT Included from database searching
(n = 10 )
Studies included in quantitative
Included
synthesis
(n = 10)
Studies included in quanlitative
synthesis
(n = 0)
Figure 1: PRISMA study flow diagram. RCT : Randomised Controlled Trials
3.3 Intervention characteristics
Interventions given according to the literature
include only foot reflexology therapy (Mahmoudirad
et al., 2013; Bagheri-nesami et al., 2014; Shahsavari
et al., 2017) and hand reflection therapy therapy
(Heidari et al., 2017; Hudson, et al., 2015).; Rosen
et al., 2013) or massage therapy without reflection
on the hand (Mei et all, 2015; Brand et al., 2013;).
Direct intervention is done by a reflectionologist or
conducted by the researcher himself but under the
supervision and direction of the reflectionist.
Record excluded based on title
and abstract
(n = 32)
Full-text articles excluded, with
reasons
(n = 78 )
 Iran language
 Arabic writing
 Intervention in addition to hand
and foot reflection massage
 Criteria post operation case
 Year of publication over 5 years
 Original research article
3.4 Clinical outcome measures
The measurement tools used to determine the
rate of anxiety in the research literature include
Spielberger State-Trait Anxiety Inventory (STAI)
(Mahmoudirad et al., 2013; Peng et al., 2015;
Bagheri-nesami et al., 2014; Ayik and Özden, 2018;
Rosen et al., 2013), numerical rating scale (NRS)
(Heidari et al., 2017; Hudson, et al., 2015),
Hamilton Anxiety Rating Scale (HAMA) (Mei et
all, 2015), Visual Analogue Scale Anxiey (VAS)
(Brand et al., 2013; Bagheri-nesami et al., 2014;
Shahsavari et al., 2017).
 Table 1 : Characteristics of included studies.
No Study Title Design Methods Participants Intervension Results
1 Mahmoudir Effect of foot Treatment RCT, 2 Patients candidate for Any patient in the intervention group There was a significant difference
ad, reflexology on anxiety groups angiography in Valiasr received foot reflexology for 20 between the two groups' anxiety mean
Gholamhos of patients undergoing hospital affiliated to Birjand minutes and patients in the control scores before, immediately after, and
yn, et all. coronary angiography Medical Sciences group received no reflexology. The half an hour after the intervention
(2013) University in 2013. extent to which patients felt anxious in (p=0.096). Also there was significant
Participatns 70 patients. the two groups before, immediately difference between changes in anxiety
(35 intervention and 35 after, and half an hour after the mean scores before, immediately after,
control) intervention was measured and half an hour after the intervention
in control and intervention groups
(p<0.001).
2 Heidari, Effect of short-term Treatment RCT, 2 90 patients (45 patients in 20 minutes prior to the coronary There was no statistically significant
Fatemeh et hand reflexology on groups intervention and placebo angiography procedure, hand differences were reported before the
all. (2017) anxiety in patients groups) who were reflexology was given to the intervention in terms of the mean score
before coronary candidates for coronary intervention group. The patients of state anxiety (p > 0.05). However,
angiography: A angiography for the first in the placebo group received general the mean score of state anxiety in the
randomized placebo time were recruited hand massage without any stimulation intervention group was significantly
controlled trial of reflexology points. lower than the placebo group (49.82 ±
1.74) after the intervention (42.67 ±
1.47) (p =0.001).
3 Mei, Lijuan Effectiveness of Treatment RCT, 2 185 subjects awaiting Participants in the control group The scores of Hamilton Anxiety Rating
et all (2015) Chinese Hand groups coronary angiography in received only conventional therapies Scale in the Chinese hand massage
Massage on a single hospital in Fuzhou, and care, and those in the Chinese hand group (11.78 [SD, 2.9]) had a
Anxiety Among China, between May 2012 massage group received the same statistically significant decrease
Patients Awaiting and September 2012 were conventional compared with those in the control
Coronary screened. 100 eligible therapies and care as the control group, group (15.96 [SD, 3.4]) at post-
Angiography participants were recruited with an additional 3-day Chinese hand procedure (P < .01). There was no
A Randomized and randomly assigned into massage intervention for 15 minutes a statistically significant difference on
Controlled Trial the control or Chinese hand day. blood pressure, heart rate, and Short-
massage group. Form Health Survey at postangiography
between the Chinese hand massage
group and the control group.
4 Peng, Effects of Massage on Treatment RCT, 2 Participants 117 cases that All patients were in a relatively quiet, Massage treatments reduced the
Sanying et The Anxiety of groups were ready to receive PCI interference-free environment during emergency response and level of
all (2015) Patients were divided into two nursing intervention. The massage time anxiety of cardiovascular patients
Receiving groups (59 in the was 20 min before surgery, and the before PCI. The post-intervention blood
Percutaneous intervention group and 58 in main massaged body parts were the pressure, heart rate, and pain score of
Coronary Intervention the control group). head, neck, shoulder, and back. the intervention group were
significantly better than those of the
control group (P<0.05).
5 Brand, The Effect of Hand Treatment RCT, 2 Conducted the study in the The nurse applied hand massage in the We also investigated whether adding
Leanne R et Massage on groups ambulatory surgery center direction of the participant’s heart and the hand massage procedure affected
all (2013) Preoperative Anxiety of a rural community began the massage on the participant’s the timing and flow The results
in Ambulatory hospital in the midwestern dominant hand. He or she massaged indicated that hand massage reduces
Surgery Patients United States. Control (n = each of the patient’s hands for five anxiety for patients awaiting
41) Intervention (n = 45) minutes. ambulatory surgery and outpatient
procedures. Participants who received
hand massage experienced lower
anxiety levels than those who received
customary nursing care. In addition, the
performance of hand massage did not
affect the flow or timing of procedures.
6 Nesami, The effects of foot Treatment RCT, 2 Participants 80 patients who The experimental group received foot The significant decrease in anxiety in
Masoumeh reflexology massage groups met the inclusion criteria reflexology massage on their left foot the experimental group following the
Bagheri on anxiety in patients were conveniently sampled 20 min a day for 4 days, while the foot reflexology massage supports the
(2013) following coronary and randomly allocated to control group was given a gentle foot use of this complementary therapy
artery bypass graft the experimental and rub with oil for one minute. technique for the relief of anxiety.
surgery: A randomized control groups after they
controlled trial were matched on age and
gender.
7 Shahsavaria, The effects of foot Treatment RCT, 2 80 candidates about to Subjects’ anxiety, heart rate, respiratory Contrary to the control group,
Hooman reflexology on anxiety groups undergo a bronchoscopy rate, diastolic and systolic blood variations of anxiety, heart rate,
(2017) and physiological were recruited conveniently pressures, and arterial oxygen respiratory rate, diastolic and systolic
parameters from Shariati teaching saturation were measured thrice, i.e. blood pressures, and arterial oxygen
among candidates for hospital that is affiliated to before foot reflexology, immediately saturation were statistically significant
bronchoscopy: A Tehran University of after reflexology, and immediately in the reflexology group (P < 0.05).
randomized controlled Medical Sciences, Tehran, before bronchoscopy.
trial Iran .
8 Ayik, The effects of Treatment RCT, 2 80 patients undergoing The experimental group, aromatherapy There was no baseline difference
Cahide and preoperative groups colorectal surgery were massage was applied in accordance between the groups. A statistically
Özden, aromatherapy massage randomly assigned to with the “Back Massage Guide” using significant difference was found
Dilek on anxiety and sleep experimental (n=40) and 5% lavender oil (Lavandula Hybrida) between the experimental and control
(2017) quality of colorectal control Group (n=40). for 10 minutes before surgery and the group in terms of the SAI and RCSQ
surgery patients: A morning of surgery. The control group mean scores recorded on the morning of
randomized controlled received standard nursing care in surgery. It was determined that the SAI
study compliance with the hospital procedure. and RCSQ mean score of the
Data were obtained by the State experimental group after aromatherapy
Anxiety Inventory (SAI) and Richard- massage on the morning of surgery
Campbell Sleep Questionnaire (RCSQ). decreased when compared to that of the
Results were analyzed using the t-test, evening before surgery.
Chi-square test or Fisher’s exact test.
9 Hudson, The impact of hand Treatment RCT, 2 Patients were recruited at a Hand Reflexology began once the Intra-operative anxiety was
 Briony F et reflexology on pain, groups private clinic specialising in participant was comfortable in the significantly lower in the reflexology
all (2014) anxiety and the minimally invasive operating theatre, before the start of the group (mean score of 3.24 on an 11-
satisfaction during treatment of venous analgesic injections and continued until point rating scale) than the control
minimally invasive conditions in London, the procedure was complete and the group (mean score of 5.0, p < .001).
surgery under local between February 2013 and participant was ready to leave theatre.
anaesthetic: A February 2014. The reflexology entailed systematically
randomised controlled 50 participants were working over different parts of the
trial randomised to the hands and arms using a massaging
reflexology group and 50 affect, with particular attention focused
participants were on areas corresponding to patients’
randomised to the control central nervous system, pituitary, spine,
group solar plexus and head reflex.
10 Rosen, Massage for Treatment RCT, 2 60 Participants were cancer For the intervention, an expert panel Massage therapy participants had a
Jennifer et Perioperative Pain and groups patients undergoing developed a reproducible, standardized statistically significant, greater
all (2013) Anxiety port placement hand massage therapy intended for reduction in anxiety after the first
in Placement of individuals undergoing surgical port intervention compared with individuals
Vascular Access insertion. receiving structured attention (-10.27 vs
Devices Both groups received 20-minute -5.21, P = .0037).
interventions immediately
pre- and postsurgery.
3.5 Analysis of intervention efficacy,
grouped per intervention
3.5.1 Reflexiology on foot
Giving reflexology therapy to the client before
surgery was obtained statistically significant results
can reduce the level of anxiety as evidenced by the
measurement results using Spielberger State-Trait
Anxiety Inventory (STAI) (Mahmoudirad et al.,
2013; Bagheri-nesami et al., 2014) and Visual
Analogue Scale Anxiey (VAS) (Bagheri-nesami et
al., 2014; Shahsavari et al., 2017).
3.5.2 Reflexiology on hand
Hand reflexology massage therapy in preoperative
patients on statistical tests showed significant results
in reducing the level of anxiety measured using
Spielberger State-Trait Anxiety Inventory (STAI)
(Rosen et al., 2013), numerical rating scale (NRS)
(Heidari et al., 2017; (Hudson, et al., 2015),
Hamilton Anxiety Rating Scale (HAMA) (Mei et
all, 2015), Analogue Scale Anxiey (VAS) (Brand et
al., 2013)
3.5.3 Massage theraphy without
Reflexiology on hand
Massage therapy without hand reflexology in
preoperative patients on statistical tests showed
significant results in reducing the level of anxiety
measured using Hamilton Anxiety Rating Scale
(HAMA) (Mei et all, 2015), Analogue Scale Anxiey
(VAS) (Brand et al., 2013).
4 DISCUSSION
The database search yielded 10 trials that discussed
the effects of reflexology and aromatherapy therapy
on anxiety in patients before surgery. Reflection
method can be done by using the extremities (hands
and feet), as well as the back area of the body like
the back. Six studies (n = 503) invested a massage
reflection effect on the hand area with a duration of
approximately 20 minutes after postoperative
surgery, and most treatments showed effective
results. Three studies (n = 230) examined the effect
of massage reflection on the foot area with a
duration of 20 minutes showed effective results.
However, different things shown in reflexology
performed on back or back massage (n = 80) did not
show effective results compared with extremities.
Preoperative measures performed on patients found
in this systematic review are cases of coronary
angiopgraphy, heart ring, brhoncoscopy, and
colorectal installation.
Preoperative patients, mostly experiencing
anxiety ranging from severe to mild (Hudson, et al.,
2015). The use of complementary therapies is one of
the actions that nurses can take to reduce them.
Complementary therapy in question is the provision
of reflexology. Massage can be done in the hands,
feet, back of the body, and around the shoulders.
This research conducted by Heidari et al., (2017)
shows that there is a significant relationship between
hand reflection and patient anxiety before coronary
angiography, but the study of Hudson et al., (2015)
showed that there was a significant association with
the weak category in patients who were given
massage therapy therapy. This suggests that
reflexology uses one of the alternative options for
use in anxiety therapy, but more specific research is
needed on how the process of reducing anxiety in
patients with acute and more severe illness.
5 CONCLUSIONS
This systematic review discusses the anxiety of
clients who will deal with surgery. One therapy used
to reduce anxiety is massage therapy and
reflexology. Massage therapy and reflexology
performed on hands and feet with a duration of 20
minutes can be used in reducing anxiety levels in
patients prior to surgery. Massage therapy and
reflexology is a complementary therapy and does not
cause adverse effects.
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