MERLOT Journal of Online Learning and Teaching

Vol. 6, No. 3, September 2010

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Using Social Networking Sites to Support Online Individual Health Behavior Change Projects
Utilizando Sitios de Red Social para Apoyar los Proyectos de Cambio
en el Comportamiento de Salud Individual

Joshua H. West
Brigham Young University
Provo, UT USA


P. Cougar Hall
Brigham Young University
Provo, UT USA

Rosemary Thackeray
Brigham Young University
Provo, UT USA

Carl L. Hanson
Brigham Young University
Provo, UT USA



Health education is a behavioral science, with teaching and learning activities focused on both behavioral objectives and learning objectives. With health behavior change and adoption of healthy lifestyle choices as its goal, health education relies heavily on social support systems and environmental factors to facilitate this objective. Providing effective online health education focused on behavior change can be a challenge. Students may feel isolated and are unable to draw on the strength and encouragement that can be found in a traditional learning environment. Web 2.0 applications such as Facebook offer ways for students to both provide and gain the social support necessary to make behavior change a reality. This instructional design note offers detailed direction for creating, implementing, and assessing the use of Facebook in an online health education course to facilitate individual health behavioral change.

Key Words: health education; behavior change; Web 2.0; Facebook; social support



La educación sanitaria es una ciencia del comportamiento, con la docencia y las actividades de aprendizaje centrado en objetivos de comportamiento y no sólo los objetivos de aprendizaje. Con el cambio de comportamiento de salud y la adopción de estilos de vida saludables como meta, educación para la salud depende en gran medida en los sistemas de apoyo social y los factores ambientales para facilitar este objetivo. Acceso a una educación efectiva de salud en línea se centró en el cambio de comportamiento puede ser un desafío. Los estudiantes pueden sentirse aislados y no pueden recurrir a la fuerza y el aliento que se pueden encontrar en un entorno de aprendizaje tradicional. Aplicaciones Web 2.0 como Facebook, ofrecen maneras para que los estudiantes proporcionar y obtener el apoyo social necesario para hacer el cambio de comportamiento en una realidad. Esta nota ofrece diseño instruccional dirección detalladas para crear, implementar y evaluar el uso de Facebook en un curso de educación para la salud en línea para facilitar el cambio de salud del comportamiento individual.

Palabras claves: educación para la salud; el cambio de comportamiento; Web 2.0, Facebook, el apoyo social.


The goal of health education is to help students adopt and maintain healthy behaviors (Telljohann, Symons, & Pateman, 2009) . In traditional school settings, health education relies heavily on social support systems and environmental factors to facilitate this objective. A key challenge in creating effective online health education is providing the necessary social support and encouragement for students toward behavioral change objectives. Finding online activities that facilitate and support individual behavior change are essential. Utilizing Web 2.0 social media applications offers promise by increasing encouragement of, and social support for, individual behavior change (Herring, Kouper, Scheidt, & Wright, 2004; Herring, Scheidt, Bonus, & Wright, 2004) . This instructional design uses one type of social media, a social networking site (SNS), to increase social support and accountability for online individual behavior change. SNSs are online locations where students create a profile and join a collaborative electronic community (Lenhart & Madden, 2007) . Inclusion of SNSs in online health education behavior change efforts builds on evidence that social support is critical in helping students change behavior (Elder, Ayala, & Harris, 1999; Elder, Geller, Hovell, & Mayer, 1994) . With a majority of students 12-17 years of age participating in SNSs, the popularity of social media among young people adds significance, relevance, and feasibility to this instructional technique.

Grade Level

This instructional technique is primarily designed for use among secondary students enrolled in an online health education or physical education course but can also be implemented in a university setting.


This instructional technique will enable students to:

  • Evaluate the use of an SNS application as social support for individual behavior change.
  • Analyze how peer support can influence healthy behaviors.
  • Demonstrate how to ask for and offer assistance to enhance and support the health of self and others using an SNS application.
  • Demonstrate the ability to work cooperatively through social media as an advocate for improving personal and peer health.
  • Appraise individual success in reaching a specific behavior change goal.

National Health Education Standards: Performance Indicators

This instructional technique corresponds with the following National Health Education Standards and Performance Indicators:

  • NHES # 6 - Students will demonstrate the ability to use goal-setting skills to enhance health. Performance Indicator 6.12.3. - Implement strategies and monitor progress in achieving a personal health goal.
  • NHES # 8 - Students will demonstrate the ability to advocate for personal, family, and community health. Performance Indicator 8.12.2. - Demonstrate how to influence and support others to make positive health choices. Performance Indicator 8.12.3. - Work cooperatively as an advocate for improving personal, family, and community health.

Materials And Resources  

  • Each student needs computer and Internet access and a personal email account.
  • The instructor and each student need an SNS profile.

Activities And Strategies

The activities and strategies for this instructional technique can be used throughout an entire online health education or physical education course depending on specific course and instructor objectives. In a health education course, this strategy may be most appropriate during a personal health unit where individual health behavior change and goal setting are emphasized. A social health unit where communication skills and the importance of supportive relationships are discussed may also benefit from this design. Those instructing students in an online physical education course may find this instructional technique beneficial throughout the entire course. Before implementing activities and strategies for online behavior change projects that include social media, teachers must understand their institutional policies regarding the use of this medium in online courses.


  • The online curriculum should empower students with basic health behavior change principles including studying the target behavior, setting goals, understanding the role of social support in behavior modification, and providing social support, including the type of socially supportive comments that are most beneficial and useful.
  1. Students should identify an individual behavior they want to change. Instructors my assist students in identifying goals that can be achieved during the course of the class, that are safe, and that occur frequently enough to benefit from online social support.


  1. Allow students time to study information about the behavior to gain additional insight, including recommended behavioral frequency and duration. Students also should assess their current behavioral practices, comparing their performance with an accepted standard. Specific guidelines for such behaviors as healthy eating, physical activity, personal protection, stress management, and checkups can be obtained from the Centers for Disease Control and Prevention.


  • If necessary, include a tutorial demonstrating how students create a free account by going to and filling out the requested information under the “sign up” heading. An email account is required. Following electronic confirmation of an email address, access will be provided to a personal Facebook page. Personal information and photos can be added to the profile page of the site (see top menu bar). With the “wall” page, users communicate with others they have invited or approved as friends. (see Table 1).


Table 1. Steps to Create a Facebook Group and Initiate Social Networking

Create an Account

  • In a web browser, navigate to
  • Create an account if necessary by clicking on the “Sign Up” icon
  • Customize personal Facebook site by adding information and photos to the “profile” page

Invite Friends

  • Locate the ‘Friends’ tab in the menu bar and select ‘Find Friends’
  • Identify students that should be participating in this activity and extend an invitation to become friends

Create a Group

  • From your Facebook home page, click on the group icon located in the application toolbar at the bottom of your screen
  • Click on the ‘Create a New Group’ link located at the top of the page
  • Complete the group information by assigning a group name and description followed by selecting a category
  • Restrict access to the group by selecting “closed” or “secret” under the “access” heading
  • Customize group by selecting the ‘options’ icon. Ensure ‘discussion board’ is selected in order to allow students to post/comment about their progress
  • Students may organize into multiple groups depending on their behavior change goals. Repeat this process for additional groups

Invite Members

  • From within the newly created group homepage, locate and click on the link, ‘Invite People to Join’
  • Select from the list of friends those people that should be invited to the group, and highlight their picture
  • Click on the icon, ‘Send Invitation’

Add a Discussion Topic

  • Once the group is operating and in the group’s home page, click on the link, ‘Start the first topic’
  • Update progress, or comment about another person’s progress
  1. Smaller online classes can remain as one Facebook group, while larger classes or multiple classes can divide into specific groups. Students in online independent study courses can easily be combined into one Facebook group. Students with similar behavior change goals can also align to provide social support for their specific target behaviors.
  2. To start, the teacher uses his/her Facebook profile to set up a “group.” To do so, click on ‘create a group’ under your profile, select a name for your group, select privacy settings, and then invite members. Activate privacy settings to restrict access so only online class members can participate in the group. To do this, the teacher should set up the group so that it is “closed” or “secret” by selecting one of these options under the “access” heading. This means that only the teacher and the group members will be able to see individual posts and comments. To facilitate group discussion, the “discussion board” should be activated. Posts and the associated comments will comprise the content of the discussion board.
  1. The ideal group size is 10-15 members. This may result in a large class having several smaller groups. Depending on the number of students enrolled in the online course, the teacher should determine the number of students in each group, but it should be an appropriate size to maximize the benefits of being a group. For example, small groups may not provide adequate social support, while groups that are too large may suffer from students feeling a sense of anonymity, and, therefore, not fully engaging in the process and posting too infrequently.
  2. Students post their goals and provide progress updates. They complete both tasks outside the classroom using a simple post on the group’s discussion board. Students should post their health behavior change goals to their group discussion board for others to see and comment on, which results in increased accountability.
  3. Posting progress can be an important way for students to cope with the challenges inherent in behavior change and a mechanism for classmates to offer advice or other helpful information. It is also a way to monitor progress toward completing the goal. Students’ daily posts are part of their status updates, which can be entered on the main Facebook page or on an individual’s profile page.
  4. Providing feedback and participating on the discussion board are important, not just for the individual student, but also for members of her social network. Students should be encouraged to be active in this process, posting comments to encourage others who are struggling to meet their goals, and reinforcing those who are accomplishing them. Each student should post a minimum of 1-2 comments daily.

Research findings show that tailored communications effectively motivate behavior change (Rimer & Kreuter, 2006) . Effective responses to peer posts should be short, genuine, motivational, and matched to the target behavior (Toscos, Faber, Connelly, & Upoma, 2008) (eg, “Great job at running for 2 miles today, Jorge! Keep up the good work; you’ll soon meet your goal of 3 miles.”).

Following previous implementations of this instructional design, student feedback has been positive. Students enjoyed peer support and found it useful for achieving their individual behavior change efforts. Their satisfaction and participation with this technique was greatest when the social network existed previously. In cases where students were unacquainted with one another prior to implementation, grade incentives were especially useful in increasing participation until motivation for social interaction occurred naturally.

Assessment Techniques

Both formative and summative assessments are key to the successful implementation of this instructional design note. These assessment techniques can safeguard against potential interpersonal conflicts and motivate student participation. The instructor should remind students of the importance of maintaining confidentiality regarding peers’ individual behavior change efforts. Sharing of information, bullying, and hurtful or sarcastic tones should not be tolerated and may result in a failing grade on the assignment.

Formative assessment through reviewing the students’ personal posts and the comments they post in response to a group member’s status can be ongoing. The instructor monitors posts and comments for appropriateness and evidence of supportive communication skills or other criteria she feels should be emphasized throughout this activity.

  • Summative assessment of the behavioral objectives can be completed in several ways: Students may write a two-page paper detailing the behavior change goal, the impact of online peer support on their goal, and a description of the degree to which they achieved their goal. Instructors can use or adapt the rubric found in Table 2 to assess student performance. Based on other course assignments, the instructor can determine the total point value for the project.

 Table 2. Rubric to Assess Student Performance in SNS Online Behavior Change Project







Individual behavior change goal

Specific, measurable, achievable, realistic, and time-specific behavior change goal

Goal is specific, measurable; may not be realistic or achievable

Goal is vague with little specificity


Frequency of posts of his or her personal progress.

Daily posts

3 times a week

Once a week or less


Frequency of response to peer postings

Daily response to at least 2 group members

3 times a week responded to at least 2 group members

Response to peers once a week or less


Quality of individual posts


References the goal; shares progress and challenges toward goal; asks for feedback or advice

References the goal; shares progress and challenges toward goal

Makes brief updates on behavior change goal with no specifics mentioned


Quality of response to peer posting



References specific behavior and the recent individual post; gives behavior specific encouragement; positive; motivational; appropriate grammar and spelling

Gives specific behavior encouragement but does not reference recent post

Comments on post but it does not relate to the behavior change goal; not motivational; inappropriate grammar and spelling


Achievement of personal behavior change goal

Achieved 100% of goal

Achieved 75% of goal

Achieved less than 50% of goal







*The instructor can determine the value of this assignment based on other course assignments.

The instructor may ask students to submit a copy of their personal SNS wall page showing all the posts they made as evidence of their ability to work cooperatively to advocate for personal and peer health and demonstrate how they asked and offered assistance in support of personal and peer health behavior change.

  • Students may respond to the following prompts in a written report submitted to the instructor:
    • How did online peer support influence your behavior change?
    • How did use of an SNS impact the monitoring of your progress in achieving your personal health goal?
    • Based upon your experience, can SNSs be used to facilitate social support for individual health behavior change?
    • What did you like about this activity?
    • What would you change about this activity?


Elder, J., Ayala, G., & Harris, S. (1999). Theories and intervention approaches to health-behavior change in primary care. American Journal of Preventive Medicine, 17(4), 275-284.

Elder, J. P., Geller, E. S., Hovell, M. F., & Mayer, J. A. (1994). Motivating health behavior. Albany, New York: Delmar Publishers Inc.

Herring, S. C., Kouper, I., Scheidt, L. A., & Wright, E. L. (2004). Women and children last: The discursive construction of weblogs. Into the Blogosphere: Rhetoric, Community, and Culture of Weblogs.

Herring, S. C., Scheidt, L. A., Bonus, S., & Wright, E. (2004). Bridging the gap: a genre analysis of weblogs. Paper presented at the 37th Annual Hawaii International Conference on System Sciences. 2004,4:40101b.

Lenhart, A., & Madden, M. (2007). Social networking websites and teens: An overview. Retrieved January 19, 2009, from

Rimer, B., & Kreuter, M. (2006). Advancing tailored health communication: A persuasion and message effects perspective. Journal of Communication, 56(S1), S184-S201.

Telljohann, S., Symons, C., & Pateman, B. (2009). Health education: Elementary and middle school applications (6th ed.). Boston: McGraw-Hill.

Toscos, T., Faber, A., Connelly, K., & Upoma, A. (2008). Encouraging physical activity in teens. Can technology help reduce barriers to physical activity in adolescent girls? Persuasive Computing Technologies for Health Care, 2008, 218-221.



Manuscript received 15 May 2010; revision received 15 Jul 2010.

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Last Modified : 2010/09/15