The Ways of Using Social Media for Health Promotion Among Adolescents: Qualitative Interview and Focus Group Study

Social media offers promising, low-cost, and accessible ways to promote adolescent health within their daily routines. Platforms such as Instagram engage users through interactive features-including quizzes, question stickers, and polls-that encourage participation and behavior change. However, risks such as addiction potential and exposure to harmful content highlight the need for carefully designed interventions.

This study aims to explore adolescents' preferences and needs for Instagram-based health promotion to inform the design of our life skill intervention, "leduin (Lebenskompetent durch Instagram)," which means "life skills through Instagram."

Following a qualitative approach, we organized 12 semistructured interviews and focus groups with 67 adolescents aged between 14 and 17 years (women: n=37, 55%; men: n=29, 43%; and nonbinary: n=1, 2%), recruited via Instagram advertisements and from schools in Germany. We conducted 5 school-based focus groups (grammar school: n=1, 20%; Montessori school: n=2, 40%; and special education school: n=2, 40%) and 2 web-based focus groups. In addition, 5 individual interviews with boys were carried out to balance gender representation, as boys were less vocal in group settings. Data were analyzed using content analysis with a combined deductive-inductive coding approach in MAXQDA software, achieving high intercoder reliability (Cohen κ=0.93). The study design followed co-design principles, the social media uses and gratifications theory, and a cultural sensitivity framework.

Adolescents valued Instagram for social connection, personal growth, and engaging content, but some felt these programs might resemble schoolwork or attract only those already interested. To improve engagement, adolescents suggested combining intrinsic motivation (authentic connections) with extrinsic incentives, such as vouchers or praise. Adolescents recommended that health programs be visually engaging, interactive, and personalized, ideally featuring peers for better relatability. Posts and reels were popular for concise information, especially when using short, subtitled reels with engaging captions. However, the advertisements were disliked. Immersive, brief stories were appreciated, with interactive features, such as quizzes, polls, and question stickers, being valued for their brevity, curiosity appeal, and anonymity. Adolescents found live videos less appealing, citing logistical issues and a lack of structure, reflecting a preference for asynchronous content. Comments were rarely used due to privacy concerns, though some saw their potential for engaging with friends. Furthermore, most adolescents did not like notifications and switched them off.

Findings support the social media uses and gratifications theory, highlighting the value of interactive and culturally sensitive content. While the small, region-specific sample limits generalizability, it reflects the depth of qualitative inquiry. Although social desirability and teacher presence may have influenced responses, efforts to foster openness aimed to minimize such effects. Instagram shows promise for adolescent health promotion through interactive, visually engaging, and culturally relevant content. Future research should explore broader and more diverse participant profiles to improve generalizability.