Who Shapes Health Narratives on TikTok? Evaluating Content Sources and Discourse Quality in Comments on Reproductive...

This study examines how TikTok creators, including health-care professionals and social media influencers, engage in contraceptive discourse with their audience. It evaluates differences in content themes, engagement metrics, and the quality of discourse in video comment sections to understand how reproductive health communication unfolds across creator types.

A dataset of 100 TikTok videos (50 from influencers, 50 from health-care providers) and 46,747 associated comments was collected using Apify. Engagement metrics (likes, views, shares, comments) were compared across groups. N-gram analysis identified linguistic differences in creator messaging. To assess discourse quality, comments were evaluated using a modified Discourse Quality Index (DQI) scored by a large language model (GPT-4o) trained on 500 human-coded examples. Structural topic modeling (STM) was used to identify dominant themes in high-quality discourse.

Influencer videos received significantly higher engagement across likes, plays, and shares. Influencers more often used affective and experiential language, while health-care providers used clinical and third-person discourse. Comments on influencer videos scored higher across six of seven DQI dimensions, including empathy, clarity, and personal experience sharing. High-quality comments on influencer content emphasized emotional well-being, long-term side effects, and social support, while provider content generated more medically detailed but often skeptical or fact-checking discussions.

TikTok influencers not only achieve broader reach but also facilitate richer, more supportive discussions about contraception compared to health-care professionals. While providers emphasize clinical accuracy, influencers foster parasocial intimacy that encourages experiential storytelling. To improve reproductive health communication on social media, hybrid approaches that integrate influencers' narrative resonance and experiential credibility with health-care providers' evidence-based guidance may be most effective.