This paper is in the following e-collection/theme issue:

Viewpoints and Perspectives (514) Medicine 2.0: Social Media, Open, Participatory, Collaborative Medicine (1641) Diabetes Self-Management (484) Cardiac Self-Management (105) Coronary Heart Disease (81)

Published on in Vol 20, No 1 (2018): January

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/7558, first published .
Facebook Groups for the Management of Chronic Diseases

Facebook Groups for the Management of Chronic Diseases

Facebook Groups for the Management of Chronic Diseases

Authors of this article:

Stephanie R Partridge1 Author Orcid Image ;   Patrick Gallagher2 Author Orcid Image ;   Becky Freeman1 Author Orcid Image ;   Robyn Gallagher2 Author Orcid Image
Article Authors Cited by (53) Tweetations (65) Metrics

    Viewpoint

    1Prevention Research Collaboration, Sydney School of Public Health, Charles Perkins Centre, The University of Sydney, Sydney, Australia

    2Sydney Nursing School, Charles Perkins Centre, The University of Sydney, Sydney, Australia

    Corresponding Author:

    Robyn Gallagher, PhD, MN, RN, BA, FAHA, FESC

    Sydney Nursing School

    Charles Perkins Centre

    The University of Sydney

    Room 2210, Level 2, Building D17

    The University of Sydney

    Sydney, 2006

    Australia

    Phone: 61 2 86270279

    Email: robyn.gallagher@sydney.edu.au


    The use of Facebook groups by health care researchers and professionals for chronic disease management, namely type 2 diabetes mellitus and coronary heart disease, is in its early stages and challenges are emerging. While Facebook groups offer great potential to deliver health support, research of Facebook groups for chronic disease management remains in its infancy, with robust evidence not yet available. Designing Facebook groups that are acceptable to users, health care researchers as well as health care professionals is a challenge, and there is a poor fit with traditional research and evaluation methods. Key recommendations for future research of Facebook groups for chronic disease management include: (1) iterative content development with input from the target patient population; (2) further understanding of the potential role of group “champions”; (3) ensuring the social media policies of health care institutions allow for real time online communication; and (4) utilizing comprehensive evaluation strategies, including the use of process evaluations.

    J Med Internet Res 2018;20(1):e21

    doi:10.2196/jmir.7558

    Keywords

    social media, prevention, intervention, Facebook 


    Patient education is a core component of chronic disease self-management, and is particularly important for type 2 diabetes mellitus (T2DM) [1] and coronary heart disease (CHD) care [2]. Group-based education provides opportunities for the delivery of detailed information, patient discussions, peer support and direct supervision, and support for behaviors such as exercise [1,2]. There is substantial evidence highlighting the benefits of peer support programs in regard to changing behaviors and reducing risk factors [1,2]. Despite their proven effectiveness, the logistics and costs of staffing and providing the specialized venues for in-person, group-based programs ultimately limits accessibility because services must be offered at fixed and limited times and locations [3]. For instance, attendance at traditional cardiac rehabilitation group-based programs and T2DM group-based self-education is persistently low, at 30% and 48% of those referred, respectively [4,5].

    Online, real-time social media platforms, such as Facebook, may offer solutions to existing problems with accessing traditional group-based programs for chronic disease management. In mid-2017, Facebook’s community reached two billion people [6]. The continued rise in users is partly due to the growing number of older adults (>65 years) who are joining the social networking site [7]. Recent data suggests that nearly 90% of older adults who were on Facebook reported using the social network to find and share health information [8]. With over 40% of older adults living with two or more chronic conditions [9], the ubiquity of Facebook in their everyday lives has contributed to the emergence of a potential new era of health care information delivery.

    Social media interactions enable individuals to read and post material at any time, and from any location, as a part of their usual routine, substantially eliminating obstacles to participation compared to in-person interactions. While expert health care staff are still required, costs may be reduced through more convenient and effective scheduling. However, the potential for Facebook groups to provide novel methods for delivering group-based health care, and enabling support from health care professionals and peers, is yet to be fully harnessed [10].

    At this present stage, systematic reviews and meta-analyses are not warranted as previous research has only investigated existing publicly available Facebook groups for general chronic disease management [11], and specifically for T2DM management [12,13], diabetic foot care [14] and hypertension [15]. Encouragingly, two studies are underway investigating the effectiveness of Facebook groups for T2DM [16] and CHD [17]. Other studies with social media groups or features were in young populations or evaluated as a part of larger multicomponent mobile health (mHealth) programs where individual effectiveness of the group could not be determined. Therefore, in this viewpoint, we discuss the issues and potential benefits of using Facebook groups for the management of chronic diseases, namely T2DM and CHD, and provide recommendations for researchers working in this space.


    There is emerging evidence that chronic disease self-management programs delivered by alternative means, such as telehealth and electronic health (eHealth) delivery, have comparable outcomes to in-person programs [18,19]. However, recent reviews have attempted to determine the effectiveness of social media, using evidence arising largely from multicomponent telehealth and eHealth interventions, which includes social media features [20-22]. The difficulty with this lack of demarcation is that social media interventions may be more complex than previously thought and create difficulty for replication and implementation into practice [23,24].

    Facebook groups may offer a mutual platform of support for the management of chronic diseases. Facebook defines their group feature as “a space to communicate about shared interests with certain people” [25]. The Facebook group feature allows patients and/or health professionals to interact through posts, which includes writing and responding to posts, in a self-subscribing forum [25]. Groups can either be open, closed or private. Closed or private groups are commonly chosen for health research, as only group members can view the content [25]. Other group features include the capacity to allocate moderating privileges to selected members [25].

    Facebook groups can enable health care professionals to give both individuals and groups support, advice, and encouragement to foster self-management and behavior change [26,27]. Further health benefits can result through the development of collective knowledge, social networking, and peer-to-peer information exchange. However, to provide robust evidence for replicatation, there are key issues in the development, implementation and evaluation of Facebook groups that require further research.


    Developing Facebook groups that are acceptable to and effective for people with chronic disease, as well as health care professionals and researchers, is a challenge requiring engagement of multidisciplinary teams [28]. While there is good evidence about how best to run in-person peer support groups across a variety of health conditions [29], there is limited guidance for how to develop content and effective engagement and communication strategies for Facebook groups to assist people with the management of T2DM or CHD.

    Content for in-person chronic disease management peer support groups cannot be directly converted to group-based interventions on Facebook, due to the difference in communication mechanisms. Pagoto et al [30] developed a model for the adaptation of behavioral interventions for social media delivery. This model provides guidance for content conversion and recommends that the content library aligns with how potential users interact with the Facebook platform [30]. An iterative content design process with input from the target audience has the potential to increase appeal and effectiveness of a Facebook group [31-33].

    Formative research on older adults with chronic diseases is lacking, with only two studies investigating cardiac patients’ frequency of social media use [34], and experience and perceptions of using Facebook [35]. One study assessed how patients with T2DM communicate health information using Facebook [36]. Research investigating Facebook groups has been predominantly focused on younger people targeting single behaviors [37-54]. Evidence from such interventions is not generalizable to older populations, considering the differences in Facebook use and communication preferences between the two generations [32].

    Moderators of Facebook groups need to be aware of the use and communication preference of older adults living with chronic diseases, as well as being experienced Facebook users themselves [30]. Considering the initial complexity of managing T2DM and CHD, initial group moderation by a health professional may be most appropriate. In addition to the moderators, there is a need to have an existing support network prior to participant enrolment, to avoid the “empty room” phenomenon [28]. This can theoretically be achieved by enrolling peer “champions,” whose role is to actively encourage participants to engage with each other [55]. The role and training of these peer “champions” requires greater understanding, as well as the ideal size of a Facebook support group for a chronic disease management.

    Moderators may also be required to provide initial education and reminders to inform group members about the privacy settings of the group, as well as their personal account. All posts within a closed or private Facebook group are only visible to moderators and group members. However, issues such as data security and privacy of data management on commercial platforms, like Facebook, requires further attention.

    Health care institutions’ policies on the use of social media by health care staff need to be flexible to account for the real-time nature of conversations on Facebook [30]. This is not currently standard practice in many health care institutional policies. For example, some health care institutions require staff, who are representing the institution on Facebook, to have all posts approved by a supervisor one month prior to posting [56]. This hinders not only the continuous and dynamic nature of conversations on Facebook, but also the progression of research in this space.

    Analysis of publicly available Facebook groups on chronic disease showed that the majority of groups identified were focused on awareness creation [11,15]. However, the few support groups for patients with chronic disease provided insights about effective content and communication strategies. For example, in the case of T2DM education, Facebook group participation has demonstrated improved knowledge, skills, confidence, and notably improved patient self-management [12]. Higher levels of interaction were seen on posts about peers’ personal experiences and realistic self-depictions of living with a chronic disease [13,14]. The usefulness of some groups was associated with the types of posts, and no association was found with the number of likes or presence of user comments [14]. This shows the potential capacity of Facebook groups to offer indirect support [27], and highlights that engagement cannot always be determined by common Facebook analytics, such as the number of likes and comments per post.

    The additional challenge of evaluating Facebook groups is that many types of data, including both quantitative and qualitative, must be collected to assess engagement and effectiveness. If the Facebook group is a component of a multicomponent program, process evaluations can potentially provide insight into the causal mechanisms of such interventions and enable fine-grained understanding of the individual components [57,58]. Process evaluation methodology is underutilized in multicomponent intervention research, and this challenges research translation to identify essential intervention components from those that are not as important [59].


    No robust evidence presently exists to showcase the advantages and/or disadvantages of using chronic disease peer support groups on Facebook. This is partly because only publicly accessible, peer-led groups have been evaluated or groups have only been evaluated as part of larger multicomponent mHealth programs. While Facebook groups can reduce the participant burden of engaging in in-person group support programs, further research is required to understand their potential future role in chronic disease management.

    Acknowledgments

    This research was supported by a New South Wales Cardiovascular Research Collaborative Grant Project.

    Authors' Contributions

    SRP, PG, BF and RG conceptualized the paper. SRP and PG wrote the paper, with input from BF and RG. All authors read and approved the final manuscript.

    Conflicts of Interest

    None declared.

    1. Deakin T, McShane CE, Cade JE, Williams RDRR. Group based training for self-management strategies in people with type 2 diabetes mellitus. Cochrane Database Syst Rev 2005 Apr 18(2):CD003417. [CrossRef] [Medline]
    2. Woodruffe S, Neubeck L, Clark RA, Gray K, Ferry C, Finan J, et al. Australian Cardiovascular Health and Rehabilitation Association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014. Heart Lung Circ 2015 May;24(5):430-441. [CrossRef] [Medline]
    3. Clark AM, King-Shier KM, Spaling MA, Duncan AS, Stone JA, Jaglal SB, et al. Factors influencing participation in cardiac rehabilitation programmes after referral and initial attendance: qualitative systematic review and meta-synthesis. Clin Rehabil 2013 Oct;27(10):948-959. [CrossRef] [Medline]
    4. Schwennesen N, Henriksen JE, Willaing I. Patient explanations for non-attendance at type 2 diabetes self-management education: a qualitative study. Scand J Caring Sci 2016 Mar;30(1):187-192. [CrossRef] [Medline]
    5. Neubeck L, Freedman SB, Clark AM, Briffa T, Bauman A, Redfern J. Participating in cardiac rehabilitation: a systematic review and meta-synthesis of qualitative data. Eur J Prev Cardiol 2012 Jun;19(3):494-503. [Medline]
    6. Facebook Newsroom. 2017 Oct 21. Two Billion People Coming Together on Facebook   URL: https://newsroom.fb.com/news/2017/06/two-billion-people-coming-together-on-facebook/ [accessed 2018-01-11] [WebCite Cache]
    7. Ofcom. Adults's media use and attitudes: report 2017   URL: https://www.ofcom.org.uk/__data/assets/pdf_file/0020/102755/adults-media-use-attitudes-2017.pdf [accessed 2018-01-11] [WebCite Cache]
    8. Tennant B, Stellefson M, Dodd V, Chaney B, Chaney D, Paige S, et al. eHealth literacy and Web 2.0 health information seeking behaviors among baby boomers and older adults. J Med Internet Res 2015;17(3):e70 [FREE Full text] [CrossRef] [Medline]
    9. Australian Institute of Health and Welfare. The burden of chronic respiratory conditions in Australia: a detailed analysis of the Australian Burden of Disease Study 2011. Canberra: AIHW; 2017.
    10. Balatsoukas P, Kennedy CM, Buchan I, Powell J, Ainsworth J. The Role of Social Network Technologies in Online Health Promotion: A Narrative Review of Theoretical and Empirical Factors Influencing Intervention Effectiveness. J Med Internet Res 2015;17(6):e141 [FREE Full text] [CrossRef] [Medline]
    11. De la Torre-Diez I, Díaz-Pernas FJ, Antón-Rodríguez M. A content analysis of chronic diseases social groups on Facebook and Twitter. Telemed J E Health 2012;18(6):404-408. [CrossRef] [Medline]
    12. Zhang Y, He D, Sang Y. Facebook as a platform for health information and communication: a case study of a diabetes group. J Med Syst 2013 Jun;37(3):9942. [CrossRef] [Medline]
    13. Greene JA, Choudhry NK, Kilabuk E, Shrank WH. Online social networking by patients with diabetes: a qualitative evaluation of communication with Facebook. J Gen Intern Med 2011 Mar;26(3):287-292 [FREE Full text] [CrossRef] [Medline]
    14. Abedin T, Al MM, Lasker MAA, Ahmed SW, Shommu N, Rumana N, et al. Social Media as a Platform for Information About Diabetes Foot Care: A Study of Facebook Groups. Can J Diabetes 2017 Feb;41(1):97-101. [CrossRef] [Medline]
    15. Al Mamun M, Ibrahim HM, Turin TC. Social media in communicating health information: an analysis of Facebook groups related to hypertension. Prev Chronic Dis 2015;12:E11 [FREE Full text] [CrossRef] [Medline]
    16. Boudreau F, Moreau M, Côté J. Effectiveness of Computer Tailoring Versus Peer Support Web-Based Interventions in Promoting Physical Activity Among Insufficiently Active Canadian Adults With Type 2 Diabetes: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2016;5(1):e20 [FREE Full text] [CrossRef] [Medline]
    17. Siegmund LA, Ahmed HM, Crawford MT, Bena JF. Feasibility of a Facebook Intervention for Exercise Motivation and Cardiac Rehabilitation Adherence: Study Protocol. JMIR Res Protoc 2017 Aug 18;6(8):e162 [FREE Full text] [CrossRef] [Medline]
    18. Neubeck L, Redfern J, Fernandez R, Briffa T, Bauman A, Freedman SB. Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review. Eur J Cardiovasc Prev Rehabil 2009 Jun;16(3):281-289. [CrossRef] [Medline]
    19. Lee SWH, Chan CKY, Chua SS, Chaiyakunapruk N. Comparative effectiveness of telemedicine strategies on type 2 diabetes management: A systematic review and network meta-analysis. Sci Rep 2017 Oct 04;7(1):12680. [CrossRef] [Medline]
    20. Maher CA, Lewis LK, Ferrar K, Marshall S, De BI, Vandelanotte C. Are health behavior change interventions that use online social networks effective? A systematic review. J Med Internet Res 2014;16(2):e40 [FREE Full text] [CrossRef] [Medline]
    21. Williams G, Hamm MP, Shulhan J, Vandermeer B, Hartling L. Social media interventions for diet and exercise behaviours: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2014;4(2):e003926 [FREE Full text] [CrossRef] [Medline]
    22. Merolli M, Gray K, Martin-Sanchez F. Health outcomes and related effects of using social media in chronic disease management: a literature review and analysis of affordances. J Biomed Inform 2013 Dec;46(6):957-969 [FREE Full text] [CrossRef] [Medline]
    23. Petticrew M, Anderson L, Elder R, Grimshaw J, Hopkins D, Hahn R, et al. Complex interventions and their implications for systematic reviews: a pragmatic approach. J Clin Epidemiol 2013 Nov;66(11):1209-1214. [CrossRef] [Medline]
    24. Petticrew M. Time to rethink the systematic review catechism? Moving from 'what works' to 'what happens'. Syst Rev 2015 Mar 28;4:36 [FREE Full text] [CrossRef] [Medline]
    25. Facebook. Group Basics. 2016.   URL: https://www.facebook.com/unsupportedbrowser [accessed 2018-01-11] [WebCite Cache]
    26. Eysenbach G, Powell J, Englesakis M, Rizo C, Stern A. Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions. BMJ 2004 May 15;328(7449):1166 [FREE Full text] [CrossRef] [Medline]
    27. Young C. Community management that works: how to build and sustain a thriving online health community. J Med Internet Res 2013;15(6):e119 [FREE Full text] [CrossRef] [Medline]
    28. Cobb NK, Graham AL. Health behavior interventions in the age of facebook. Am J Prev Med 2012 Nov;43(5):571-572. [CrossRef] [Medline]
    29. Embuldeniya G, Veinot P, Bell E, Bell M, Nyhof-Young J, Sale J, et al. The experience and impact of chronic disease peer support interventions: a qualitative synthesis. Patient Educ Couns 2013 Jul;92(1):3-12 [FREE Full text] [CrossRef] [Medline]
    30. Pagoto S, Waring ME, May CN, Ding EY, Kunz WH, Hayes R, et al. Adapting Behavioral Interventions for Social Media Delivery. J Med Internet Res 2016;18(1):e24 [FREE Full text] [CrossRef] [Medline]
    31. Xie B, Watkins I, Golbeck J, Huang M. Understanding and Changing Older Adults' Perceptions and Learning of Social Media. Educ Gerontol 2012 Apr 01;38(4):282-296 [FREE Full text] [CrossRef] [Medline]
    32. Leist AK. Social media use of older adults: a mini-review. Gerontology 2013;59(4):378-384 [FREE Full text] [CrossRef] [Medline]
    33. Schein R, Wilson KK. Literature review on effectiveness of the use of social media: a report for Peel public health. 2010.   URL: https://www.peelregion.ca/health/resources/pdf/socialmedia.pdf [accessed 2018-01-11] [WebCite Cache]
    34. Gallagher R, Roach K, Sadler L, Glinatsis H, Belshaw J, Kirkness A, et al. Mobile Technology Use Across Age Groups in Patients Eligible for Cardiac Rehabilitation: Survey Study. JMIR Mhealth Uhealth 2017 Oct 24;5(10):e161. [CrossRef]
    35. Partridge SR, Grunseit AC, Gallagher P, Freeman B, O'Hara BJ, Neubeck L, et al. Cardiac Patients' Experiences and Perceptions of Social Media: Mixed-Methods Study. J Med Internet Res 2017 Sep 15;19(9):e323 [FREE Full text] [CrossRef] [Medline]
    36. Menefee HK, Thompson MJ, Guterbock TM, Williams IC, Valdez RS. Mechanisms of Communicating Health Information Through Facebook: Implications for Consumer Health Information Technology Design. J Med Internet Res 2016 Aug 11;18(8):e218 [FREE Full text] [CrossRef] [Medline]
    37. Joseph RP, Keller C, Adams MA, Ainsworth BE. Print versus a culturally-relevant Facebook and text message delivered intervention to promote physical activity in African American women: a randomized pilot trial. BMC Womens Health 2015 Mar 27;15:30 [FREE Full text] [CrossRef] [Medline]
    38. Haines-Saah RJ, Kelly MT, Oliffe JL, Bottorff JL. Picture Me Smokefree: a qualitative study using social media and digital photography to engage young adults in tobacco reduction and cessation. J Med Internet Res 2015;17(1):e27 [FREE Full text] [CrossRef] [Medline]
    39. Bull SS, Levine DK, Black SR, Schmiege SJ, Santelli J. Social media-delivered sexual health intervention: a cluster randomized controlled trial. Am J Prev Med 2012 Nov;43(5):467-474 [FREE Full text] [CrossRef] [Medline]
    40. Patrick K, Marshall SJ, Davila EP, Kolodziejczyk JK, Fowler JH, Calfas KJ, et al. Design and implementation of a randomized controlled social and mobile weight loss trial for young adults (project SMART). Contemp Clin Trials 2014 Jan;37(1):10-18 [FREE Full text] [CrossRef] [Medline]
    41. Napolitano MA, Hayes S, Bennett GG, Ives AK, Foster GD. Using Facebook and text messaging to deliver a weight loss program to college students. Obesity (Silver Spring) 2013 Jan;21(1):25-31. [CrossRef] [Medline]
    42. Rote AE, Klos LA, Brondino MJ, Harley AE, Swartz AM. The Efficacy of a Walking Intervention Using Social Media to Increase Physical Activity: A Randomized Trial. J Phys Act Health 2015 Jun;12 Suppl 1:S18-S25. [CrossRef] [Medline]
    43. Valle CG, Tate DF, Mayer DK, Allicock M, Cai J. A randomized trial of a Facebook-based physical activity intervention for young adult cancer survivors. J Cancer Surviv 2013 Sep;7(3):355-368 [FREE Full text] [CrossRef] [Medline]
    44. Wojcicki JM, Geissler JD, Stokes CW, Heyman MB, Tran CT. The use of the RESPeRATE device to lower blood pressure in inner city obese adolescents and children: a pilot feasibility study. High Blood Press Cardiovasc Prev 2013 Jun;20(2):89-92 [FREE Full text] [CrossRef] [Medline]
    45. Herring SJ, Cruice JF, Bennett GG, Davey A, Foster GD. Using technology to promote postpartum weight loss in urban, low-income mothers: a pilot randomized controlled trial. J Nutr Educ Behav 2014;46(6):610-615. [CrossRef] [Medline]
    46. Young SD, Cumberland WG, Lee S, Jaganath D, Szekeres G, Coates T. Social networking technologies as an emerging tool for HIV prevention: a cluster randomized trial. Ann Intern Med 2013 Sep 3;159(5):318-324 [FREE Full text] [CrossRef] [Medline]
    47. Cavallo DN, Tate DF, Ries AV, Brown JD, DeVellis RF, Ammerman AS. A social media-based physical activity intervention: a randomized controlled trial. Am J Prev Med 2012 Nov;43(5):527-532 [FREE Full text] [CrossRef] [Medline]
    48. Struik LL, Baskerville NB. The role of Facebook in Crush the Crave, a mobile- and social media-based smoking cessation intervention: qualitative framework analysis of posts. J Med Internet Res 2014;16(7):e170 [FREE Full text] [CrossRef] [Medline]
    49. Lelutiu-Weinberger C, Gamarel KE, Golub SA, Parsons JT. Race-based differentials in the impact of mental health and stigma on HIV risk among young men who have sex with men. Health Psychol 2015 Aug;34(8):847-856. [CrossRef] [Medline]
    50. Rice E, Tulbert E, Cederbaum J, Barman Adhikari A, Milburn NG. Mobilizing homeless youth for HIV prevention: a social network analysis of the acceptability of a face-to-face and online social networking intervention. Health Education Research 2012 Jan 13;27(2):226-236. [CrossRef]
    51. Ridout B, Campbell A. Using Facebook to deliver a social norm intervention to reduce problem drinking at university. Drug Alcohol Rev 2014 Nov;33(6):667-673. [CrossRef] [Medline]
    52. Merchant G, Weibel N, Patrick K, Fowler JH, Norman GJ, Gupta A, et al. Click “like” to change your behavior: a mixed methods study of college students' exposure to and engagement with Facebook content designed for weight loss. J Med Internet Res 2014;16(6):e158 [FREE Full text] [CrossRef] [Medline]
    53. Jones L, Saksvig BI, Grieser M, Young DR. Recruiting adolescent girls into a follow-up study: benefits of using a social networking website. Contemp Clin Trials 2012 Mar;33(2):268-272 [FREE Full text] [CrossRef] [Medline]
    54. Kim SJ, Marsch LA, Brunette MF, Dallery J. Harnessing Facebook for Smoking Reduction and Cessation Interventions: Facebook User Engagement and Social Support Predict Smoking Reduction. J Med Internet Res 2017 May 23;19(5):e168 [FREE Full text] [CrossRef] [Medline]
    55. Fleury J, Keller C, Perez A, Lee SM. The role of lay health advisors in cardiovascular risk reduction: a review. Am J Community Psychol 2009 Sep;44(1-2):28-42. [CrossRef] [Medline]
    56. South Eastern Sydney Local Health District. 2015. Business Rule - SESLHD Use of Facebook NSW Government   URL: http:/​/www.​seslhd.health.nsw.gov.au/​Policies_Procedures_Guidelines/​Corporate/​Communications/​Documents/​SESLHDUseofFacebook.​pdf [accessed 2018-01-11] [WebCite Cache]
    57. Liu H, Muhunthan J, Hayek A, Hackett M, Laba T, Peiris D, et al. Examining the use of process evaluations of randomised controlled trials of complex interventions addressing chronic disease in primary health care-a systematic review protocol. Syst Rev 2016 Aug 15;5(1):138 [FREE Full text] [CrossRef] [Medline]
    58. Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ 2015;350:h1258 [FREE Full text] [Medline]
    59. Guise J, Chang C, Viswanathan M, Glick S, Treadwell J, Umscheid C. Systematic Reviews of Complex Multicomponent Health Care Interventions Rockville (MD): Agency for Healthcare Research and Quality (US). 2014.   URL: https://www.ncbi.nlm.nih.gov/books/NBK194846/ [WebCite Cache]

    ‎
    CHD: coronary heart disease  
    eHealth: electronic health 
    mHealth: mobile health 
    T2DM: type 2 diabetes mellitus

    Edited by G Eysenbach; submitted 27.02.17; peer-reviewed by P Balatsoukas, TR Soron, M Ashford, PDJ Ehlers, A Cyr, J Rumbold, T Bose; comments to author 12.07.17; revised version received 07.11.17; accepted 04.12.17; published 17.01.18

    Copyright

    ©Stephanie R Partridge, Patrick Gallagher, Becky Freeman, Robyn Gallagher. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.01.2018.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.