From clinics to clicks: Investigating the motivations and competency framework of healthcare professionals on social media.

To explore the underlying motivations that prompt healthcare professionals (HCPs) to engage in social-media health communication and to construct a competency framework explaining how they develop and sustain this activity. We employed grounded theory and qualitative content analysis, conducting semi-structured in-depth interviews with 28 verified HCPs on major Chinese platforms (Douyin, Weibo, Zhihu, Xiaohongshu). Open, axial and selective coding mapped the resulting categories onto the classic Onion Model. Coding generated 237 initial concepts, 33 first-order categories, and eight axial competencies, which were organized into a three-layer competency framework: Motivation layer highlighting intrinsic drivers such as achievement motivation, mission-driven purpose, and constructive responses to burnout; Personal Identity & Roles layer encompassing key traits, evolving role identities, and collaborative teamwork; and Professional Competencies layer covering medical expertise, digital skills, information literacy, and communication proficiency. This framework clarifies how HCPs sustain effective engagement despite tightened regulation and limited financial return. HCPs' presence on social media is driven by intrinsic motivation and enabled by a layered mix of personal and trainable competencies. The proposed framework offers actionable guidance for hospitals, professional bodies and platform operators seeking to design training, recognition and policy mechanisms that foster high-quality, trustworthy digital health communication.