The Dual Impact of Time and Content Exposure of Social Media on Diabetes Self-Management in Older Adults: Cross-Sectional Study

BACKGROUND: Self-management is critical for older adults with type 2 diabetes mellitus (T2DM); however, its practice remains suboptimal. Social media has become an accessible and effective stimulus source for the public, which has the potential to promote health behaviors, but its effect on the self-management of older adults with T2DM remains unknown. OBJECTIVE: We aimed to investigate the relationship between social media exposure, specifically time exposure and content exposure, and the self-management of older adults with T2DM. METHODS: In this cross-sectional study, we enrolled 257 older adults with T2DM who used short-form video apps from community health care centers. We assessed subjective and objective time and content exposure. We transformed text-based content exposure into diabetes-related content exposure encompassing irrelevant, harmful, hypobeneficial, and hyperbeneficial categories using Q-methodology. Self-management was assessed through a validated questionnaire. We used restricted cubic splines and linear regression models to model the relationships between time exposure and content exposure and self-management, respectively. RESULTS: Of 257 older adults with T2DM, the median age was 69 (IQR 65-72) years, 53.3% (n=137) were women, the mean sum score of self-management was 35.7 (SD 10.4), the median subjective time exposure was 120 (IQR 60-120) minutes, and 61.1% (n=157) of them were exposed to hyperbeneficial content. There was an approximate L-shaped dextrorotatory relationship between time exposure and self-management, with a decline in self-management when time exposure surpassed 139.8 minutes daily. Exposure to hyperbeneficial content was positively associated with the overall self-management (B=3.46, 95% CI 0.71-6.21). For participants exposed for more than 139.8 minutes daily, this positive association remained robust (B=7.27, 95% CI 1.54-13.00). In subdimensional analyses, hyperbeneficial content exposure was positively associated with general diet (B=1.51, 95% CI 0.54-2.49) and blood glucose testing (B=1.31, 95% CI 0.25-2.38). CONCLUSIONS: Social media exposure presented a double-edged sword for self-management of older adults with T2DM. Self-management declined when the daily time spent on social media exceeded 139.8 minutes. However, exposure to hyperbeneficial content was associated with better self-management of individuals, regardless of excessive time spent on social media. Future longitudinal and experimental studies that validate the multifaceted association between social media exposure and health behaviors are needed. If confirmed, these findings would support the implementation of media prescription programs by health care providers in communities.