College students frequently encounter both physical and mental health issues, exhibiting vulnerability to mental health problems, as well as engaging in risky behaviors, including alcohol consumption, substance use, and unprotected sex. In response, many university health centers have increasingly integrated social media platforms into their health promotion strategies, disseminating targeted health messages and implementing health intervention programs. However, there remains a paucity of systematic inquiry into the extent to which these messages incorporate theoretically grounded constructs and effectively elicit engagement from college students. Accordingly, the present study adopts the Reasoned Action Approach (RAA) to analyze the theoretical underpinnings of university health services’ social media content and to investigate the degree of student engagement with these health-related posts.
The study conducted a content analysis of 405 Instagram posts randomly selected from health centers at 10 major state flagship universities in the United States during the Fall 2020 and Spring 2021 semesters. Analyses were focused on core components of the Reasoned Action Approach (RAA), specifically the presence and types of target behaviors, positive attitudinal expectancies, social norms, and efficacy. Additionally, the visual elements of each message and student engagement metrics, such as the number of likes and comments, were recorded. Statistical analyses were conducted to examine the relationships between message components and engagement metrics.
The study indicated that nearly half (43.7%) of health-related Instagram posts from university health centers contained at least one core component of the Reasoned Action Approach (RAA)—namely, target behaviors, positive expectancies, social norms, or efficacy. Self-care and self-management behaviors were the most frequently encouraged, with positive expectancies (28.61%) appearing slightly more often than efficacy (26.98%) and social norms (17.28%). Among positive expectancies, mental health improvement was most commonly cited (17.78%); however, references to academic performance, despite their relative rarity (5.19%), were associated with higher numbers of “likes,” suggesting a potential disconnect between student preferences and institutional messaging strategies. Regarding visual elements, most posts included either static images (80.99%) or videos (6.67%), with abstract or decorative images (39.75%) being the most common, followed by images featuring students (21.23%) and campus or building visuals (14.32%). Regression analyses further revealed that posts containing both positive expectancies and efficacy statements significantly predicted greater numbers of likes, whereas social norms did not have a significant effect. Additionally, one-way ANOVA analyses by subtype indicated that messages highlighting academic performance generated the highest engagement, and those emphasizing general efficacy (overall capacity for success) garnered more likes compared to behavior-specific self-efficacy messages. None of the RAA constructs, however, significantly predicted whether a post received comments.
Takeaway: Strategically aligning health messaging with college students’ interests—specifically by connecting health behaviors to academic performance and emphasizing general efficacy—can enhance student engagement and, ultimately, contribute to more effective health promotion among college populations.