A cross-sectional study was performed at the Vietnam National Hospital of Dermatology and Venereology (NHDV) from September to November 2018. The NHDV was chosen due to the diversity of dermatology illnesses and the background of treated patients. As a leading hospital for dermatology and venereology diagnosis and treatment in Vietnam, the NHDV receives patient referrals from health facilities at various levels. A convenient sampling technique was adopted to recruit participants for this study. Sample size calculation was conducted using inputs determined based on a study of a similar topic in 13 European countries [44]: an expected mean social engagement score of 0.70, expected standard deviation of 0.20, and a confidence level of 95%. The calculation resulted in a minimum sample size of 385 participants. We selected from the pool of patients attending the outpatient department at the NHDV using the pre-determined eligibility criteria of age ≥18 years, a diagnosis of any dermatology disease, receiving services in the outpatient clinic, ability to provide coherent answers to the interview questions, and agreeing to participate by providing written consent. A total of 519 participants was successfully recruited for the study. The response rate was 100%.

We built a structured questionnaire to collect data concerning the sociodemographic status of participants and their social media use and engagement regarding dermatological issues and information. The questionnaire also assessed various aspects of health status and service utilization, based on data from other studies exploring these topics [45]. The questionnaire was first piloted in 10 patients to validate the language and logic of each item. After revising the questionnaire based on the patient feedback, face-to-face interviews were conducted by undergraduate medical students from the Hanoi Medical University, who were well-trained in conducting community interviews. A private room at the hospital was used to hold the interviews to ensure the confidentiality and comfort of the participants.

We analyzed the data using Stata version 15.0 (Stata Corp. LP, College Station, TX). Multivariable logistic regression analysis was used to determine the factors correlated with social media use and interest in any dermatological information on social media. Multivariable tobit regression analysis was used to identify the factors associated with the engagement score. Potential explanatory variables included sociodemographic characteristics (age, gender, education, marital status, and occupation), social network platforms, and the credibility score. Stepwise forward selection strategies were combined with the multivariable regressions to reduce the models. A value of 0.2 of the log-likelihood’s P value was considered the threshold of variable selection. The results of a previous study indicated that engagement depended heavily on specific contexts, ie, specific social network platforms as well as the credibility of the information from each platform [47]. P<.05 was considered statistically significant.

The Institutional Review Board of the NHDV approved the study protocol (document number 855/HDDDBVDLTU dated September 7, 2018).

Our study found that, despite social media use by a high proportion of dermatology patients, utilizing this platform as a source of credible information for dermatological issues remains modest. Women were more likely to be interested in dermatological information on social media and be engaged with social media. The findings suggest that increased dermatologist involvement in contributing to online dermatological content and more effort to develop targeted, individualized information should be considered to take advantage of social media platforms.

Previous studies have documented the modest use of social media to find or share health-related content and particularly dermatology-related information. Despite reportedly high general social media engagement (85.0-99.3% of the participants reported regular access of at least one social media platform), only 19.0-31.7% of the participants reported accessing dermatology-related information [29,48]. We found that younger patients (aged 18-30 years) were significantly more likely to use social media. Young people in Asia are influenced more by social media than young people in Western countries because young people in Asia have a higher rate of smartphone use [49].

The higher percentage of use found in our study may reflect the increased popularity of social media in health care, due to technological advances and recent changes in the public perception of social media [50]. Our findings support the argument that there has been a desire among patients to use social media as an additional medium to traditional platforms for obtaining medical information [48]. Thus, social networking sites can be utilized as a platform to distribute educational information regarding dermatological issues for a wider reach of the population and at a potentially lower cost, especially in resource-poor settings in developing countries [51,52].

Regarding the sources of dermatological information on social media sites, our findings showed that the highest credibility scores were given to information received from family members, friends, televisions programs, and magazines. This popularity of informal information sources further highlights the lack of active contribution from dermatological health care providers and dermatologists to health information online. Dermatologists have expressed concern that patients might be misled by other social media indicators (eg, number of followers) without checking the educational background and clinical experience of information providers [53]. Increasing the involvement of medical professionals is crucial, as contributions by those with certified expertise would enhance the accuracy and reliability of information available online, reducing the possibility of incidents occurring as a result of misleading, inaccurate information [29,54]. Indeed, concerns over the quality of dermatology-related knowledge obtained online are a main barrier to enhancing the use of social media as a source of health information for health care service users [29]. Such concerns among service users may explain the medium level of engagement with social media for dermatological content reported in our study. Another possible reason for such low engagement may be participant concern about the privacy and security of personal data shared online [55,56]. Taking necessary measures to ensure the confidentiality of patient information over online platforms would also be important when attempting to boost the utilization of social media sites.

In addition, the sociodemographic characteristics of our participants were associated with their level of concern regarding dermatological information on social media and social media engagement. Women, married respondents, and Facebook users were more likely to be interested in dermatological issues on social media. These findings suggest that Facebook, in particular, could serve as the primary social media platform for disseminating dermatological information to targeted groups of online users. For example, this information could focus on dermatological issues that are most relevant to women and married individuals. Previous studies have argued the potential of Facebook for knowledge distribution, owing to its large user base, versatility in providing information in various forms, and capacity to allow for interactions and connections between users [57,58]. The positive association between engagement and the credibility score given to family members and dermatology companies as sources of social media information may also be partially explained by the ability to facilitate communications between sources and receivers of information: the more credible the sources, the more those sources would be used.

One of the implications that can be drawn from our findings is that the presence of dermatologists on social media platforms to provide official, scientific, evidence-based dermatological information should be increased. To facilitate this, the marketing capabilities of dermatology health facilities should be enhanced, so they can reach a wider population. And, patient-physician communication should be encouraged through social networking sites, notably Facebook, with careful consideration of privacy protection measures. The adoption of the Law on Cybersecurity in Vietnam provided stricter regulations on the content and transfer of data online and can be expected to impact the extent of online channel use by both patients and physicians. This should be taken into consideration when designing communication and education campaigns and programs. Regarding content, dermatological information should be created and distributed in an individually customized manner, targeting specific groups with relevant information.

This study has certain limitations. First, the self-reported nature of the questionnaire may have introduced recall bias. Second, although effort was made to enhance the diversity of participants by conducting research at a central dermatological hospital, the adoption of a convenient sampling technique and the fact that the study was conducted at a single hospital could affect the generalizability of our study. In addition, although the instrument we used to measure social media engagement has a theoretical background and provides valuable insights on the topic, it has not been officially validated. There are also several possible research considerations and directions not yet covered in our study that may be recommended for further studies. Further research may benefit from studying other online media platforms such as Google and YouTube that have considerable influence on dermatology patients in developed countries [59,60] or exploring the relationship between social media and cutaneous concerns associated with stigmatized medical conditions (eg, substance abuse). Moreover, further research may consider examining the effect of dermatological conditions on family quality of life, such as atopic dermatitis [61], as well as the impact of social media on caregivers of dermatology patients [62].

In conclusion, this study found high levels of social media use among dermatology patients, but only a moderate level of utilization and credibility regarding the use of social media as a source of dermatological information. Sociodemographic characteristics were associated with dermatology-related social media use and engagement. The results of this study recommend enhancing the involvement of dermatologists on social media platforms, in terms of knowledge contribution through social media for both patients and the general public. In addition, more efforts should be given in developing individualized information that targets specific groups of dermatology patients.