Can lip-syncing save lives?

Viral health information on TikTok

Clare Southerton

With the rapid rise of short-form video-sharing platform TikTok, health professionals have started mobilising the popularity of the site to provide users insight into their work conditions as well as offer health advice. In the wake of the COVID-19 coronavirus crisis, social media has played a particularly central role in the spread of information, with the situation changing rapidly and events unfolding on a global scale. Health-related content on TikTok is diverse, ranging from everyday health issues, such as psychologists making ‘TikToks’ offering tips to deal with anxiety, to content that responds to emerging crises like COVID-19, with Italian doctors offering glimpses of their everyday lives and organisations like the Red Cross demonstrating proper hand hygiene. Despite ongoing controversies about misinformation, it’s important to acknowledge the positive potential for health information dissemination that TikTok presents, especially with reports suggesting that its popularity is increasing during the COVID-19 outbreak.

TikTok’s significant reach

There’s no doubt that Chinese-owned TikTok, known in China as Douyin, is now a major player on the global social media market. In January this year, it was the most downloaded (non-game) app worldwide across both the Apple App Store and Google Play. TikTok’s 800 million active monthly users create 15-second videos set to music, with lipsyncing and dancing being popular content. TikTok is oriented around humour and strongly focused on virality, with the app being characterised by a constant stream of prank videos and short, video punchlines. The app has significant potential to reach young people, with a largely preteen user base, especially given that recent reports in the US suggest many teens consider their internet use ‘near-constant’.

Health professionals take to TikTok

It might be surprising given the youthful nature of the platform, that doctors, nurses and health organisations are taking to TikTok to spread health messages. Yet, health-focused content on the app is popular, ranging from more-traditional informational content such as medical professionals using the short-form videos to explain specific concepts, conditions or practices. For example, a doctor might explain what to expect at your first pap smear exam or a mental health worker might offer a tool to help deal with impulses to self-harm. These demonstrations would rely on short explanations and perhaps be set to music in keeping with the usual style on the platform. While the health professionals on TikTok do draw on their authority as qualified medical practitioners, often appearing in their scrubs, stethoscopes slung around their necks, or in other distinctive workplace attire, the style of many informative TikToks are informal, often taking the format of ‘did you know?’.

The platform-specific conditions of TikTok, oriented around play and virality have facilitated the development of a genre of health-focused TikToks that are funny and informational. These videos might feature doctors and nurses offering behind-the-scenes views of their work in hospitals, highlighting the more light-hearted aspects of their often emotionally and physically demanding work. For example, medical staff have filmed videos of themselves dancing in various parts of the hospitals they work in or made videos mocking the most unreasonable requests patients have made while in their care.

COVID-19: potential and controversies

As the COVID-19 (coronavirus) pandemic has unfolded, TikTok has been criticised for failing to control misinformation in videos about the outbreak on its app, with some videos uploaded featuring users fraudulently posing as doctors or COVID-19 patients, or spread conspiracy theories about the virus. In response, TikTok has partnered with the World Health Organization (WHO) to produce content with experts from the organisation for the platform. The WHO verified TikTok account shares informational TikToks and runs live streams to answer questions about the virus. The social media giant also pledged $10 million (USD) to the WHO to help fight the spread of COVID-19. TikTok also joined forces with Microsoft and Facebook to help the WHO with a global hackathon to try to find software solutions for the pandemic. Alongside this partnership, other organisations like the Red Cross and the UN have recently joined the platform to share COVID-19 related health advice with videos on handwashing and tips for staying healthy at home.

TikTok viral trends have also played a role in the dissemination of health information and encouraging social distancing measures as COVID-19 has become a global crisis. TikTok enlisted one of their most popular content creators, Charli D’Amelio – a fifteen-year-old with more than 41 million followers on the site – to create a viral dance to encourage her young fans to stay at home and practice social distancing to reduce the spread of the virus. The #distancedance original video has over 170 million views, with millions of users creating their own dance videos.

Content from these health organisations and TikTok partnerships now dominates COVID-19 related search results, which is a welcome relief from controversial ‘corona challenge’ videos that had previously been popular on the site. These viral videos, which involved users licking toilet seats and door handles, have resulted in the hospitalisation of at least one person and drawn criticism to the platform. While TikTok’s response to COVID-19 is, in part, also a reaction to criticism of the site hosting controversial virus-related content, this is only the latest in a series of controversies to hit the social media platform when it comes to health information.

In July last year, nursing staff in the Sick and Newborn Care Unit (SNCU) in Odisha faced disciplinary action, India after they filmed a TikTok at work that featured newborn babies. Then, in January of this year, a US nurse, known on TikTok as Nurse Holly, found herself at the centre of an internet scandal after she posted a video for her 1.7 million followers that advised that abstinence was the best way to prevent STIs. Another nurse, Danyelle Rose, also faced backlash for a TikTok she created in which she made fun of patients who exaggerate their pain. In the wake of these controversies, The Association for Healthcare Social Media (AHSM) issued a statement concerning ‘social media behaviour that may perpetuate health misinformation’ and warned that’ ‘the perception of a fragmenting medical community may further drive distrust in the medical profession’. Some scholars have even expressed concern that patient trust could be eroded with the proliferation of informal information.

Navigating pitfalls by understanding the platform

Medical professionals who are active on TikTok or other social media platforms have spoken out in the wake of the backlash, emphasising their experiences on the sites are largely about connecting with the community, sharing evidence-based information and addressing misinformation.

What we see with the #distancedance is an effective mobilising of the core elements of the platform, the playful affordances that communicate effectively with the predominantly young user-base. The message is simple, telling users to stay inside. The engagement of an influencer is an important strategy that sidesteps some of the tricky concerns about maintaining professionalism I’ve identified. This is not to say that medical professionals can’t draw on the elements of dance, lip-syncing and meme-making that are the dominant language of TikTok. In fact, many of the health organisations on the platform do engage these strategies very successfully. However, recent controversies show that health workers do take a risk when they engage on TikTok in a professional capacity. When medical professionals invoke their authority on TikTok this extends expectations of professionalism into a space characterised by a quest for viral hits and this may, at times, be incompatible with their intentions to spread evidence-based health messages.

Though it is a difficult task, at times, to strike a balance between entertainment and information, there has never been a more important time to think more creatively about health promotion. Despite the Australian Prime Minister labelling a lot of the COVID19 information social media “gossip and nonsense”, it is clear from the significant number of medical professionals and health organisations engaged on these platforms that any assertion that expertise cannot be engaged in these places is false. The rapidly changing pandemic we are currently facing is a problem that demands diverse and innovative public health solutions. Though a 15-second dance video might not be a familiar format to get the message out, the time is now to engage. After all, as we can see from TikTok, health information circulates within these platforms, only increasing during global health events like COVID-19. The question is whether health professionals and organisations contribute to the conversation.