Reassessing the impact of social media on healthcare delivery: insights from a less digitalized economy

Abstract

Social media plays a crucial role in modern healthcare by promoting patient engagement, facilitating communication among professionals, and serving as a platform for health education and outreach. Its significance in healthcare delivery continues to grow as digital communication becomes increasingly integral to the industry’s efforts to improve healthcare outcomes. Nonetheless, existing studies have not adequately and empirically explored its impact in less digitalized economies. Thus, this study seeks to investigate the impact of social media on healthcare delivery systems in a less digitalized economic context. Leveraging the social media engagement theory, the study employs a partial least squares (PLS-SEM) approach to explore the impact of social media in Ghana’s healthcare system. Based on a purposely selected sample of 457 healthcare professionals from Ghana, the study found that using social media for crisis management, patient-doctor relationships, and information dissemination positively impacts healthcare systems. On the contrary, social media use for public relations activities did not have any significant impact on healthcare delivery. This study contributes to the growing literature on the affordances of social media in the circular economy towards improved healthcare delivery in emerging economies. The study offers a strategy for optimizing the use of social media within healthcare settings to foster enhanced healthcare outcomes, particularly a less digitalized economies.

Keywords:

• Social media
• digital healthcare
• health information
• healthcare delivery
• Ghana

Reviewing Editor:

• Joe Thomas, School of Global Health, Institute of Health and Management, Victoria, Melbourne, Australia

Subjects:

• Management of IT
• Databases
• Information & Communication Technology (ICT)

1. Introduction

In the past decades, the evolution of technology has transformed the dissemination of information around the globe. Since the emergence of social media, healthcare providers have realized its relevance in their delivery system (Kawachi & Berkman, 2000). Kaplan and Haenlein (2010) described social media as ‘a group of Internet-based applications that allow the creation and exchange of user-generated content’. In other words, social media comprises a variety of user-generated platforms designed to ‘contribute, receive, and explore content’ amongst users (McGowan et al., 2012). Some of the widely used social media platforms include Twitter, Facebook, YouTube, WeChat, Instagram, LinkedIn, and Blogs (Casella et al., 2014); these platforms enable users to share information and ideas (Probst & Peng, 2018). Global Digital Review Report (2020) shows that social media and internet users have reached more than 3.8 billion and 4.5 billion, respectively, indicating the technological role in the day-to-day activities of individuals and businesses. For instance, Facebook remained the social media platform with the most active users worldwide, with over 2.75 billion people as of June 2021. In the context of health, the use of social media technologies has become part of the healthcare delivery system. Social media technologies are fundamentally changing the way of communication between healthcare providers and patients, sharing information and guidance with patients, and crisis management (Katsas et al., 2021). One significant value of healthcare delivery is improving patients’ health outcomes (Seeman, 2008), and social media platforms can be utilized to share illness treatment and prevention.

The healthcare delivery system is formulated to provide secure, accessible, affordable, and quality health services to patients (Chauhan et al., 2012; Fennell et al., 2021; Von Muhlen & Ohno-Machado, 2012). According to Amrita and Biswas (2013), access to health care services comprises five dimensions namely; affordability, accessibility, availability, acceptability, and accommodation, through which the main actors, such as the patients, health care providers, organizations, families, communities together with strategies, policies, and promotions geared towards quality healthcare delivery (Bryant, 2018; Nworuh, 2008). Amrita and Biswas (2013) state that healthcare delivery has evolved through the use of new medical technologies. Telemedicine technology and tools have been utilized to educate the public and manage patients remotely, which significantly affects quality healthcare delivery (Farrer et al., 2023; Hollander & Carr, 2020; Velella et al., 2023). The effective usage of social media can keep patients under the supervision and control of healthcare providers (Ndayishimiye et al., 2023; Pentescu et al., 2015). Williams (2011) argued that healthcare providers who use social media provide effective patient care, build networks, organizational promotion and improve public health programs. McCaughey et al. (2014) believe that healthcare providers (hospitals, pharmaceutical firms, health systems, and patient advocacy groups) that focus on social media usage, can improve collaborative information, knowledge sharing, and enhanced organizational visibility. Househ (2013) for instance reported that 70% of United States healthcare organizations have adopted and utilized social media technologies for quality healthcare delivery.

Given the increasing level of competition, to provide healthcare and emergency management, scholars have proposed the adoption of social media among healthcare providers in developing countries to improve healthcare delivery and enhance doctor-patient communication (Ennab et al., 2022; Kanchan & Gaidhane, 2023; Luu et al., 2022). It is also evidenced that social media is becoming a growing and competitive innovative tool for health providers, specifically helping them to focus on patients, for physical health monitoring, improvement in diet behavior, cardiac rehabilitation, and reduce management health crises (Colineau & Paris, 2010; Kung & Oh, 2014; McKeon et al., 2022; Wang et al., 2022). Furthermore, other scholars have observed that social media platforms could be a beneficial tool for doctor-patient interaction (Ahmed et al., 2017; Alsughayr, 2015; Kichloo et al., 2020) and augment clinical education (Srimarut & Techasatian, 2019). However, social media could pose potential risks to healthcare delivery (Antheunis et al., 2013; Hao & Gao, 2017) as negative comments/reviews cannot be managed and controlled, infringement of patients’ confidentiality and potential risk for depression (Broom, 2005; Rupert, 2016).

Although social media plays a pivotal role in healthcare delivery, its adoption among healthcare providers in emerging economies is relatively low (Adu-Gyamfi et al., 2019; Afful-Dadzie et al., 2023; Alkhwaldi & Abdulmuhsin, 2022; Sokey et al., 2018). These studies submitted social media adoption to enhance services in the context of healthcare delivery. Besides, it has been suggested that delivering quality healthcare from the modern technology’s viewpoint should be the main focus of healthcare providers in emerging economies like Ghana to improve patient interaction and support (Martin-Yeboah et al., 2022). Nevertheless, past studies have limited the focus on social media usage and healthcare delivery in emerging economies (Abdulbaqi et al., 2021; Koumpouros et al., 2015; Laranjo et al., 2015; Stroever et al., 2011). Additionally, while most researchers have conducted studies on social media usage and healthcare delivery relationship in the developed economies context (Benetoli et al., 2017; Fisher & Clayton, 2012; Hawn, 2009; Paul et al., 2018; Rozenblum et al., 2017), a clear impact of social media usage and healthcare delivery in emerging economies remains underexplored (Duong et al., 2023; Gamor et al., 2023; Liang et al., 2022). Hence, this study aims to examine the impact of social media effects on healthcare delivery in the less digitalized economies context. Specifically, the current study aims to investigate the impact of social media usage on the healthcare delivery system in Ghana and its effect on patient-physician relationships. This study highlights the need for investigations that establish a correlation connection between social media usage and healthcare delivery outcomes. A comprehensive understanding by healthcare professionals on how social media applications impact healthcare delivery is imperative for quality services and health crisis management. The study also unwraps the social media role in doctor-patient communication, providing insights into how social media can be utilized to manage crises in health settings. Moreover, it distinguishes between information and guidance to patients and social media usage, uncovering their significant effects on healthcare delivery.

This current study provides the following contributions. First, the current study contributes to the existing literature on social media and healthcare delivery in a less digitized economy, since few empirical studies have been carried out in this context. Second, the study contributes to the healthcare delivery literature by empirically investigating the effective utilization of social media applications in the Ghanaian context and its impact on healthcare. Third, the current study contributes to the social media engagement theory, which supports the utilization of social media in improving productivity and building relationships with patients. Finally, the paper provides significant guidance for healthcare professionals to strategically use social media tools for information sharing, crisis management, and improving healthcare delivery.

This paper continues with a literature review and hypotheses development, details of the methodology, findings, and discussion. The study concludes with both theoretical and practical contributions and avenues for future research.

2. Theoretical background and hypotheses development

Social Media Engagement Theory (SMET) posits that social media networking sites allow firms to interact with consumers and achieve organizational objectives. The theory holds that social media interactions enable users to build harmonious relationships and provide a translucent way of interactions where information, ideas, and opinions can be shared (Di Gangi & Wasko, 2016; Prahalad & Ramaswamy, 2004). The emergence of social media as a result of technological evolution significantly offers a unique user experience and also provides numerous benefits due to its capabilities. Scholars are increasingly applying SMET to assess the significant impact of organizational usage of social media particularly to engage customers and improve business performance (Bruce et al., 2023; Di Gangi & Wasko, 2016; Throuvala et al., 2019). In the context of health, social media recently played a pivotal role in healthcare delivery (Durowaye et al., 2022; Ventola, 2014) and its application has led to better patient care and emergency management (Dahou et al., 2023).

Through the lens of SMET, Aase and Timimi (2013) conducted a study on social media engagement and healthcare delivery. Their study revealed that through social media engagement, patients can seek valuable health-related information and receive guidance on diagnosis and treatment online. According to Khamis and Geng (2021), social media usage helps provide health awareness information and empower the patient-physician relationship. A significant study was carried out on social media integration in health communication (Robledo, 2012). The study proffers that social media integration and its application positively affect the quality of healthcare, having a significant impact on enhancing the knowledge of medical practice and raising public awareness regarding health issues. Alshakhs and Alanzi (2018) buttress that social media is a powerful tool for patient education and general health information. In effect, information and guidance to patients, crisis management, and quality health care delivery can be achieved through social media usage. Furthermore, improving patient engagement and promotion of healthy behaviors were found to be significant reasons for social media usage by healthcare providers.

Drawing on the SMET, this study demonstrated that healthcare providers stand to gain several benefits from the integration of social media, reinforcing that social media can be used to build relationships with patients, enhance the quality of care, and patient interaction, and even hire professionals (Pomare et al., 2022). Also, the recent acceptance of social media by patients and healthcare providers has facilitated health-related processes and activities and processes, hence we argue that integration of social media into health-related activities would successfully transform the constant patient-doctor engagement, which plays a significant role in improving healthcare performance.

2.1. Social media

Social media applications are dynamic communication tools with significant effects on people’s daily lives. These applications have been utilized extensively in developed economies, especially in the health sector for patient-physicians’ communications and health education (Alshakhs & Alanzi, 2018). For example, these applications enable the firms to effectively share information and improve healthcare outcomes (Yaagoob et al., 2023; Zhao et al., 2023). Studies have reported that health institutions have integrated social media marketing strategies, which has become an essential tool that assists in healthcare delivery (Alshakhs & Alanzi, 2018; Giustini et al., 2018; Jeyaraman et al., 2023; Khamis & Geng, 2021; Robledo, 2012). For instance, Benetoli et al. (2017) and Farsi et al. (2022) outlined the benefits of social media applications to health institutions, including regular interaction between doctors and patients, emergency management, the public, and the development of professional networks. Based on the advantages, this present study extends the utilization of social media in the health context (among healthcare professionals). This leads to how healthcare professionals adopt and utilize social media to enhance communication mainly between healthcare providers, patients, and the general public (Braghieri et al., 2022). A recent study by Novera et al. (2023) investigated the trend of social media on health workers’ mental health and concluded that social media usage significantly influences patient self-management.

2.2. Health care delivery

Literature has assessed the role of social media in healthcare in developed economies (Eckler et al., 2010; Eysenbach, 2008), other submitted that social media is essential in healthcare professionals’ duty of line, especially to track patients’ health conditions and provide medical and emotional support. Nonetheless, limited studies have focused on social media and healthcare delivery in a less-digitalized economy. Grounded on social media engagement theory (SMET), the study highlights social media applications as essential tools for improving healthcare delivery. Moreover, previous studies (Alshakhs & Alanzi, 2018; Eckler et al., 2010; Jain & Bickham, 2014; Mayer & Leis, 2012; Rodríguez-González et al., 2013) have evidenced a positive influence of social media usage on healthcare delivery. For instance, Denecke et al. (2013) acknowledged the significant effect of Twitter as a social media tool to detect and monitor chronic diseases like malaria and cholera. Similar work by Denecke et al. (2015) further admonished that physicians can use social media applications to search for patients and to learn more about their condition and behavior. However, it has been argued that social media usage can be managed while sharing and posting information about patients, in order not to disclose peculiar health conditions to the public (Herigon, 2011). In light of Smailhodzic et al. (2016), the study proposes the social media usage role in healthcare organizations as a platform to create health awareness and acquisition of health-related information.

2.3. Crisis management

According to Coombs (2014), a crisis happens as a result of ineffective communication. Strandberg and Vigsø (2016) noted that every organization is bound to face crisis and the ability to manage the crisis is crucial for its success. Špoljarić (2021) proposed that communication is key in crisis management. The author advocated that effective communication eliminates the negative effects of crisis in an organization. Social media is seen as a crisis communication strategic tool that can be utilized to provide emotional support during a crisis. Thus, managing a crisis using social media applications lowers the tension between healthcare providers and patients, which offers opportunities for healthcare providers to identify crises in the health context (Choi & Lin, 2009; Cohen et al., 2023; Stephens & Malone, 2009). According to Seltzer and Mitrook’s (2007) research on the dialogic potential of weblogs in relationship building, it was revealed that social media connect health stakeholders and patients during crisis management. Besides, Ishii (2010) examined crisis management, they assessed 159 university students’ utilization of social media in crisis management. The study found a significant and positive relationship between social media usage and crisis management. Recent studies (Abbas et al., 2021; Zhou et al., 2021) on social media’s role in crisis management, have further evidenced a positive link between social media usage and crisis management in mental health. Accordingly, this study hypothesized that

H1: Crisis Management through social media usage would positively affect healthcare delivery.

2.4. Doctor-patient communication

Many scholars have extensively studied the doctor-patient relationship through social media usage (Dogra et al., 2023; El Kheir et al., 2022; Weiner, 2012). It has been concluded that effective usage of social media has a positive effect on the doctor-patient relationship, given the importance of social media as a two-way communication (Ayers et al., 2023; Oh & Lee, 2012; Srimarut & Techasatian, 2019; Wentzer & Bygholm, 2013). Similar work by Lee and Wu (2014) pointed out that diagnosing the needs of a patient highly depends on effective communication. In addition, the authors observed that social media tools play an essential role in delivering quality health care to patients. Considering this, recent studies (Derevianko et al., 2023; Sun et al., 2022; Jiang et al., 2023) found that social media usage helps healthcare providers to build healthy relationships with patients and to deliver quality healthcare services. Finally, according to Alshakhs and Alanzi (2018) involving 120 Saudi Arabian healthcare professionals, Bartlett and Coulson (2011) also investigated how social media affects health professional/patient communication; it was evidenced that social media contributes to suboptimal interactions and improves healthcare services. Hence, the study hypothesis is formulated as follows:

H2: Doctor-patient communication through social media usage positively affects healthcare delivery.

2.5. Information and guidance to patients

Social media has become increasingly essential for healthcare delivery competitiveness due to its growing communication effectiveness (Broom, 2005; Zenone et al., 2023). In recent times, social media has become an avenue for discussing health conditions outside of the healthcare providers’ offices. Househ (2013) stated that patients can join online communities where they can listen to physicians, read newsletters, and share experiences regarding particular medical conditions Past literature has established the link between social media and information channels for patients (Fogelson et al., 2013; Moorhead et al., 2013). For instance, Singh et al. (2016) concluded that social media provides platforms that can be used to share information and receive immediate feedback from patients. An empirical observation by Benetoli et al. (2017) confirmed a positive relationship between social media usage and healthcare competitiveness. It has been further stated that the usefulness of social media applications is positively associated with healthcare delivery services (Lu et al., 2020; Popat & Tarrant, 2023). Moreover, scholars have advocated the use of social media applications as a supplement tool to provide information and guidance to patients’ capacity management (Antheunis et al., 2013; Jent et al., 2011). Based on the aforementioned, the study hypothesizes that:

H3: Information and guidance to patients through social media usage would positively affect healthcare delivery.

2.6. Public relations

Singh et al. (2016) have acknowledged the significance of social media and its role in health organizations. It has been observed that social media networking sites, such as Facebook, Instagram, Twitter, WeChat, and Twitter can be utilized by health institutions to promote health programs, and health behaviors and to make health strategic decisions (Probst & Peng, 2018), which have a significant effect on better health outcomes (Cerci, 2017; Kanchan & Gaidhane, 2023). Thackeray et al. (2012) also highlighted the importance of social media in healthcare delivery and overall health program promotion. In addition, several studies have identified the direct effect of social media usage as a public relations tool on healthcare delivery. For example, Tha’er Majali et al. (2021) revealed that social media applications have enabled healthcare providers to communicate and create public awareness about diseases and prevention methods. The study focused on the Malaysian healthcare practitioners. It has also helped healthcare organizations to post information on disease treatments and other information of interest (Jiang et al., 2023; Shaw et al., 2017; Wang et al., 2022). Furthermore, Alkhateeb et al. (2011) demonstrated that social media has a positive impact on healthcare delivery, in terms of public relations and the doctor-patient relationship. Similarly, Hazzam and Lahrech (2018) found that social media plays a crucial and complementary role in providing health information to the general public. Therefore, based on the above discussion, it is evidenced that social media are positively related to health public relations, hence the following hypothesis is proposed (Figure 1):

Figure 1. Author proposed conceptual framework.

H4. Public relations through social media usage would positively affect healthcare delivery

3. Methodology

3.1. Respondents’ profile, method, and data collection

Although scholars have highlighted the essence of social media in the healthcare setting (Afful-Dadzie et al., 2023; Alkhwaldi, 2022), scanty empirical studies exist about how social media usage affects healthcare delivery services from the Ghanaian perspective (Egala et al., 2022; Martin-Yeboah et al., 2022). To execute and accomplish the research aims, the study used a quantitative research approach from a deductive inquiry perspective. The researchers sought to primary research approach. We utilized a cross-sectional research design for the present study. With this in mind, we sought to investigate social media’s influence on healthcare delivery, primarily focused on the health sector for its data collection. To achieve the main objective of this study, the authors adopted a non-randomized sampling technique, especially, convenience sampling to choose the study respondents/participants who readily volunteer the needed information for the data processing/analysis. According to Newsted et al. (1998), the survey approach is useful for gauging sentiments and patterns by gathering quantitative data. Specifically, the researchers developed a structured questionnaire administered among healthcare professionals particularly doctors, Physician Assistants, nurses, pharmacies, and records departments. The study adopted convenient sampling due to its recent usage in articles in the healthcare domain and grounded on the participants’ availability, quick data collection, low cost, and keenness to produce the required information needed to accomplish this study objective (Akafuah & Sossou, 2008; Amin et al., 2021; Ofori et al., 2021). In addition, official consent was sought and was deemed necessary for ethical consideration. The consent of the selected respondents was asked via email before carrying out the data collection.

The questionnaires were designed through Google Forms and distributed via participants’ emails and other social media networking sites (i.e. WhatsApp, Twitter, LinkedIn, etc.) to facilitate responses. Google Forms was restricted to avoid double responses in light of potential duplication in the online self-administration questionnaire. Since every question was required, no data gaps were noted (Amoah et al., 2021). The structured questionnaire was therefore administered to healthcare professionals who primarily utilized social media networks for healthcare-related services. The purpose of using healthcare professionals who use social media platforms in the data collection process was to generate results that will provide concrete evidence that would be helpful for both theory and practice. Before the main data collection, a pilot study with 50 respondents was conducted to test the variables and constructs involved in the study. To add more, the pilot study was deemed necessary to establish the reliability and validity of the constructs through the values of the Cronbach alpha. The pre-test assisted in shaping the final collection of questions for the survey instruments. As a result of the early pilot tests, the researchers were able to further improve the instrument’s validity and reliability. Cronbach’s alpha results were utilized for assessing the results for the primary questionnaire’s future improvement. All items in the questionnaire were logical since they all fell within the permissible reliability thresholds. Additionally, four months were used by the researchers to carry out data collection processes, between January and April 2023. Specifically, the respondents were informed not to indicate their details/particulars to ensure a high ethical standard. To run, analyze, and finalize the data (research model and its corresponding hypotheses), the researchers adopted a PLS-SEM partial least squares and structural equation modeling, specifically, the PLS 4.0 version of the software. The study adopted a PLS-SEM (Partial least squares and structural equation modeling) due to its possibility to evaluate very complex models and the method’s adaptability in terms of data requirements and measurement specification. Table 1 represents the information of the respondents’ information used in this current study. In all, 457 healthcare professionals were sampled for this study. Ahmad and Halim (2017) and Hair et al. (2013) discovered that a quantitative research sample ought to have at least 300 respondents for its data and processing. As a result, the study’s sample size of 457 respondents is consistent and deemed fit for the intended purpose.

Table 1. Background information of respondents.

Details	Groups	Frequency (N = 457)	Percentage 100%
Age	Below 30 years	121	26.48
	31–40years	145	31.73
	41–50years	105	22.97
	51 above	86	18.82
Gender	Male	278	60.83
	Female	179	39.17
Level of education	Cert/Diploma	205	44.86
	Degree	115	25.16
	Doctorate	90	19.69
	Others	47	10.28
Work experience	1–3 years	97	21.22
	4–6 years	162	35.45
	Above 7 years	198	43.33
Respondents categories	Doctors	89	19.47
	Nurses	172	37.64
	Physician Assistants	98	21.44
	Pharmacists	32	7.00
	Others	66	14.44

3.2. Constructs measurement

The authors of the study took inspiration from prior publications when developing the validity of the concepts. Hence, the study constructs, such as Crisis Management (Phengsuwan et al., 2021; Saroj & Pal, 2020), Patient-Doctor Communication (Bosslet et al., 2011; Daniel et al., 2018), Healthcare Delivery (Phengsuwan et al., 2021; San et al., 2013), Information and Guidance to Patients (Sillence et al., 2019), and Public Relations (Kelly et al., 2013; Sillence et al., 2019) were taken from previous works of literature. On a 5-point Likert scale, the questionnaire’s measuring items were evaluated (Anwar et al., 2015; Leung, 2011; Metzker et al., 2021). However, the researchers followed particular preparations and procedures in the design, testing, and administration of the questionnaires to extract precise and correct insights from the healthcare professionals. To elucidate more, the items in the questionnaire were well arranged, asked clear questions, and the use of better scale items (Podsakoff et al., 2003), were used to make it challenging for respondents to guess the survey’s results. To address this bias further, measurement items for independent and dependent variables were separated into different sections of the questionnaire (Krishnan & Lymm, 2016). The majority of the statements in the questionnaire asked respondents to rate how much they agreed or disagreed with each proposition.

3.3. Test of common method variance (CMV)

Since the current study utilized autonomous data collection, shared method variance is largely plausible. Respondents were ensured of safeguarding the data in their responses submitted throughout the questionnaire because the study addresses ethical norms in research. Bagozzi and Yi (1988) and Zhou et al. (2021) confirmed the presence of a common method variance (CMV) (CMB). This observation encouraged the researchers to create the questionnaire with a page for the title summary and to have full trust in the responses of participants. The questionnaire was intentionally developed with the opportunity for respondents or participants to withdraw their consent at any time after answering. To confirm the presence of common method variance (CMV), the researchers undertook a test of multicollinearity with the VIF (variance inflation factor). The after-hoc analysis assessment findings demonstrate that CMV is present in only a handful of instances because the thresholds are fewer than ten (10) specified by (Jordan & Troth, 2020; MacKenzie & Podsakoff, 2012). In the end, since the CMV issues identified throughout this survey are minor, they are not equally important. Other researchers have claimed that techniques for combating common method consequences can be classified as preventive, detective, or corrective. Preventive tactics, also known as procedural remedies, are methods for reducing or eliminating the occurrence of frequent method effects by incorporating characteristics into the conceptualization of the data collection instrument (Kock et al., 2021; Podsakoff et al., 2003; Viswanathan & Kayande, 2012). Detective techniques try to notify researchers of the presence of common method bias, but they are unable to quantify its extent or produce revised estimates that have been ‘purified’ from the impacts of shared procedures. The most frequent of them is ‘Harman’s Single-Factor Test’, which is also employed in this study. It is critical to notice and emphasize in this study that there was no common method bias in this data because the total variance recovered by one component was less than the recommended threshold of 50%.

4. Empirical results

4.1. Assessment of model appropriateness

The Partial Least Square-Structural Equation Modeling (PLS-SEM) applicability literature of scholarly articles (Hair et al., 2017, 2019) served as a stimulus for the researchers as they extensively tested the constructs’ reliability and validity using Dijkstra-rho Henseler’s with Cronbach alpha values (Kock et al., 2021). PLS-SEM version 4.0 was utilized to evaluate the constructs’ cognitive properties. The composite reliability of the constructs likewise suggests that Jöreskog’s Rho (pc) and the Cronbach Alpha reliability values accomplish the required minimum and maximal standards of 0.7 and 0.8, as well, as shown in Table 2 below. As suggested in Table 2, the average variance extracted (AVE), or convergent validity, had a predetermined threshold of 0.5 above, and the Cronbach alpha reliability values for the constructs of the coefficients were 0.759 and 0.820.

Table 2. Test of validity and reliability of research construct.

Constructs	Dijkstra-Henseler’s rho (ρA)	Jöreskog’s rho (ρc)	Cronbach’s alpha (α)	The average variance extracted (AVE)
Crisis Mgt	0.762	0.861	0.759	0.674
Pat-Doc Comm.	0.768	0.851	0.767	0.589
Healthcare Deliv.	0.802	0.871	0.801	0.627
Info. and Guid. patient	0.823	0.881	0.820	0.650
Public relations	0.797	0.865	0.793	0.616

Source: Author’s processing from PLS-SEM version 4.0.

Per Zhou et al. (2021), it’s crucial to make sure that all of the constructs’ factor loadings have been thoroughly investigated and loaded to suitable locations. Therefore, the current study examined checking to see if such an assumption is true. As a result, Table 3 below demonstrates that the indicators were effective by satisfying the premise with a threshold of 0.6. Additionally, the lowest and maximum loadings of the used constructs have been identified with the values 0.746 and 0.825, respectively. While testing the variance inflation factor (VIF), the researchers were also particularly intrigued by the subject of multicollinearity and employed the common method variance (CMV) to find it. The variance inflation factor of the numerous indicators used below is less than the maximum threshold of ten, according to several studies (Attor et al., 2022; Bruce et al., 2023), proving overall common method variance is not something to worry about (see Table 3 below).

Table 3. Construct items, loading, and variance inflation factor (VIF).

Construct	Indicator/measurement of operationalization	Loading	VIF
Crisis management	CM1: It helps in information dissemination	0.825	1.495
	CM2: An avenue for public participation to provide timely responses	0.819	1.630
	CM3: Gauge the overall health of the public, and spread messages and awareness	0.819	1.501
Patience-doctor communication	PDC1: Social media communicates more effectively.	0.757	1.486
	PDC2: It improves patient education	0.746	1.421
	PDC3: Enables medical professionals to manage more patients	0.769	1.520
	PDC4: Aids in keeping track of patient’s health and enhancing treatment compliance	0.796	1.597
Healthcare delivery	HCD1: Social media helps in quality health care via its platforms	0.748	1.450
	HCD2: It helps in emergency management & and preparedness.	0.822	1.772
	HCD3: Enhancement in participatory medicine	0.812	1.811
	HCD4: Allows physicians to handle a larger number of patients	0.785	1.450
Information and guidance to patients	IGP1: In my view, social media has created a platform for information sharing and assistance to patients	0.823	1.862
	IGP2: Information shared is confidential between patient-health care professionals.	0.808	1.777
	IGP3: Doctor-patients use social media as a channel to get feedback.	0.820	1.707
	IGP4: It serves as a means of advice	0.772	1.575
Public relations	BD1: There are opportunities to interact with healthcare professionals on various SM platforms	0.798	2.9831
	BD2: Awareness can be created through Social media	0.784	2.5374
	BD3: It serves as a medium for public education.	0.792	2.6430
	BD4: Reassures patient about the disease	0.765	3.2220

Source: Author’s processing from PLS-SEM version 4.0 software.

The discriminant validity of the variables employed in a study must be assessed. To be sure of this, Hair et al. (2019) encouraged the researchers to use the Fornell and Larcker (1981) criterion to identify the latent variables of the discriminant validity. The information in the table below, which also displays the average variance retrieved, indicates that each of the values on the diagonally arranged, including 0.821, 0.767, 0.792, 0.806, and 0.785, appropriately satisfy the required threshold specifications of above 0.5 as the starting point for its assessment. Considering the Fornell-Larcker criteria’s necessity that the Average Variance Extracted (AVE) have greater values than the other constructs, as shown in the discriminant validity table below, the fundamental and substantial parameters of the study constructs were established (Fornell & Larcker, 1981). Table 4 below depicts discriminant validity measurement through the usage of Fornell Larcker.

Table 4. Discriminant validity using Fornell Larcker.

Constructs	CM	PDC	HDC	IGP	PC
Crisis management	0.821
Patience-doctor communication	0.694	0.767
Healthcare delivery	0.730	0.709	0.792
Information and guidance to patients	0.769	0.763	0.720	0.806
Public relations	0.762	0.723	0.699	0.793	0.785

Source: Author’s processing from PLS-SEM version 4.0.

Note: The diagonal bold values are the square root of the average variance extracted.

4.2. Hypothesis testing—PLS-SEM

The model’s fit was evaluated in light of the trajectory analysis, sometimes referred to as structural modeling. At this stage in the analysis, the researchers evaluated the model and then transitioned to structural modeling to look at possible relationships between constructs (Hair et al., 2019, 2020). The statistical estimations were calculated using the significant values; T-values > 1.96 (or p-values 0.05) of the research constructs and the regression coefficients (β). Four hypotheses were also investigated. To be clear, three of the proposed hypotheses had a positive association with the result of the variable (healthcare delivery), whereas one did not. Furthermore, the findings demonstrated the correlation coefficient of determination-R² (predictive power) for the conceptual framework (namely, the dependent variable). The coefficients show the percentage of variance in the dependent variable that the independent variable explains. According to the table below, predictive variables explain 62% of healthcare delivery (see Table 5 and Figure 2 correspondingly).

Figure 2. Estimated research model.

Source: Authors’ processing form PSL-SEM software.

Table 5. Hypothesis testing.

Effect	Beta (β)	Standard bootstrap results
		Mean value	Standard error	t-Value	p-Value (2-sided)	Decision
Direct effect
H1: CM->HDC	0.312	0.309	0.069	4.517	0.000	Agreed
H2:PDC->HDC	0.264	0.265	0.072	3.680	0.000	Agreed
H3: IGP->HDC	0.174	0.174	0.074	2.355	0.019	Agreed
H4: PR->HDC	0.133	0.135	0.080	1.666	0.096	Not Agreed
Construct	Coefficients of determination (R^2)			Adjusted R^2
Healthcare delivery	0.632			0.628

Source: Author’s processing from PLS-SEM version 4.0 software.

5. Discussion of results

The global diffusion of information has changed during the last few decades as a result of technological development. Healthcare providers have recognized the value of social media in their delivery system since its inception. The healthcare delivery system is designed to offer patients secure, accessible, inexpensive, and high-quality healthcare services (Casella et al., 2014). Healthcare delivery has transformed as a result of the usage of new medical technologies, such as social media. For instance, telemedicine tools and technology are currently applied to patient management and public education (Hollander & Carr, 2020). Given the presence and benefits of social media space within the healthcare system, this study seeks to investigate how 21st-century technology (social media) influences healthcare delivery from the perspectives of a developing or emerging economy, specifically Ghana. The study put forth four hypotheses targeted at reaching the study’s objective after conducting a thorough literature analysis under the direction of the social media engagement theory (SMET). The analysis provides empirical evidence regarding the influence of social media on healthcare delivery. Out of the four hypotheses formulated, three of them were significant while one of them was insignificant. Based on the results generated, the first hypothesis which states that: Crisis Management through social media usage would positively affect healthcare delivery is supported. Based on the research conducted by Al-Dmour et al. (2020) and Kavota et al. (2020), it can be inferred that social media has emerged as a medium for delivering healthcare services. According to Kavota et al. (2020), social media have a crucial role in managing crises and have a substantial impact on healthcare delivery. Consistent with Egala et al. (2022), the COVID-19 pandemic significantly influenced the provision of healthcare due to the substantial impact of health information disseminated through social media. This confirms that social media, as a contemporary technology, enables the effective handling of crises in the healthcare industry. The findings reinforce the justification for the widespread use of social media and other social networking platforms by healthcare facilities and centers to express their viewpoints during crisis management, both during and after evaluating healthcare situations. Social media serves as a valuable instrument for addressing the health needs of both individuals and populations. Social media platforms facilitate communication among groups and individuals, allowing them to discuss many subjects and issues, including those that impact people of colour or persons who are unable to voice their opinions through traditional media (Kouri et al., 2017; Laranjo et al., 2015).

According to Srimarut and Techasatian (2019), social media is now a crucial tool for determining and identifying a patient’s condition. Social media use is significant enough for managing emergencies and facilitating doctor-patient communication. Following this, the study hypothesized that H2: Doctor-patient communication through social media usage positively affects healthcare delivery. Studies, such as Ineji and Ogar (2021) and Shah et al. (2019) have affirmed this hypothesis. The present revelation aligns seamlessly with a well-entrenched tenet within the healthcare milieu. The assertion that social media integration facilitates enhanced communication between patients and healthcare practitioners finds empirical validation. Ostensibly, the utilization of social media emerges as a transformative force, simplifying and enriching communication channels between patients and medical professionals. This phenomenon assumes particular significance in emergency management, substantiating its pivotal role in the sphere of healthcare communication. Building upon this premise, the scholarly discourse, exemplified by Bell et al. (2017), underscores the paramount importance of efficient communication in discerning and addressing patient needs. The advent of social media, with its facilitation of two-way contact, engenders positive interactions between patients and medical providers in line with the literature (Nair et al., 2022; Townsend et al., 2015). The strategic use of social media becomes imperative in cultivating enhanced relationships between doctors and patients, constituting a multifaceted approach to disseminating health information to the broader public. According to Nair et al. (2022), social media enables doctors to provide patients with precise health information and medical advice. Relatedly, healthy relationships are a crucial component of providing healthcare, which is why there is a link between using social media and having a good relationship with your doctor’s patients. The intricate interplay between social media usage and the quality of doctor-patient relationships underscores the symbiotic nature of modern communication tools in shaping the fabric of healthcare provision (Afful-Dadzie & Egala, 2022).

Relative to the effect of social media on its influence on healthcare delivery, the result was in support of the hypothesis that H3: information and guidance to patients through social media usage would positively affect healthcare delivery. This assertion has been affirmed by previous studies (Amoah et al., 2021; Naslund et al., 2016; Scanfeld et al., 2010; Wang et al., 2022). The increasing efficacy of social media in communication highlights its growing necessity in the competitive realm of healthcare delivery. In affirmation of the proposition, Egala et al. (2022) explain the current evolution of social media as a dynamic platform for discussing medical topics, going beyond the usual boundaries of therapeutic contacts. While patients participate in online platforms aided by social media, they may access a plethora of scholarly and expert opinions and engage in discussions related to specific medical issues. Furthermore, social media platforms facilitate the effortless dissemination of information and prompt gathering of patients’ feedback, by the viewpoints expressed by Bond and Ahmed (2016) and Lu et al. (2020). The collaborative aspect of social media is emphasized by how healthcare professionals and people use its tools to share their findings and knowledge with others facing similar medical issues. This cooperative sharing of knowledge corresponds to the conclusions expressed by Bond and Ahmed (2016) and Naslund et al. (2016). Nevertheless, a more subtle viewpoint arises, contradicting the claims made by Bond and Ahmed (2016) and Naslund et al. (2016). On the other hand, the argument suggests that using social media for online conversations plays a crucial role in enabling medical experts to propose different treatment alternatives and spread important medical information (Egala et al., 2022).

On the contrary, the proposition that public relations through social media usage would positively affect healthcare delivery was not supported. This finding contravenes the results of (Kanchan & Gaidhane, 2023; Singh et al., 2016). Respondents were of the view that social media in its current frame cannot be used as a vessel for public relations in achieving healthcare delivery. The growing importance of social media and its function in health organizations has been recognized by numerous research. Typically, health organizations can use social networking websites like Facebook, Instagram, Twitter, WeChat, and Twitter to highlight health programs, and healthy practices, and to make tactical patient decisions that can significantly impact achieving better health outcomes. Social media has been validated (Pianese & Belfiore, 2021) in their review of social networks’ use in healthcare delivery as an efficient tool for healthcare professionals’ public relations (Egala et al., 2022; Tha’er Majali et al., 2021). Furthermore, the scholarly inquiry by Baird et al. (2019) delves into the utilization of social media by healthcare practitioners in Australia and New Zealand, focusing specifically on otolaryngologists. Their empirical investigation substantiates the assertion that the incorporation of social media significantly influences healthcare promotion within this specialized medical domain. The divergence of findings underscores the multifaceted impact of social media, not only as a strategic communication tool for health organizations but also as an instrumental force in shaping healthcare professionals’ public relations and promotional endeavors.

5.1. Implications

This study sought to investigate the impact of social media usage on the healthcare delivery system in a less digitalized economic context. Specifically, the study explores how social media impacts the healthcare sector relative to improving patient-physician relationships. This study comes with several implications. Empirically, this study advances the literary argument that leveraging social media in healthcare settings within less digitalized economies can significantly enhance crisis management. This study contributes to the existing body of knowledge on the importance of using social media to share up-to-date information, particularly during times of emergency. Existing studies confirm that social media has emerged as a powerful tool for disseminating information during pandemics and natural occurrences. The ultimate effect is to enhance the accessibility of information by enhancing the overall provision of healthcare services during emergencies. Once more, this study offers proof that social media enhances doctor-patient interactions. In essence, social media enhances doctor-patient connection, highlighting the potential advantages of integrating these platforms into healthcare delivery systems. Hence, medical practitioners and individuals seeking medical advice can utilize social media platforms to share knowledge, address inquiries, and help, thereby potentially resulting in patients who are better informed and content. Therefore, contributes to the existing empirical understanding of how social media might be used to manage healthcare delivery. This study further emphasizes the need to utilize social media platforms to disseminate information and offer guidance to patients. This highlights the necessity for social media and healthcare providers to create educational content and tools on social media platforms to empower individuals with health information, ultimately leading to improved healthcare results. While the study results challenged the idea that public interactions on social media affect healthcare delivery, this study argues that social media is an effective platform for promoting the timely distribution of health information. Ensuring a favorable internet image is crucial, but its influence on healthcare provision is just as significant as other aspects, such as communication and crisis handling.

The theoretical contribution of this study lies in the extension of the Social Media Engagement Theory, particularly in unexplored terrain within the healthcare setting. Validated by empirical findings, the study addresses a significant gap in the literature by demonstrating the applicability of the social media engagement theory in the less digitalized economies of the healthcare sector. The investigation reveals that social media engagement, specifically in crisis management, doctor-patient communication, and patient education, exerts a positive influence on the healthcare delivery system. Importantly, the research elucidates that not all facets of social media usage exert equivalent impacts on healthcare outcomes. It advocates for future research to discern and categorize various functions of social media, such as information dissemination, communication, and public relations, to unravel their distinct influences on healthcare delivery. Furthermore, the study underscores the pivotal role of economic and digitalization contexts. It accentuates that the influence of social media on healthcare delivery is contingent upon the levels of digitalization and economic development in a given region. This nuanced understanding becomes imperative for the formulation of healthcare policies and strategies, emphasizing the need for tailored approaches based on the specific economic and digitalization landscape of the targeted region. Furthermore, the study contributes to the theoretical framework by expanding the application of the social media engagement theory to healthcare contexts, while also advocating for a nuanced examination of social media’s multifaceted functions and recognition of contextual variables in shaping healthcare policies.

From a practical standpoint, this study offers a tangible strategy for optimizing the use of social media within healthcare settings, thereby fostering enhanced healthcare outcomes. The findings present actionable insights for healthcare organizations operating in less digitally advanced economies, providing a roadmap for the strategic integration of social media into their operational frameworks. Key focal areas include crisis management, doctor-patient communication, and patient education. The practical implications encompass the establishment and maintenance of official social media profiles, the provision of training for healthcare professionals to enhance their online communication skills, and the development of tailored content addressing specific patient needs. While emphasizing the importance of a robust information dissemination mechanism, the study underscores the critical need for allocating necessary resources to fortify social media utilization in healthcare operations. Furthermore, the study advocates for a nuanced approach that accentuates functions directly enhancing healthcare delivery, striking a balance between online image cultivation and substantive improvements in patient care. The framework proposed aligns with the necessity for healthcare providers to customize their social media strategies, accounting for the unique needs, preferences, and challenges inherent in less digitally advanced economies. This may involve content delivery in local languages, ensuring accessibility for individuals with limited digital literacy, and addressing privacy concerns. Beyond organizational considerations, the study extends its practical contributions to guide policymakers and healthcare regulatory bodies. The insights derived from the study serve as a foundation for the development of comprehensive guidelines and regulations governing the ethical and responsible use of social media in healthcare delivery, particularly in regions with limited digital infrastructure. These guidelines aim to harness the benefits of social media while ensuring its ethical and responsible deployment for the mutual benefit of patients and healthcare providers.

5.2. Conclusion

There is evidence that social media has blossomed into a cutting-edge, competitive tool for healthcare professionals that enables them to concentrate on patients while tracking their physical health, changing their eating habits, undergoing cardiac rehab, and managing health crises. The purpose of this study was to revisit the driving factors of social media on healthcare delivery. Grounded on the social media engagement theory (SMET), the driving factors of social media were measured quantitatively. This study gathered data from 457 healthcare professionals made up of Doctors, Nurses, Physicians Assistants, and Pharmacists among others from both government and private health facilities. Following the four hypotheses generated, it came out that crisis management, patient-doctor communication, and information and guidance through social media have significant and positive impacts on healthcare delivery. Nonetheless, no relationship was found between the usage of social media for public relations and healthcare delivery. To analyze the data gathered, the partial least square structural equation model (PLS-SEM) was adopted in this study.

5.3. Limitations

This study has several restrictions. The study’s findings may only apply to a specific period or region. This is to say, the context from which the study was conducted may be limited to extrapolating and generalizing the conclusions. Hence, an extension of the study and or a comparative analysis with other contexts should be considered in future studies. The underlying relationships may differ across divisions and nations or perhaps lose their significance over time because this study is a cross-sectional survey. Again, to demonstrate how social media can enhance healthcare delivery in a cross-cultural setting, more research is required. Neglecting patients in the data collection also poses a limitation to this present study. Thus, studies that are patient and perhaps both patients and physicians could offer a comprehensive understanding of the phenomenon in future studies. Furthermore, the dynamics of social media are fast changing given its multiplicity nature. While, this study focused on just the information distribution segment, perhaps future studies could explore the phenomenon using a multi-attribute decision-making approach.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data will be made available upon the request of the editor subject to the approval of the research respondents.

Additional information

Notes on contributors

Emmanuel Bruce

Emmanuel Bruce is a Doctoral researcher at the University of Electronic Science and Technology of China, Chengdu-China, School of Management and Economics. Emmanuel has been in the research domain for the past three years and the results of his research have been published in high-ranked respected journals. He also serves as a reviewer for some respected journals around the globe. His main research areas are SME development, social media Analysis, and Service Marketing among others.

Zhao Shurong

Dr. Zhao Shurong is a Professor at School of Public Affairs and Administration of University of Electronic Science and Technology of China (UEST C), and Director of Center for West African Studies of UEST C. She serves as the Deputy Executive Editor in Chief for Management Science as well as Council Members for Chinese Society of African Historical Studies, the “Belt & Road” African Studies Alliance and Chinese Society for Asian and African Studies. The results of her research have been published in peer-reviewed scientific journals and presented at numerous international conferences around the globe.

John Amoah

John Amoah holds a Doctoral degree in Marketing Management from the Tomas Bata University, Zlin Czech Republic, Faculty of Management and Economic Department. He currently lectures at KAAF University College, Kasoa, Ghana, with the Department of Marketing and Human Resource Management. His main research areas are SME development, Social media Analysis, and Service Marketing among others. The results of his research have been published in peer-reviewed scientific journals.

Sulemana Bankuoru Egala

Sulemana Bankuoru Egala is a lecturer with the Department of Informatics, Faculty of ICT at the Simon Diedong Dombo University of Business and Integrated Development Studies (SDD-UBIDS), Wa, Upper West, Region, Ghana. His current research interests include health informatics, data mining, service quality, and social business analysis and have published papers in peer-reviewed scientific journals.

Francis Kofi Sobre Frimpong

Dr. Francis Kofi Sobre Frimpong holds a Ph.D. in Accounting and Finance from the Open University of Malaysia. Currently, he serves as a Dean of the Faculty of Business Administration and doubles as a Lecturer at KAAF University College, in Central Region-Ghana. He has published in high-ranked journals. Since 2011, he worked with Elitrust Fincone Ltd as a lead consultant on key assignments on Micro, Small & Medium Enterprises (MSME) development. He has also served as a key member in executing several high- profile projects in business development, business advocacy, capacity building, and training for international development partners and institutions including the World Bank, DANIDA, The EU, USAID, DFID, the Netherlands development organization, SNV, techno serve, GIZ, etc.