Mpox on Instagram: A content analytic study (Preprint)

<sec> <title>BACKGROUND</title> Mpox was declared a public health emergency of international concern in 2022. Instagram is widely used by age groups and communities disproportionately affected by mpox, yet platform-specific evidence on mpox information characteristics and engagement is limited. </sec> <sec> <title>OBJECTIVE</title> To characterize sources, content, and engagement features of mpox-related Instagram posts, to describe prevention and treatment framing, and to compare the top 10% most-liked posts with the remaining corpus. </sec> <sec> <title>METHODS</title> We retrieved English-language public Instagram posts via CrowdTangle containing “mpox” or “monkeypox” dated May 5, 2022 to January 17, 2023 (initial N=18,616). Using a pretested, deductive codebook adapted from prior Instagram health studies, two coders completed two pilot rounds; variables with low agreement were excluded. Interrater reliability across retained variables showed mean κ=0.70 (median κ=0.83). A randomized analytic sample of N=1,000 posts was coded for source type, content features, and prevention/treatment framing. Descriptive statistics were computed. For engagement contrasts, we compared the top 10% most-liked posts with the bottom 90% using tests of differences in independent proportions (mean differences [MD] with p-values). </sec> <sec> <title>RESULTS</title> Most posts originated from organizations (76.0%) versus individuals (24.0%). Organizational sources most commonly included businesses (57.4%) and news/media outlets (52.8%); government (22.9%), nonprofits (17.3%), and health-care organizations (9.2%) were less frequent. About one-third of posts cited a source (34.4%), most often the WHO and CDC/other federal entity. Posts predominantly used illustrated images/infographics (82.7%); photos appeared in 47.3% and videos in 12.4% of posts. Prevention content appeared in 38.4% of posts, most commonly vaccination (68.5% of prevention posts), followed by avoiding close contact (14.5%), avoiding contact with objects (8.3%), abstaining from sexual activity (7.6%), and condom use (1.3%); 28.9% of prevention posts noted barriers. Treatment mentions were uncommon (2.5% traditional biomedical; 0.2% alternative). Compared with the bottom 90%, the top 10% most-liked posts: 1) were more likely to originate from public figures/celebrities among individuals (MD=-0.591; p&lt;.001) and from businesses (MD=-0.299; p&lt;.001) or news/media (MD=-0.350; p&lt;.001) among organizations; 2) were less likely to be from government, nonprofit, or health-care organizations (all p&lt;.01); and more often included non-moving images (MD=-0.119; p&lt;.05), visible lesion depictions (MD=-0.081; p&lt;.05), prevalence mentions (MD=-0.180; p&lt;.001), and citations (MD=-0.162; p&lt;.01). </sec> <sec> <title>CONCLUSIONS</title> During the initial outbreak period, highly engaged mpox content on Instagram skewed toward posts by public figures and news/business accounts and toward static, citation-bearing visuals that included prevalence context and occasionally lesion imagery. Public-health communicators seeking reach on Instagram should prioritize clear static infographics with explicit source citation and epidemiologic context and consider co-publishing with trusted creators and news outlets, while addressing access barriers highlighted in prevention posts. </sec>

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