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The 'Memeification' of Sexual Health Communication on Instagram

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Title: The 'Memeification' of Sexual Health Communication on Instagram
Language: English
Authors: Andrew Porter (ORCID 0000-0001-8315-7932), Spring Cooper, Ashley Falcon (ORCID 0000-0001-5936-5176), Megan Piller, Ritika Modi, Emily Hawver
Source: Sex Education: Sexuality, Society and Learning. 2025 25(2):221-237.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 17
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Descriptors: Social Media, Photography, Visual Aids, Handheld Devices, Health Education, Public Health, Sex Education, Health Promotion, Mass Media Role, Evidence Based Practice, Humor, Popular Culture, Internet, Social Attitudes, Information Dissemination, Audio Equipment, Electronic Publishing, Mass Media Effects
DOI: 10.1080/14681811.2023.2300069
ISSN: 1468-1811
1472-0825
Abstract: The lack of accurate and comprehensive sexual health education in the USA persists as a pressing public health issue. The Sex Wrap (TSW) is a multimedia sexual health podcast and social media presence that educates followers on sexual health and ancillary themes such as sexuality, relationships and communication. TSW's Instagram account repackages the evidence-based sexual health information discussed during the podcast into Internet memes. We analysed the top-performing TSW posts from Jan 2019-Dec 2020 according to Instagram's engagement metrics to determine what type of posts were most interesting to followers and begin to understand how social media helps drive interventions. The meme-based sexual health intervention via TSW's Instagram increased engagement, improved reach, and converted followers to podcast listeners. Insight data demonstrates how social media can address the sexual health education disparities caused by the failure of abstinence-only-until-marriage (AOUM) curricula. This case study exhibits how social media-based interventions can comprehensively fill existing gaps in sexual health education.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1466692
Database: ERIC
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  Value: <anid>AN0183055793;bf401mar.25;2025Feb18.03:58;v2.2.500</anid> <title id="AN0183055793-1">The "memeification" of sexual health communication on Instagram </title> <p>The lack of accurate and comprehensive sexual health education in the USA persists as a pressing public health issue. The Sex Wrap (TSW) is a multimedia sexual health podcast and social media presence that educates followers on sexual health and ancillary themes such as sexuality, relationships and communication. TSW's Instagram account repackages the evidence-based sexual health information discussed during the podcast into Internet memes. We analysed the top-performing TSW posts from Jan 2019-Dec 2020 according to Instagram's engagement metrics to determine what type of posts were most interesting to followers and begin to understand how social media helps drive interventions. The meme-based sexual health intervention via TSW's Instagram increased engagement, improved reach, and converted followers to podcast listeners. Insight data demonstrates how social media can address the sexual health education disparities caused by the failure of abstinence-only-until-marriage (AOUM) curricula. This case study exhibits how social media-based interventions can comprehensively fill existing gaps in sexual health education.</p> <p>Keywords: Sexual health; sexual health education; social media; memes; meme communication; sexual minorities</p> <hd id="AN0183055793-2">Introduction</hd> <p>In the USA, heteronormative abstinence-only-until-marriage (AOUM) sexual health education limits access to inclusive and accurate sexual health information for adolescents (Keiser, Kwon, and Hobaica [<reflink idref="bib13" id="ref1">13</reflink>]). AOUM sexual health education curricula not only neglect to provide information for gender and sexual minority groups but also fail to acknowledge pregnant individuals or those who have experienced sexual assault, contributing to an extensive web of stigma and discrimination (Santelli et al. [<reflink idref="bib25" id="ref2">25</reflink>]). This type of curriculum also leaves expansive knowledge gaps in relation to issues of contraception, STI diagnosis and treatment, and the relationship between sexual and mental health (Santelli et al. [<reflink idref="bib25" id="ref3">25</reflink>]). Across the USA, 29 states require that abstinence be stressed in sexual health education, four states require that only negative or discriminatory information be provided about homosexuality and same sex relationships, and only 11 states require that issues of consent be addressed, highlighting the far-reaching negative effects of AOUM curriculum (Guttmacher Institute [<reflink idref="bib9" id="ref4">9</reflink>]).</p> <p>Apart from failing institutionalised sexual health education – focusing primarily on the AOUM curriculum – young people place the most trust in the sexual health information they receive from people they have close relationships with, such as family members and friends (Jones and Biddlecom [<reflink idref="bib12" id="ref5">12</reflink>]). These relationships are often forged within, and strengthened through, the use of social media, especially for 14- to 29-year-olds, as evidenced by the amplification of peer-to-peer interactions described by Nesi, Choukas-Bradley, and Prinstein ([<reflink idref="bib21" id="ref6">21</reflink>]). The sexual health education curriculum needs to be tailored for the habits and environments of individuals, notably social media use, which has emerged as a modern classroom for sexual health education. A systematic review of social media's role in sexual health promotion by Gabarron and Wynn ([<reflink idref="bib8" id="ref7">8</reflink>]) supports the idea that those in need of sexual health education can be reached via social media platforms and reaffirms the effectiveness of social media in advancing a comprehensive sexual health education agenda.</p> <p>To help address the problems created by AOUM sexual health education, and account for the emerging importance of social media in the realm of sexual health education, Andrew Porter and Spring Cooper created The Sex Wrap (TSW) in 2016. TSW is a free multimedia podcast and social media presence that educates followers on sexual health using listener-submitted questions. The podcast provides credible, evidence-based information consistent with the guidelines developed by the Sexuality Information and Education Council of the United States (SIECUS). These guidelines engage with six main concepts: human development, relationships, personal skills, sexual behaviour, sexual health, and society and culture (SIECUS [<reflink idref="bib27" id="ref8">27</reflink>]).</p> <p>TSW has more than 200 episodes averaging 30 minutes each, which can be listened to individually or as a continuous conversation depending on the interests of the listener. Episodes answer listener-submitted questions that cover topics related to 'anything you were too afraid to ask at home, too embarrassed to ask at school, or was just too hard to ask your partner' (Porter and Cooper [<reflink idref="bib23" id="ref9">23</reflink>]). When the podcast began, questions were submitted by undergraduate students at The University of Miami. However, as the podcast has grown, questions have come to be submitted by listeners and social media followers through TSW Google Voice line, social media direct messages, and email.</p> <p>The podcast aims to create an ongoing dialogue between the hosts and listeners which is designed to equip TSW's listenership with the skills required to broach sexual health-related conversations with friends, family, and sexual or romantic partners. The camaraderie between the podcast's hosts and its conversational tone strike a similar rapport to that which a listener might build with a close friend to enhance listener comprehension and level of trust listeners place in the validity of the information (Thackeray, Neiger, and Keller Rosemary,Neiger, and Keller [<reflink idref="bib24" id="ref10">24</reflink>]). Parasocial interaction in TSW creates a sense of closeness between listeners and podcast creators is akin to friendship, although it is mostly one-sided as it is the media users who develop feelings of connection with media personas (Horton and Wohl [<reflink idref="bib6" id="ref11">6</reflink>]). TSW enhances this relationship by regularly posting relatable content, sharing personal stories, and encouraging interaction, allowing followers to engage with sexual health topics privately and comfortably.</p> <p>The podcast's initial growth led to a new interventional arm through the use of social media. TSW's social media accounts include Facebook, Twitter/X, TikTok, and TSW's most popular account, Instagram. These accounts have grown over time. As of December 2023, TSW's Instagram account has the most expansive following of over 43,500 people and the highest levels of engagement; it therefore forms the focus of this study's social media analysis. The account repackages the podcast's sexual health information as original or reposted content, utilising a consistent branding format, to create a sense of community, and to promote parasocial relationships cultivated through social media. Branded content provides the account with a consistent and recognisable aesthetic to help foster a sense of community and contribute to perceived legitimacy (Rosemary, Neiger, and Keller [<reflink idref="bib24" id="ref12">24</reflink>]). Editable meme and quote templates help standardise original content, making TSW identifiable and accessible to users in the oversaturated world of social media.</p> <p>The rise of social media use in recent decades has led to the creation and implementation of Internet memes. Memes are an intuitive form of online communication, employing media (usually images or GIFs) to capture a relatable sentiment paired to a specific situation to create spreadable humour (Yus [<reflink idref="bib32" id="ref13">32</reflink>]). Dawkins ([<reflink idref="bib5" id="ref14">5</reflink>]) has identified three main meme characteristics: (<reflink idref="bib1" id="ref15">1</reflink>) fidelity, i.e. meme transmission without altered content; (<reflink idref="bib2" id="ref16">2</reflink>) fecundity, i.e. a high rate of information spread; and (<reflink idref="bib3" id="ref17">3</reflink>) longevity, i.e. meme capacity for survival in a chained spreading process. Internet memes, a driving force among TSW's target audience (ages 14–29) at both a micro and macro level, disseminate robust sexual health information and differ slightly from Dawkins' original description of memes by their ability to be altered by individual viewers (Byron, Albury, and Evers [<reflink idref="bib3" id="ref18">3</reflink>]; Shifman [<reflink idref="bib26" id="ref19">26</reflink>]). Meme virality and alteration expand Instagram's reach beyond TSW's followership.</p> <p>TSW employs text-image (Twitter/X format) memes, a simple template containing a text box at the top of an image, short video, or gif that triggers an empathetic connection with the content through humour facilitating engagement by means of memes linked to users' social identities. Twitter/X format memes apply text phrases that candidly interact with user identity in the first person (e.g. 'me when I ... '). This identity-level connection aims to expand TSW's reach (the number of unique users who saw the post) in a distinctly personalised manner by curating and disseminating content designed to deeply resonate with users' lived experiences (Yuhao, Aamir Masood, and Joseph [<reflink idref="bib31" id="ref20">31</reflink>]).</p> <p>This study utilised with the rich data reservoir of TSW's Instagram account to understand user engagement with sexual health content. Data were collected and analysed from 213 posts using Instagram's built-in analytics. We extracted metrics on engagement, audience demographics, and post characteristics. We also conducted a content analysis of the memes to categorise them into eight prominent themes.</p> <p>To address the prevalent inadequacy in sexual health education within the USA, TSW ventures into a novel terrain by integrating the reach of social media, specifically Instagram, with the depth of podcast content, presenting sexual health topics in a relatable meme format. In this paper, our central argument revolves around analysing the efficacy of this strategy in bridging the sexual health knowledge gap. Drawing on data from TSW's most engaging Instagram posts, we aim to shed light on the potential of digital interventions, particularly social media, to redefine and enhance sexual health education through the use of memes.</p> <p>As we analyse TSW's approach and its outcomes, we recognise that the integration of memes and educational podcasts, as utilised by TSW, is reflective of broader trends in health communication. While the strategy we describe is not entirely novel, TSW's specific implementation offers unique insights into its effectiveness. By examining TSW's distinctive methods of meme creation and audience engagement, this case study contributes to the understanding of multi-channel models in sexual health education.</p> <hd id="AN0183055793-3">Materials and methods</hd> <p>TSW's Instagram account has over 42,000 followers. For a free online sexual health intervention, the audience is large, signifying broad outreach and the potential to influence many individuals. This large following underscores the relevance and appeal of TSW's content and positions it as an excellent platform for collecting comprehensive and engagement data. Instagram followers are platform users who have chosen to connect to another Instagram account. When a user follows an account, they automatically receive updates in their feed from that account, meaning they see the posts and stories the account shares. Followers are essentially subscribers to an organisation's content; the number of followers an account has provides an indication of its popularity, reach and influence.</p> <hd id="AN0183055793-4">Data collection</hd> <p>We collected data on posts uploaded to TSW Instagram account between 19 January 2019, and 4 December 2020 (no posts coincided with university breaks between June 2019 and August 2019, and between July 2020 and September 2020). 213 total posts were analysed, with 122 of those posts being TSW's standardised meme format.</p> <hd id="AN0183055793-5">Post selection</hd> <p>Engagement data was collected for TSW posts uploaded between 19 January 2019, and 4 December 2020. Then, the top two performing posts were selected based on the number of likes reported in Instagram metrics – from each week of the study period and recorded metrics on these posts.</p> <hd id="AN0183055793-6">Instagram metrics</hd> <p>Research assistants gathered 'engagement' data, including weekly activity and audience metrics from TSW's Instagram account, separated into three categories: content interaction, profile activity, and discovery. These metrics and their categorical groupings were pulled from Instagram's creator portal and were not created by the research team. The metrics were averaged by post type. Content interaction refers to individual posts and consists of likes, comments, shares, and saves. Profile activity pertained to posts stimulating interaction with TSW's Instagram profile quantified by profile visits, web clicks, and followers; TSW exhibited consistent follower growth with a 1.5% average weekly increase from January 2020 to April 2020 (Figure 1). Discovery referenced the posts' overarching ability to reach new people, evaluated by reach, percent following, and impressions.</p> <p>Graph: Figure 1. Weekly Instagram reach, interactions, and follower total insights from January to April 2020.</p> <p>Two-tailed independent samples t-tests were used to determine whether there were any statistically significant differences between sample means of two unrelated groups and were run for all metrics, comparing memes to each alternative post type. Linear regression analysis was used to determine if follower growth and time were correlated and, if so, the strength of that relationship. These regression analyses also allowed for calculating R<sups>2</sups>, a goodness-of-fit measure also known as the coefficient of determination, which specifies the amount of variance in one variable that can be explained by another variable or combination of variables. This in turn sheds light on the predictive value of a regression model (i.e. the ability to predict the value of a variable by knowing the value of another).</p> <p>Research assistants also collected additional audience data regarding geographical distribution (top cities and countries), age ranges, and the gender of followers (see Figure 2 below).</p> <p>Graph: Figure 2. Instagram Demographics from January 2020.</p> <hd id="AN0183055793-7">Branded post formats</hd> <p>Research assistants collected social media metrics from original branded posts directly through the Instagram business platform. Metrics included post date, episode reference, type of post, number of slides, and number of hashtags used. The post type refers to one of seven original content formats used on TSW's social media accounts as defined in Table 1 below. If the post included multiple images (multi-post or swipes), the post type was determined exclusively by the first image, as this is the image that Instagram shows followers on their feed. Research assistants averaged key insight metrics by post type.</p> <p>Table 1. Original content formats.</p> <p> <ephtml> <table><thead><tr><td>Type of Post</td><td>Description</td></tr></thead><tbody><tr><td>Affirmation</td><td>validating, feel-good messages as text</td></tr><tr><td>Audio Quote</td><td>a quote embedded in the post as an audio file</td></tr><tr><td>Meme</td><td>text-image format meme</td></tr><tr><td>New Episode</td><td>announcement of a new episode</td></tr><tr><td>Promo</td><td>promotion of giveaway, content, or event exclusive to The Sex Wrap</td></tr><tr><td>Quote</td><td>a text quote, typically from a podcast episode</td></tr><tr><td>Tip</td><td>light suggestion or piece of advice referred to as 'Just the Tip'</td></tr></tbody></table> </ephtml> </p> <hd id="AN0183055793-8">Meme content analysis</hd> <p>Research assistants reviewed posts and identified meme post content themes by consulting SIECUS guidelines, reading the post captions, interpreting the picture/video, and writing terms representing the content covered. Through this qualitative process, eight content themes were identified: (<reflink idref="bib1" id="ref21">1</reflink>) sex positivity, (<reflink idref="bib2" id="ref22">2</reflink>) relationships, (<reflink idref="bib3" id="ref23">3</reflink>) self-worth, (<reflink idref="bib4" id="ref24">4</reflink>) safe sex, (<reflink idref="bib5" id="ref25">5</reflink>) anatomy, (<reflink idref="bib6" id="ref26">6</reflink>) sexual harassment, (<reflink idref="bib7" id="ref27">7</reflink>) social issues, and (<reflink idref="bib8" id="ref28">8</reflink>) LGBTQ+. Research assistants identified six to twelve search terms per category based on the content review (see Table 2 below). They then counted posts once per classification regardless of the number of search terms assigned, such that posts were included in multiple themes if search terms from distinct categories were present. The researchers totalled the number of posts with any subject tag relevant to each category and calculated the overall percentage of posts per category (see Figure 6 below).</p> <p>Table 2. Content themes and their written search terms derived from qualitative post-analysis.</p> <p> <ephtml> <table><thead><tr><td>Content Themes</td><td>Search Terms</td></tr></thead><tbody><tr><td>Sex Positivity</td><td>sex positive, pleasure, masturbation, sex toy, g spot, orgasm, threesome, oral sex, anal sex, kinky, horny, lube</td></tr><tr><td>Relationships</td><td>communication, relationship, polyamory, single, partner, dating</td></tr><tr><td>Self-Worth</td><td>self-worth, self-love, body positivity, confidence, insecurity, mental health</td></tr><tr><td>Safe Sex</td><td>STI, pregnancy, safe sex, protection, condom, contraceptive, PreP</td></tr><tr><td>Anatomy</td><td>anatomy, penis, vagina, period, breasts, ejaculation, semen, clitoris, hymen, balls</td></tr><tr><td>Sexual Harassment</td><td>sexual harassment, consent, objectification, sexual trauma, rape, sexual assault</td></tr><tr><td>Social Issues</td><td>social change, equality, stigma, toxic masculinity, feminism, norms</td></tr><tr><td>LGBTQ+</td><td>LGBTQ, lesbian, gay, bisexual, trans/transgender, queer, sexuality, pride, gender</td></tr></tbody></table> </ephtml> </p> <hd id="AN0183055793-9">Results</hd> <p></p> <hd id="AN0183055793-10">Instagram metrics</hd> <p>The R<sups>2</sups> value for the follower total was 0.989. Given that R<sups>2</sups> can range from 0 to 100%, where 100% represents a regression model in which all variance is explained, this finding indicates a strong positive linear association between follower growth and time (Ozili [<reflink idref="bib22" id="ref29">22</reflink>]). Followers fell primarily in the 25–34 age bracket (47%), followed by the 18–24 age bracket (27%). 43% of followers lived in the USA, and 70% of TSW's followership were women (Figure 2).</p> <hd id="AN0183055793-11">Branded post metrics</hd> <p>Since January 2020, memes surpassed other post types of original content in several insight metrics. Independent t-tests revealed a statistically significant difference between memes and almost every other post type in likes, comments, shares, and saves (Table 3). Memes had the highest average likes per post (<reflink idref="bib452" id="ref30">452</reflink>), followed by quotes (<reflink idref="bib212" id="ref31">212</reflink>) (Figure 3). They concurrently sustained the most average shares (<reflink idref="bib70" id="ref32">70</reflink>) compared to quotes (<reflink idref="bib21" id="ref33">21</reflink>) and possessed the highest average saves (<reflink idref="bib46" id="ref34">46</reflink>), followed by quotes (<reflink idref="bib24" id="ref35">24</reflink>). Promo posts received the most extensive mean number of comments (<reflink idref="bib67" id="ref36">67</reflink>), followed by meme posts (<reflink idref="bib5" id="ref37">5</reflink>).</p> <p>Graph: Figure 3. Bar chart showing content interactions by post type, on a logarithmic scale, with solid bars indicating statistical significance.</p> <p>Table 3. Two-tailed independent t-test results, statistical significance when <emph>p</emph> <.05(5E–02).</p> <p> <ephtml> <table><thead><tr><td /><td>Meme vs. Affirmation</td><td>Meme vs. Audio Quote</td><td>Meme vs. New Episode</td><td>Meme vs. Promo</td><td>Meme vs. Quote</td><td>Meme vs. Tip</td></tr></thead><tbody><tr><td><bold>Likes</bold></td><td>1.54E–05</td><td>1.74E–27</td><td>1.63E–23</td><td>6.89E–05</td><td>2.21E–06</td><td>1.09E–23</td></tr><tr><td><bold>Comments</bold></td><td>1.31E–02</td><td>1.83E–03</td><td>4.21E–03</td><td>1.88E–01</td><td>1.40E–05</td><td>2.52E–09</td></tr><tr><td><bold>Shares</bold></td><td>7.13E–08</td><td>3.41E–12</td><td>1.43E–10</td><td>2.78E–11</td><td>1.01E–05</td><td>1.18E–07</td></tr><tr><td><bold>Saves</bold></td><td>8.66E–04</td><td>4.62E–22</td><td>2.41E–14</td><td>7.98E–17</td><td>4.62E–04</td><td>9.04E–09</td></tr><tr><td><bold>Profile Visits</bold></td><td>2.84E–01</td><td>4.91E–15</td><td>1.06E–02</td><td>6.76E–01</td><td>3.45E–02</td><td>5.23E–02</td></tr><tr><td><bold>Web Clicks</bold></td><td>3.27E–06</td><td>1.11E–01</td><td>6.17E–01</td><td>3.54E–05</td><td>6.56E–07</td><td>3.04E–03</td></tr><tr><td><bold>Follows</bold></td><td>1.41E–03</td><td>7.91E–12</td><td>4.72E–06</td><td>7.65E–01</td><td>1.24E–03</td><td>7.82E–05</td></tr><tr><td><bold>Reach</bold></td><td>5.18E–04</td><td>1.78E–01</td><td>7.11E–07</td><td>3.99E–02</td><td>4.75E–04</td><td>3.98E–17</td></tr><tr><td><bold>% Following</bold></td><td>1.04E–01</td><td>6.41E–02</td><td>1.05E–03</td><td>2.88E–01</td><td>8.81E–01</td><td>1.67E–02</td></tr><tr><td><bold>Impressions</bold></td><td>2.45E–03</td><td>2.01E–01</td><td>3.36E–06</td><td>7.14E–02</td><td>3.43E–04</td><td>1.16E–15</td></tr></tbody></table> </ephtml> </p> <p>Memes also garnered higher profile activity, maintaining 67 average profile visits compared to promos (<reflink idref="bib57" id="ref38">57</reflink>), affirmations (<reflink idref="bib49" id="ref39">49</reflink>), tips (<reflink idref="bib42" id="ref40">42</reflink>), and quotes (<reflink idref="bib40" id="ref41">40</reflink>) (Figure 4). Memes tied with new episodes for the most web clicks (5 per post). Promos retained the highest number of average new followers (<reflink idref="bib8" id="ref42">8</reflink>), followed by memes (<reflink idref="bib7" id="ref43">7</reflink>).</p> <p>Graph: Figure 4. Bar chart showing profile activity by post type, on a logarithmic scale, with solid bars indicating statistical significance.</p> <p>Memes sustained the most extensive discovery, determined by reach, percent following, and impression numbers (Figure 5). Memes possessed an exceptional mean reach (<reflink idref="bib6" id="ref44">6</reflink>,<reflink idref="bib238" id="ref45">238</reflink>) compared to promos (<reflink idref="bib3" id="ref46">3</reflink>,<reflink idref="bib885" id="ref47">885</reflink>) and quotes (<reflink idref="bib3" id="ref48">3</reflink>,<reflink idref="bib884" id="ref49">884</reflink>) while simultaneously tying with quotes for the most elevated 'Percent Following' ratio at 69%. Memes also received notable average impressions (<reflink idref="bib6" id="ref50">6</reflink>,<reflink idref="bib969" id="ref51">969</reflink>) compared to promos (<reflink idref="bib4" id="ref52">4</reflink>,<reflink idref="bib699" id="ref53">699</reflink>) and quotes (<reflink idref="bib4" id="ref54">4</reflink>,<reflink idref="bib446" id="ref55">446</reflink>).</p> <p>Graph: Figure 5. Bar chart showing overall reach by post type, on a logarithmic scale, with solid bars indicating statistical significance.</p> <hd id="AN0183055793-12">Meme content analysis</hd> <p>Meme posts covered content in all categories delineated in Table 1. 'Relationships' was the content category most addressed by branded meme posts (35.6%). The second most mentioned content category was 'Sex-positivity' (22.7%). 'Self-worth' was mentioned in 9.3% of meme posts, followed by 'Safe sex' (8.8%), 'LGBTQ+' (7.7%), 'Social issues' (7.2%), 'Anatomy' (6.2%), and 'Sexual harassment' (2.6%) (Figure 6).</p> <p>Graph: Figure 6. Content analysis of meme posts.</p> <hd id="AN0183055793-13">Discussion</hd> <p></p> <hd id="AN0183055793-14">Instagram metrics</hd> <p>Weekly insights from Instagram showed a consistent follower increase after meme communication implementation began in earnest. While reach and interactions fluctuated weekly, the average follower numbers increased from January to April, denoting memes' overall success. The two most reached age brackets indicate that the target audience (14–29) maintained interactions with meme content and highlights the need and desire for accessible, evidence-based online sexual health information, especially when considering the near majority of followers was comprised of individuals between the ages of 25 and 34. This population represents adults who may have missed out on comprehensive and inclusive sexual health education, which is evidenced by the significant decline in young peoples' formal instruction relating to methods of birth control, STIs, and saying no to sex in the USA between 2006 to 2013 (Lindberg, Maddow-Zimet, and Boonstra [<reflink idref="bib15" id="ref56">15</reflink>]).</p> <hd id="AN0183055793-15">Branded post metrics: content interaction</hd> <p>The investigators analysed original Instagram content to determine meme communication's efficacy in repackaging sexual health information to promote social media engagement. Likes are a ubiquitous, user-facing metric on all social media platforms, making likes an intuitive baseline metric on Instagram. Memes amassed 2–4 times more average likes than non-meme posts (see Figure 3 earlier). This preference for memes may be explained by their entertainment-oriented nature, which has previously been deemed key for effective sexual health education (McKee et al. [<reflink idref="bib17" id="ref57">17</reflink>]). Memes also had twice as many saves on average as non-meme post types (Figure 3). Saves indicate user relevance and repeated consumption of memes presenting sexual health content. The most significant insight from Figure 3 is the higher average shares per meme post. Average shares suggest that memes encouraged users to circulate TSW's sexual health content within their respective following circles, thereby increasing the reach of TSW content beyond the account's follower base. A networked community of sex-positive users was crucial to the design and success of this intervention and sexual health information dissemination on social media. Promos retained a higher number of average comments than meme posts, the only statistically insignificant relationship in this category. However, promos are associated with giveaways (so followers are incentivised to interact). When excluding promos, memes retained the highest number of comments indicating the level at which people interact with meme posts compared to the other post types.</p> <hd id="AN0183055793-16">Branded post metrics: profile activity</hd> <p>Memes received more profile visits, indicating that memes encouraged users to learn more about sexual health (see Figure 4 earlier). Although memes secured superior numbers overall, memes were not significantly different from affirmations and promos for profile visits (see Table 3 earlier). Regarding web clicks, memes remained statistically significant for all post types except new episodes with an equal number of average web clicks compared to memes (see Figure 4 earlier) and audio quotes see (Table 3 earlier). Memes independently pushed people to web clicks and motivated users to learn more about sexual health, demonstrating that memes encouraged information seeking and were able to convert meme consumers to podcast listeners. Promos acquired the highest average number of followers due to their associated giveaways (see Figure 4 earlier). When excluding promos, memes received the highest new follower numbers and were statistically significant concerning all other post types (see Table 3 earlier). The followers metric demonstrates that memes retain individuals to maintain a discussion, contributing to further exposure to sexual health topics.</p> <hd id="AN0183055793-17">Branded post metrics: content discovery</hd> <p>Memes possessed a more expansive scope than non-meme post types. Meme posts' reach was almost double non-meme posts, showing that memes draw people to the account beyond the followership (see Figure 5 earlier). Memes retained statistically significant reach numbers compared to non-meme posts except for audio quotes (Table 3). Audio quotes possessed a low sample size explaining this discrepancy. Meme longevity helps expound this impressive metric, demonstrating memes' pervasive nature because they are continuously shared. Memes tied with quotes for the highest average 'percent following' number, displaying their versatility as pieces continually consumed by TSW's follower base (Figure 5). Percent following received few statistically significant comparisons (only new episodes and tips), which could be attributed to Instagram's algorithm circulating account material primarily among the follower base (Table 3). Memes sustained statistically significant average impressions numbers for every post type except audio quotes and promos (Table 3). The impressions metric demonstrates a higher meme fecundity compared to non-memes. High consumption levels are essential to interventional maintenance over time.</p> <hd id="AN0183055793-18">Meme content analysis</hd> <p>This study demonstrates how effectively memes can convey sexual health education information. While memes mentioned each of the eight content categories more than once, 'Relationships' was cited most, followed by 'Sex Positivity'. Several reasons exist for the content categories' impressive size. The written search term primarily driving the generous size of the 'Relationships' content category was communication. Communication is involved with almost all other topics, underscoring its importance to safe, fun and consensual sexual encounters. 'Sex-positivity' remains a large content category because of TSW's mission, creating a sex-positive, safe space for followers. Discussing diverse sex-positive topics, especially ones absent in traditional sexual health curricula, is critical to successful sexual health education. It is important to note that not all sexual health topics, like sexual harassment and sexual assault, are well suited for memeification, as memes often use humour as a way to connect a viewer to the content. Sex-positive meme communication allows followers to feel comfortable learning about and exploring various sexual health topics without shame or fear in an entertaining and informative way. In both instances, these content categories also represent sexual health information that is often desired but lacking in school-based education (McKee et al. [<reflink idref="bib17" id="ref58">17</reflink>]).</p> <p>Overall, this data indicates that meme posts maintained high interaction levels among users, generated new followers, and encouraged a community of sharing within TSW's followership and beyond compared to different non-meme post types. Meme shares, likes and views indicate their consumption by the intervention's target demographic and their efficacy as pieces of sexual health marketing, communication and education.</p> <p>In educational contexts, higher engagement with educational content could relate to its efficacy or relatability (Harris, Shields, and DeMaria [<reflink idref="bib10" id="ref59">10</reflink>]; London, Downey, and Mace [<reflink idref="bib16" id="ref60">16</reflink>]). The relationships between likes and shares on social media platforms and educational outcomes are complex and also similar to challenges in other learning environments. There are several ways in which engagement in social media may relate to learning and comprehension. The number of likes and shares could indicate engagement in a similar way to hands raised in a classroom (Trunfio and Rossi [<reflink idref="bib29" id="ref61">29</reflink>]). They can also serve as an immediate type of feedback, like classroom assessment techniques common in engaged classroom pedagogies (Epstein et al. [<reflink idref="bib7" id="ref62">7</reflink>]). If a meme gets numerous likes and shares, it could indicate that the content was well-received, understood, and found to be valuable by the audience or that followers might not understand the content.</p> <p>Similarly, classroom participation and asking questions related to educational content allow educators to assess the learning and engagement level of the learner (Nadile et al. [<reflink idref="bib20" id="ref63">20</reflink>]; Chin and Chia [<reflink idref="bib4" id="ref64">4</reflink>]). Through social media, users were able to engage with content in the same way as through posted comments and direct messages (Trunfio and Rossi [<reflink idref="bib29" id="ref65">29</reflink>]). Posts were monitored by intervention staff who provided feedback and responded to questions quickly, which allowed TSW to quickly correct misinformation. Educational outcomes are not just about individual learning but also about building a community of learners (Summers and Svinicki [<reflink idref="bib28" id="ref66">28</reflink>]). Likes and shares may foster a sense of community in which followers feel connected to others with similar interests or questions. Likes and shares may also increase the sense of peer validation of the importance or credibility of a post (Vohra and Bhardwaj [<reflink idref="bib30" id="ref67">30</reflink>]). It is important to approach the relationship between social media engagement and educational outcomes with nuance. Likes and shares offer valuable insights in some contexts and may be potential proxy measures of learning and comprehension.</p> <hd id="AN0183055793-19">Limitations</hd> <p>Reported findings should be considered within the context of study limitations. The primary limitation befalling this case study remains the difficulties encountered in collecting Instagram data due to the temporary availability of account insights. Consequently, the research assistants could not retroactively collect data, limiting the ability for metric comparison between all-time points. The inability to retrieve some past data also complicated the analysis of confounding factors, such as follower growth, that could impact the conclusions drawn about meme efficacy. Research assistants could not control for posting time because time is not a metric currently provided by Instagram for retroactive data collection. Posting time affects post success, explaining some extreme outliers from the original content insight data, irrespective of the post type. Post weeks ending on March 18 and 25 March 2020, occurred amid the COVID-19 shutdown in the USA, and TSW's social media experienced some subsequent management lapses.</p> <p>Additionally, Instagram's account creation system allows only male and female gender selection. Audience insights may not adequately represent users identifying beyond the traditional gender binary. These insights also illustrate that approximately half of The Sex Wrap's measured audience resides outside of the USA, which can, in some ways, limit the interpretation of the results as this study has a domestic focus. Finally, it is important to note that social media platforms such as Instagram often view sexual health information in violation of community guidelines and often partially censor or completely ban any form of media that addresses sexual health and its related topics. This extreme form of content moderation is often the result of a perceived threat to social, political or religious order and has significant adverse effects on sexual health education efforts across all social media platforms (Borrás Pérez [<reflink idref="bib2" id="ref68">2</reflink>]).</p> <p>In discussing the engagement metrics of TSW's Instagram account, we acknowledge that metrics such as likes and shares primarily indicate audience interest and the reach of content, as engagement, while a positive indication of content resonating with its audience, does not automatically translate to effective learning or comprehension. This study utilises these metrics as a gauge of content popularity and dissemination, rather than as definitive markers of educational impact. The significant engagement with TSW's content is commendable, as capturing the interest of young people in sexual health education is a notable challenge in itself. However, it is important to recognise that further research is needed to explore the extent to which such engagement correlates with learning outcomes. This study, therefore, lays the groundwork for future inquiries into the relationship between social media engagement and the efficacy of sexual health education, which could involve a more nuanced examination of how audience interaction with online content translates into knowledge acquisition and behavioural changes.</p> <hd id="AN0183055793-20">Conclusion</hd> <p>TSW helps fill sexual health education gaps in the USA by repackaging evidence-based information. The 'memeification' of evidence-based sexual health information improved all aspects of TSW's Instagram account, including the reach and engagement of sexual health messages. Meme communication served as an effective way to deliver sexual health education because these memes infuse humour through relatability, encouraging introspection and empathetic connection on the user's behalf. When users feel comfortable doing so, shareability within the user's social media circles increases, enlarging the reach of TSW's sexual health-related messaging in a positive feedback loop when followers of TSW interact with and share meme posts related to sexual health with their friends and followers, TSW's reach is expanded allowing for interaction with individuals that do not follow our social media account or who do not often interact with sexual health education content. The sexual health messaging coded in TSW's original meme content is made explicit via relevant podcast episode references. Podcast links help convert Instagram followers to podcast listeners and broaden users' sexual health literacy. Keeping memeified content varied, like the podcast itself, ensures information applicability to the diverse audiences addressed by TSW.</p> <p>Meme communication remains an effective health communication medium and warrants further study. Beyond expanding the evaluation of social media metrics, linking engagement with memes to sexual health behaviours is an important area of research. Previous research demonstrates the link between general social media and sexual behaviours and the prevalence of STIs, though a more in-depth assessment of the efficaciousness of various forms of social media intervention would build on this current body of work (Gabarron and Wynn [<reflink idref="bib8" id="ref69">8</reflink>]; Landry et al. [<reflink idref="bib14" id="ref70">14</reflink>]). Given the potential for memes to relay messaging that can elevate risk, research should focus on both harm-reducing and harm-inducing sexual behaviours, as well as the impact of memes on unintended audiences for which a crafted meme may be considered inappropriate (Herbenick et al. [<reflink idref="bib11" id="ref71">11</reflink>]; McKee et al. [<reflink idref="bib17" id="ref72">17</reflink>]). Another potential avenue of inquiry is assessing the utility of memes for promoting social change that supports increased access to evidence-based sexual education. Memes have long been used to critique and disrupt politics, although it is unclear whether intentional efforts to use memes to promote such social change would be effective and warrant study given the current need (Miltner [<reflink idref="bib18" id="ref73">18</reflink>]; Mortensen and Neumayer [<reflink idref="bib19" id="ref74">19</reflink>]). The use of memes disseminated through a social media platform for public health sexuality education interventions offers a unique and contemporary way to reach audiences, especially younger demographics, but it is important to consider the challenges and limitations. Social media companies are for-profit and often direct users to content with the highest engagement and income potential. There may be content restrictions and censorship, issues with users' digital literacy, rapidly evolving platforms, ever-changing algorithms, and platform metric changes that can make longitudinal data collection difficult. Even with the potential limitations, social media platforms are a powerful way to disseminate health information.</p> <p>Based on the findings of this study, it is possible to offer several recommendations about the use of memes in health communication. First, regular posting is crucial to maintain relevance in Instagram's feed algorithm, making daily posts at peak Instagram times vital to successful meme communication and for the intervention staff to frequently engage with followers through comments and likes. Instagram's algorithm is a pivotal factor on the platform and affects both content visibility and user engagement. The algorithm impacts content visibility and reach because its primary purpose is to curate a user's feed based on interests and engagement. We also recommend posting frequently because the algorithm favours recent content. Older content is still discoverable through direct searches, hashtags and links, but the frequency of posts and stories increases the way the algorithm promotes branded content. An important limitation of using a social media platform like Instagram as part of a health intervention is that Instagram does not publish its algorithm and updates it frequently, so any sexual health intervention utilising the platform should monitor Instagram metrics to ensure maximum reach and impact.</p> <p>Second, cross-posting original Instagram content to other social media platforms (e.g. Twitter/X and Facebook) enhances the sexual health message's reach to tangential audiences, such as the aforementioned missed opportunity group of adults, and allows for direct links to older content. Other rapidly growing platforms, like TikTok, are also a good way to disseminate health information, albeit in an altered meme format (ex., videos instead of pictures). Third, memes in health communication campaigns should follow the 'edutainment' style in which evidence-based sexual health messaging is shared in an entertaining, humorous, intimate, or relatable manner. Those populations in need of sexual health education, especially adolescents and young adults, wish their health education to come from a reputable source but to be presented in an engaging and dynamic way (Albury [<reflink idref="bib1" id="ref75">1</reflink>]).</p> <p>Lastly, future recommendations include adhering strictly to the brand presence a social media account creates. New material constantly inundates the world of social media marketing. Therefore, reliably distinguishable content is pivotal to maintaining meaningful social media and health education impacts.</p> <hd id="AN0183055793-21">Acknowledgments</hd> <p>We thank the dedicated interns and research assistants who played a crucial role in making this intervention a success. Special thanks go to Nina Wojtowicz, Aubrey Dale, Jessica Ripes, Lydia Franklin, and Marissa Maddalon for their unwavering commitment, invaluable contributions, and exceptional work. 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  Data: <searchLink fieldCode="DE" term="%22Social+Media%22">Social Media</searchLink><br /><searchLink fieldCode="DE" term="%22Photography%22">Photography</searchLink><br /><searchLink fieldCode="DE" term="%22Visual+Aids%22">Visual Aids</searchLink><br /><searchLink fieldCode="DE" term="%22Handheld+Devices%22">Handheld Devices</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Education%22">Health Education</searchLink><br /><searchLink fieldCode="DE" term="%22Public+Health%22">Public Health</searchLink><br /><searchLink fieldCode="DE" term="%22Sex+Education%22">Sex Education</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Promotion%22">Health Promotion</searchLink><br /><searchLink fieldCode="DE" term="%22Mass+Media+Role%22">Mass Media Role</searchLink><br /><searchLink fieldCode="DE" term="%22Evidence+Based+Practice%22">Evidence Based Practice</searchLink><br /><searchLink fieldCode="DE" term="%22Humor%22">Humor</searchLink><br /><searchLink fieldCode="DE" term="%22Popular+Culture%22">Popular Culture</searchLink><br /><searchLink fieldCode="DE" term="%22Internet%22">Internet</searchLink><br /><searchLink fieldCode="DE" term="%22Social+Attitudes%22">Social Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Information+Dissemination%22">Information Dissemination</searchLink><br /><searchLink fieldCode="DE" term="%22Audio+Equipment%22">Audio Equipment</searchLink><br /><searchLink fieldCode="DE" term="%22Electronic+Publishing%22">Electronic Publishing</searchLink><br /><searchLink fieldCode="DE" term="%22Mass+Media+Effects%22">Mass Media Effects</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/14681811.2023.2300069
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1468-1811<br />1472-0825
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: The lack of accurate and comprehensive sexual health education in the USA persists as a pressing public health issue. The Sex Wrap (TSW) is a multimedia sexual health podcast and social media presence that educates followers on sexual health and ancillary themes such as sexuality, relationships and communication. TSW's Instagram account repackages the evidence-based sexual health information discussed during the podcast into Internet memes. We analysed the top-performing TSW posts from Jan 2019-Dec 2020 according to Instagram's engagement metrics to determine what type of posts were most interesting to followers and begin to understand how social media helps drive interventions. The meme-based sexual health intervention via TSW's Instagram increased engagement, improved reach, and converted followers to podcast listeners. Insight data demonstrates how social media can address the sexual health education disparities caused by the failure of abstinence-only-until-marriage (AOUM) curricula. This case study exhibits how social media-based interventions can comprehensively fill existing gaps in sexual health education.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1466692
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1466692
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/14681811.2023.2300069
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 17
        StartPage: 221
    Subjects:
      – SubjectFull: Social Media
        Type: general
      – SubjectFull: Photography
        Type: general
      – SubjectFull: Visual Aids
        Type: general
      – SubjectFull: Handheld Devices
        Type: general
      – SubjectFull: Health Education
        Type: general
      – SubjectFull: Public Health
        Type: general
      – SubjectFull: Sex Education
        Type: general
      – SubjectFull: Health Promotion
        Type: general
      – SubjectFull: Mass Media Role
        Type: general
      – SubjectFull: Evidence Based Practice
        Type: general
      – SubjectFull: Humor
        Type: general
      – SubjectFull: Popular Culture
        Type: general
      – SubjectFull: Internet
        Type: general
      – SubjectFull: Social Attitudes
        Type: general
      – SubjectFull: Information Dissemination
        Type: general
      – SubjectFull: Audio Equipment
        Type: general
      – SubjectFull: Electronic Publishing
        Type: general
      – SubjectFull: Mass Media Effects
        Type: general
    Titles:
      – TitleFull: The 'Memeification' of Sexual Health Communication on Instagram
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Andrew Porter
      – PersonEntity:
          Name:
            NameFull: Spring Cooper
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          Name:
            NameFull: Ashley Falcon
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          Name:
            NameFull: Megan Piller
      – PersonEntity:
          Name:
            NameFull: Ritika Modi
      – PersonEntity:
          Name:
            NameFull: Emily Hawver
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      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 1468-1811
            – Type: issn-electronic
              Value: 1472-0825
          Numbering:
            – Type: volume
              Value: 25
            – Type: issue
              Value: 2
          Titles:
            – TitleFull: Sex Education: Sexuality, Society and Learning
              Type: main
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