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The Native Hawaiian and Pacific Islander (NHPI) population experiences disproportionately higher rates of food insecurity, which is a risk factor for cardiometabolic diseases such as cardiovascular disease, type 2 diabetes, obesity, and hypertension, when compared to white individuals. Novel and effective approaches that address food insecurity are needed for the NHPI population, particularly in areas of the continental United States, which is a popular migration area for many NHPI families. Social media may serve as an opportune setting to reduce food insecurity and thus the risk factors for cardiometabolic diseases among NHPI people; however, it is unclear if and how food insecurity is discussed in online communities targeting NHPI individuals.
The objective of this study was to characterize the quantity, nature, and audience engagement of messages related to food insecurity posted online in community groups and organizations that target NHPI audiences.
Publicly accessible Facebook pages and groups focused on serving NHPI community members living in the states of Washington or Oregon served as the data source. Facebook posts between March and June 2019 (before the COVID-19 pandemic) and from March to June 2020 (during the COVID-19 pandemic) that were related to food security were identified using a set of 36 related keywords. Data on the post and any user engagement (ie, comments, shares, or digital reactions) were extracted for all relevant posts. A content analytical approach was used to identify and quantify the nature of the identified posts and any related comments. The codes resulting from the content analysis were described and compared by year, page type, and engagement.
Of the 1314 nonduplicated posts in the 7 relevant Facebook groups and pages, 88 were related to food security (8 in 2019 and 80 in 2020). The nature of posts was broadly classified into literature-based codes, food assistance (the most common), perspectives of food insecurity, community gratitude and support, and macrolevel contexts. Among the 88 posts, 74% (n=65) had some form of engagement, and posts reflecting community gratitude and support or culture had more engagement than others (mean 19.9, 95% CI 11.2-28.5 vs mean 6.1, 95% CI 1.7-10.4; and mean 26.8, 95% CI 12.7-40.9 vs mean 5.3, 95% CI 3.0-7.7, respectively).
Food security–related posts in publicly accessible Facebook groups targeting NHPI individuals living in Washington and Oregon largely focused on food assistance, although cultural values of gratitude, maintaining NHPI culture, and supporting children were also reflected. Future work should capitalize on social media as a potential avenue to reach a unique cultural group in the United States experiencing inequitably high rates of food insecurity and risk of cardiometabolic diseases.
Food security is defined as “enough food for an active, healthy life” for all members of a household [
The prevalence of food insecurity in the United States has increased during the COVID-19 pandemic, impacting an estimated 54 million households [
Social networking platforms, and the online communities they foster, have been capitalized on in various ways in efforts to address chronic cardiometabolic diseases and food insecurity. Facebook is one of the largest online social networking platforms, which was used by over 2 billion people each month in 2019 and 2020 [
Native Hawaiian and Pacific Islander (NHPI) communities are a priority population for consideration as the digital food environment continues to evolve in the United States. NHPI adults experience a disproportionately higher prevalence of cardiovascular disease, diabetes, hypertension, and obesity compared to other demographic groups [
Healthy Hearts Among Pacific Islanders (HHAPI) is an educational program created by and for NHPI people. The goal of HHAPI is to utilize culturally grounded evidence-based interventions to mitigate cardiometabolic conditions in the NHPI population via self-management of hypertension and diabetes at the individual, family, and policy levels. At the individual and family levels, HHAPI began in 2016 with in-person hypertension management classes hosted in community organizations in the Pacific Northwest, with one of the largest NHPI populations outside of Hawaii [
The purpose of this study was to explore the online presence (static website, social media accounts) of NHPI-serving community groups and cultural or health-focused organizations in Washington state, and to compare the nature (eg, educational, event promotion, resource sharing) and frequency of food insecurity–related messages posted on their social media sites from March through June 2019 and from March through June 2020. We also evaluated the amount and type of engagement (ie, likes, shares, comments) on food insecurity–related messages by the nature of the post.
The sample of online data was extracted from publicly accessible Facebook pages and groups. On Facebook, individuals make posts, comprised of text, image(s), video(s), and/or hyperlink(s) to other webpages, and other individuals can engage with the post. Engagement includes commenting with their own text, image(s), video(s), and/or hyperlink(s), or by clicking the “reaction” button to show one of seven possible reactions (Like, Love, Care, Haha, Wow, Sad, and Angry) as a small, animated symbol listed under the original post [
Facebook business pages and groups focused on serving NHPI community members in the Pacific Northwest region were identified through consultation with three staff members who identified as Native Hawaiian or Pacific Islander and lived in the Pacific Northwest, a region with large communities of NHPI people. Each group’s Facebook page or group was reviewed to ascertain corresponding details about each organization’s mission or objective. To help maintain confidentiality, the names of the groups and organizations are not included in this manuscript.
The study was certified as “Exempt” from approval by the Washington State University Institutional Review Board (IRB) on March 22, 2021 (IRB #18784).
The list of keywords used to identify posts related to food security was generated in three steps. First, the keywords were identified through a review of related literature [
One research team member searched all identified Facebook pages and groups using each keyword as the search term. The results were restricted to posts made in the months of March through June in the years 2019 and 2020 to compare social media engagement before the COVID-19 pandemic to the same period during the pandemic. The researcher conducting the searches was not a member of any of the Facebook groups or a follower of the Facebook pages searched. All searches were logged and the date of any resulting posts was documented. Each post was then assessed for its relevance to food security. Posts were considered related to food security if they contained information about food assistance opportunities/events or about individual or community needs for food due to income or access constraints. If the post was considered relevant to food security, additional data were documented about the content of the post (ie, text, web links, images, videos) as well as the amount and type of engagement (ie, comments, shares, and reactions). All posts that were not considered relevant were excluded from coding and analysis. These searches were conducted between June and August 2021.
To identify and quantify the nature of posts identified, a content analytical approach was used to assess patterns of posts and related engagement by their categorical nature [
To describe the online presence of the NHPI-serving groups and organizations identified, the purpose or mission of the organization’s page or group was broadly categorized. Means and frequencies were used to describe the number of users engaged by each page or group. To assess the nature and engagement of posts, the number of posts identified per page by year and types of engagement (eg, reactions, shares) were enumerated. Codes resulting from the content analysis were described and compared by year, page type, and engagement. Qualitative coding was organized in a spreadsheet (Excel, Microsoft Office 365) and quantitative descriptive analyses were conducted in STATA/MP 17.0 (StataCorp, LP).
Seven relevant Facebook pages (n=5, 71%) or groups (n=2, 29%) were identified. Broadly, the stated missions or objectives of these organizations and groups created a welcoming online space to build community among Pacific Islanders, share resources, promote events or local businesses, preserve culture, and/or address social or health inequities. All groups or pages had, on average, 4229 (SD 2731) followers or members. Facebook groups had, on average, a greater number of members (mean 6010, SD 2279) than pages had followers (mean 3516, SD 2769).
Across all groups or pages, 1594 posts were identified using all search terms during the selected time periods. Of these, 278 posts were duplicates (ie, different search terms resulted in the same post being identified) and were removed. Of the 1316 nonduplicated posts, 88 (6.69%) were considered relevant to food security. Nonrelevant posts included announcements for surveys and information about hours of local businesses, among other topics. Among the 88 relevant posts, a subset of posts (n=8) were reposted 2-4 times on different dates and/or in different groups with identical text content. These posts were treated as unique and remained in the data set to reflect their greater potential reach. In 2019, there were 8 relevant posts identified in contrast to 80 relevant posts identified in 2020. Across the 7 groups or pages, a range of 0-45 relevant posts were identified with a mean of 12.6 posts (16.2 SD) per group or page. Of the 88 posts, 12 (14%) had comments associated with the posts, which were qualitatively analyzed and are described below.
A total of 20 codes for posts and 7 codes for comments were developed and used to characterize the data set. Codes were not mutually exclusive, and each post had a mean number of 3.8 (SD 1.7) codes applied. For the posts in 2019, a total of 15 codes were applied (mean of 1.9 per post), whereas the posts in 2020 had a total of 321 codes applied to them (mean of 4.0 per post). Among posts with comments, a mean of 1.8 (SD 0.8) codes were applied to the comments. After coding was complete, the concepts for posts were broadly organized into 6 categories, with some codes represented in more than one category, to assist with interpretation and presentation of results. Given the small number of comments included in the data set, all 7 codes for comments were interpreted and presented together.
The prevalence of codes based on concepts related to food insecurity or studies of social media–based communication were relatively low (
Literature-based codes, definitions, and example posts.
Codes and subcodes | Definition (post text, hashtags, or images) | Example post |
Nonfood social risk factors | Refers to other resources or circumstances that are related to food insecurity but not directly about food availability, such as housing, transportation, health, safety, education, income, isolation, and/or employment | … |
Education | Provides education (or refers to educational resources) to learn more about the issue of food security, and/or opportunities for individuals or households to acquire education about food preparation and/or nutrition |
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Paid event or business promotion | Provides information about businesses or events that require payment to support |
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Free meals for kids | Indicating that children are provided meals for free at events (or businesses) that otherwise require payment for food |
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Food item(s) | Identify specific types or examples of foods (not meal occasions) that are being sold or distributedc |
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Cultural context | Directed toward AAPIe subpopulations through direct mention of population(s), mention of cultural consideration and/or traditional/local foods, inclusion of NHPIf language or words, photographs of community members, and/or an AAPI language is mentioned as part of the service/event being described |
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aEBT: Electronic Benefits Transfer.
bP-EBT: Pandemic Electronic Benefits Transfer.
cExcludes images.
dSNAP: Supplemental Nutrition Assistance Program.
eAAPI: Asian American and Pacific Islander.
fNHPI: Native Hawaiian and Pacific Islander.
By far, the most common topic (69/88, 78%) of posts was sharing information about food assistance for community members (
Food security specific codes, definitions, and example posts.
Codes and subcodes | Definition (post text, hashtags, or images) | Example post | |||
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Food assistance resources | Describe specific events, programs, or other information about food assistance (groceries, meals, and/or lunches) available to individuals and/or children |
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Child food assistance | Food assistance (lunches, meals, groceries, etc) mentioned is specific to (or primarily targeted toward) providing food for children and/or families with children |
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Confidentiality of assistance | Refer to confidentiality or privacy of the food assistance being offered |
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Logistics of assistance | Provides logistical information about the assistance, such as times/days, location(s), and/or eligibility (or a link or phone number to access this information)a |
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Updates to food assistance | Provides time-sensitive information about unanticipated changes to the timing and availability (ie, food is gone or event is over) of food assistance within a time frame of 1 week or lessa |
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Food item(s) | Identify specific types or examples of foods (not meal occasions) that are being sold or distributedb |
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Cultural context | Posts are directed toward AAPIc subpopulations through direct mention of population(s), mention of cultural consideration and/or traditional/local foods, inclusion of NHPId language or words, photographs of community members, and/or an AAPI language is mentioned as part of the service/event being described | … |
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Self-disclosure | Refers to personal experiences of food insecurity or related food hardships experienced by user or user’s family members | Not applicable; no relevant content identified | ||
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Critical jests about food assistance | Presents information or cues specific to food assistance framed as a critique or joke |
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Feedback | Requests that readers provide feedback or provide stories about their experiences with food security or food assistance on surveys or through other structured data collectiona |
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aExcludes hashtags.
bExcludes images.
cAAPI: Asian American and Pacific Islander.
dNHPI: Native Hawaiian and Pacific Islander.
eEBT: Electronic Benefits Transfer.
A minority of identified posts demonstrated how Facebook groups could be used by members to communicate their opinions, perceptions, or personal experiences with food insecurity (
Positivity and promotion of community were salient sentiments in identified posts (
Community- and context-related codes, definitions, and example posts.
Codes and subcodes | Definition (post text, hashtags, or images) | Example post | |
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Gratitude | Mentions appreciation for support of individuals, organization, or the broader community for support of programs, events, and/organizations |
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Support opportunities | Refer to opportunities for community members to provide support to food security through volunteering, food donations, fundraising, or by attending events that support food banks or other charitable organizations |
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Reallocation of resources received | Indicates the user has excess food or related resources received for food security that they would like to give awaya |
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COVID-19 | Refers to the COVID-19 pandemic explicitly or implicitly and/or ramifications of the pandemic, such as staying healthy, wearing masks, or disruptions to the food system |
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Federal policies | Refers to federal policy news updates or short-term political activities that may be related to current or future food security |
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Emoticon use to supplement text | Supplemented with the addition of emoticon(s)a,b |
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aExcludes hashtags.
bExcludes images.
A subset (34/88, 39%) of identified posts remarked on broader contextual factors beyond the individual- or community-level, which may affect food insecurity (
The text in included posts was often supplemented by additional methods of communication, such as images (72/88, 82%), emoticons (20/88, 23%), and/or videos (2/88, 2%). This supplementary content can serve to draw social media users’ attention and/or efficiently provide additional information (
There were similarities and differences in the themes of the comments (
Comment codes, definitions, and example comments from 2019 and 2020.
Comment code | Definition | Example comment |
Educational | Refers to educational resources to learn more about the issue of food security and/or opportunities for individuals or households to acquire education about food preparation and/or nutrition | Not applicable; no relevant content identified. |
Paid event or business promotion | Provides information about businesses or events that require payment to support | Not applicable; no relevant content identified. |
Self-disclosures | Mentions personal experiences of food insecurity or related food hardships experienced by user or user’s family members |
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Gratitude | Mentions appreciation for the actions and/or information provided in the post |
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Support | Mentions prior, current, desired, or intended financial support for the cause or organization mentioned in the post |
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Interest in resources | Mentions the user’s interest in receiving the resources mentioned in the post |
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Critical jests about food assistance | Presents information or cues specific to food assistance framed as a critique or joke |
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aEBT: Electronic Benefits Transfer.
Among the analyzed posts, 74% (65/88) had some form of engagement via comments, reactions (Like, Love, Care, Haha, Wow, Sad, and Angry), or shares. Posts coded as reflecting community gratitude or support had descriptively more engagement (mean 19.9, 95% CI 11.2-28.5) in comparison to those that were not (mean 6.1, 95% CI 1.7-10.4). Engagement did not appreciably differ when all other broad code categories were compared. However, posts coded as incorporating culture into their text also had higher amounts of engagement (mean 26.8, 95% CI 12.7-40.9) than those that did not (mean 5.3, 95% CI 3.0-7.7).
Understanding and addressing food insecurity is a critical step in reducing the risk of cardiometabolic disease, including hypertension, heart disease, and diabetes, among NHPI cultural groups. The objective of this study was to describe the quantity, nature, and audience engagement of messages related to food insecurity posted online in community groups and organizations that serve NHPI audiences before and during the COVID-19 pandemic. Overall, there was a greater number of food insecurity–related Facebook posts during the pandemic compared to before the pandemic. The majority of identified posts focused on food assistance, including sharing information about resources, time-sensitive updates about services, and opportunities to support these initiatives. Cultural values of children’s food security and maintaining NHPI culture were reflected by the quantity of posts and related engagement. Broadly, rhetoric reflected sentiments of gratitude and use of humor to discuss the sensitive, and potentially stigmatizing, topic of food insecurity. This study offers a sample of the discussion on Facebook and provides a unique comparison of food insecurity discussions before and during the COVID-19 pandemic. Future work should capitalize on social media as a potential avenue to reach the unique NHPI cultural group experiencing inequitably high rates of food insecurity and risk of cardiometabolic diseases.
Keeping in mind the heterogeneity of NHPI groups with differing histories, cultural practices, and language, most of these groups faced drastic, detrimental changes after Western contact that impacted physical and mental health, which contributed to an increased risk of cardiometabolic disease and food insecurity [
Communication online related to food security and health is likely influenced by factors established in the broader communication literature. This study demonstrates how cultural values of gratitude and support were reflected in posts online. Posts that reflected these values or incorporated cultural words and references into their text had greater levels of online engagement via comments, shares, and other digital reactions. These results align with broader research in the communications field, which suggests that the way messages are presented, in their framing [
With the substantial increases in the use of social media, food insecurity, and the digital food environment since the onset of the COVID-19 pandemic, we explored changes in the nature and frequency of messages during and before the pandemic. Similar to research identifying changes in social media use since the onset of the COVID-19 pandemic [
Individuals experiencing food insecurity may feel shame about their household’s circumstances [
Given the large presence of NHPI members in Pacific Northwest–based Facebook groups and pages, social media may provide useful platforms to provide information and social support related to food insecurity and health conditions in future interventions. Prior research describes how Facebook has been used for diabetes support groups, and particularly in the nutrition management of diabetes [
Many future research questions could build off this study. Research that seeks to ask similar questions with publicly available social media data may benefit from using community-engaged research approaches, including community members as leaders of research studies. A recent metareview found that community-engaged research can not only support culturally centered interventions but also improve the approach of observational studies [
This study was not without limitations. First, qualitative research is inherently subjective and individual interpretations of the data vary. For example, had members of the Facebook group been a part of the study team, it would have allowed for insider knowledge to aid coding. However, researchers not belonging to any of the groups studied allowed for greater confidentiality during data extraction. Separately, as this was not an intervention, health data among users were not gathered. Instead, this study serves as a foundation for future research regarding food insecurity among NHPI populations. The study was also limited by the exclusive extraction of data from Facebook. While other social media sites such as Instagram, Twitter, TikTok, and Reddit draw varying demographics, Facebook use is the highest across gender, age, income, education level attainment, and household rurality characteristics [
Cardiometabolic diseases are prevalent and have pervasive impacts among the NHPI population, with food insecurity as a potential precipitating factor leading to multiple negative health outcomes. Social media and the digital food environment may be an important mechanism to reduce food insecurity and cardiometabolic diseases. Results suggest that Facebook pages and groups provide a setting for NHPI people to virtually gather and share food resources and reinforce NHPI cultural values, which has increased substantially since the onset of the COVID-19 pandemic. Future research will benefit from continued exploration of social media and the digital food environment as a mechanism to reduce food insecurity and reduce cardiometabolic disparities among NHPI adults. Specifically, social media should be further explored as a tool to promote health. Partnerships with nutrition-related organizations such as SNAP-Ed may help NHPI-serving organizations to disseminate culturally tailored messages about food assistance and educational materials to reduce food insecurity and improve health.
Electronic Benefits Transfer
Healthy Hearts Among Pacific Islanders
Institutional Review Board
Native Hawaiian and Pacific Islander
Supplemental Nutrition Assistance Program
Supplemental Nutrition Assistance Program Education
Special Supplemental Nutrition Program for Women, Infants, and Children
This research was supported by funding from the National Institute on Minority Health and Health Disparities at the National Institutes of Health, under award number U54-MD011240. The funding body had no role in study design, data collection, analysis, or interpretation.
None declared.