Neknominate: Challenging public health professions to think about the impact of social media in health?

PictureAn example of a Facebook conversation about Neknomination.

By Heide Busse

When I first came across the term ‘Neknominate’, I didn’t quite believe what it was, or that anyone would take part in such an activity. I soon learnt that this new trend is dominating Facebook, as well as other social media channels such as Youtube, Twitter and Instagram.

In case this is an unfamiliar term to you, Neknominate (also known as Nekchallenge) is an online drinking challenge, in which individuals nominate one another to drink an alcoholic drink in one go within the next 24 hours. Once evidence of this is provided, typically via a video upload, they can then nominate two others to do their own drinking dare within the next 24 hours.

Neknominate is said to have started in Australia in 2013 and has since gone viral, reaching people of all ages and backgrounds. Individuals try to outperform each other, drinking extreme amounts or combinations of alcohol in increasingly dangerous settings.

Why should we be concerned?
Alcohol intake is a major public health concern in the UK and other countries. It can impact on health, well-being and educational outcomes, and alcohol misuse costs the UK government more than £3 billion each year. The dangers of binge drinking (consuming large amounts of alcohol within a short period of time), particularly among young people, are increasingly recognised. The UK government’s alcohol strategy calls for excessive drinking to become less socially acceptable and includes reducing the number of binge drinkers as one of its main aims.

Neknominate seems to present drinking excessive amounts as normal and fun, it facilitates drinking while being alone, and presents drinking overall as a way to make new friends and to gain approval from others.

Engaging in the challenge risks short- and long-term health consequences, and even death, due to the excessive alcohol intake involved, and the dangerous settings often chosen. Posting the evidence online might also cause ‘cybershame’ (another new term to me) – the feeling of embarrassment that follows seeing unfavourable images of oneself online – and impact on future employment chances, as many employers now check social network sites when recruiting.

PictureOnline communities bring together a range of social groups that may remain separate in real life, which may be why these communities are so influential.
Why do people take part in Neknominate?
As a psychologist by background, I am interested in trying to understand the reasons behind individuals’ health-related behaviours and choices. In the case of Neknominate, many possible explanations came to mind: Do people take part because they want to belong to a group or are afraid of being viewed negatively? Is it the thrill experienced from engaging in risks? The positive feeling of approval from others? Or maybe trying to live up to one’s self-image as fun, creative and spontaneous? 

The impact and influences of an individual’s social surroundings on their behaviour seem to be particularly relevant here. Research has shown that young people are particularly susceptible to peer influences, which can encourage them to engage in risk behaviours. In the case of Neknominate, not only immediate peers but also their peers are able to see whether or not the challenge has been completed. This potential magnified ‘peers-of-peers’ pressure might be an important factor when trying to explain online behaviours.

Theories like the Social Identity Theory developed by Tajfel and Turner (1979)* can help to explain why we try so hard to belong to social groups. This theory proposes that belonging to a group provides an individual with a social identity and an overall sense of belonging in the world. Being part of a group can have an impact on the individual’s attitudes, perceptions, evaluations and behaviour. 

The ‘social group’ involved in Neknominate represents the whole online social media community. This community combines a whole range of usually separate social groups, including friends, family, colleagues, neighbours and acquaintances. This may explain the strong influence it can have on our social identity, and the importance often placed on presenting a positive image online.

As others ‘like’ and positively comment on videos of Neknominate participants, participation is presented as a normative and accepted behaviour of those in the online community. This is underlined by the tendency of online spaces to inform everybody about others’ actions at all times. Seeing Neknominate as an accepted and normative behaviour may increase an individual’s likelihood of taking part, to show that they belong to this online community. Similarly, fear of rejection by the online community might make it more likely to act in line with what is shown by others in the online community.

We know from social psychology research that individuals are more likely to adhere to messages, including those about health behaviours, if they come from many others, and if they come from individuals close to oneself – both of these hold for Neknomination. Additionally, research has found that the more the individual values the group membership and sees this as part of their identity, the more likely they are to conform to norms and to act in line with the perceived group identity. As our online community often includes most of the people that we know, it is likely that we will behave in similar ways.

It has also been found that the presence of a group might lead individuals to take part in behaviours that are not in line with that individual’s personal opinions. For example, research showed that around one third of 18-24 year olds reported to have felt pressured by friends to drink more than they wanted.

Additionally, individuals in groups with a strong sense of group unity are known to be less likely to question group norms and rules. It is interesting that individuals feel that they have the right to Neknominate others after they have completed it. This resembles the initiation rites that exist in many cultures across the world, in which individuals have to take part in a certain type of challenge or ritual to belong to the group. Research has shown that the occurrence of initiation rites may lead to a closer bond within the group in question.

PictureThe ubiquity of tablets and internet-enabled phones means many of us are constantly connected to our online networks.
Social media signs – potential value and pitfalls 
In the age of thriving social networks, constant online interactions, and updates on others’ behaviours, the online community impacts hugely on our behaviour and the way we see the world. Analysing social media can help us understand behaviour and decision-making, allowing us to pick up health trends and behaviours. 

Social media can be a useful tool in health research: for example, to gain access to individuals, recruit or communicate with participants, or share findings with the wider world.  We in DECIPHer make use of social media in our research in various ways, including using Facebook to communicate with participants, and using TwitterYoutube and blogs to inform others about our research.

In some cases, social media might even form part of an intervention to promote health, or change social norms about health behaviours. In the case of Neknominate, there may be potential to use the same social media that helped the trend proliferate to raise awareness of its dangers, or to come up with alternative challenges with a more positive outcome.

On the other hand, social media might promote or normalise unhealthy behaviours, as is happening with Neknomination. Raising topics in the media and discussing those in detail might encourage others’ interest in those behaviours, as has been found in research on reporting of suicides and media coverage of new drugs.

The (social) media in public health represents a double-edged sword, whose functions and opportunities for public health still need to be further investigated. Questions that come to my mind include the following:

  • How can we use social media networks and tools to advance our understanding of health behaviours and influences? 
  • In what ways can we engage the public in social media awareness and protect the public from (false) health messages?
  • How can we effectively impact and change existing norms in social media forums? 
  • What are the ways to best monitor and react to new trends such as Neknomination? 

I am interested to hear your views on the potential of the social media in health research and in explaining health behaviours, so please get in touch

*Tajfel, H., & Turner, J. C. (1979). An integrative theory of intergroup conflict.The social psychology of intergroup relations, 33, 47.

Image of people – source: Gregory Pleau, via Flickr.

Heide Busse is a research assistant at DECIPHer, based at the University of Bristol.

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