Persuasion Strategies in Facebook Health Communication: A Comparative Study between Egypt and the United Kingdom

1 Introduction

Social media is widely used in health communication by individuals, health professionals, disease centres, and other health regulatory bodies (Afful-Dadzie et al., 2023). Research has shown that social media is used by health-care providers for several purposes, including dissemination of health information, monitoring of disease pandemics, health promotion, recruitment of clinical study participants, and social media-based health interventions (Huo et al., 2019). With this wide use of social media for health purposes, governmental departments of health have recently started to communicate with the public via their social media accounts, particularly in the wake of the COVID-19 pandemic (e.g., Abunadi & Kumar, 2021; Park, 2022). Governmental departments of health make use of popular social media networks in this regard, particularly Facebook because it is the most widely used social media platform (Statista, 2023). Facebook has been extensively used by public health organizations and departments of health for health promotion and behaviour change campaigns and activities (Kite et al., 2016; Sharif et al., 2021). This extensive use of Facebook in health communication has recently attracted the attention of several scholars (e.g., Balogun et al., 2023; Jung & Sundar, 2022; Lovari et al., 2021). However, limited information is still available on the effective and efficient use of Facebook.

The current study aims to contribute to this line of research by examining the persuasive strategies used by departments of health to promote their health services to the public. In particular, the study compares the use of persuasive strategies in health communication on Facebook by the Egyptian Ministry of Health and Population versus the British Department of Health and Social Care. The focus on these two departments was motivated by the fact that the Egyptian and the British societies represent two distinctly different cultures as they represent the East versus the West. Hence, the current study is multidisciplinary in nature since it falls under the field of Health Communication, a sub-field of Science Communication that is concerned with how communication strategies are used to inform and influence individuals and communities with respect to health messages (Thomas, 2006), and the field of Cross-cultural Pragmatics, which examines how language is used across different cultures (House & Kádár, 2021).

The current study gains special significance for three reasons. First, the study fills a gap in the literature which needs further research on using Facebook in health communication. As noted earlier, although Facebook is widely used for the communication of health messages, relatively limited information is available on its efficient and effective use for this purpose. Second, the present study explores the types of persuasive strategies used on Facebook to convince the public to use the health services provided by the departments of health and to change their behaviour with respect to health practices. Although persuasion has been studied extensively in other domains (e.g., Fanani et al., 2020; Hill, 2020; Krishnan et al., 2020), relatively little is known about its use in online health communication. Third, the findings of the current study will shed light on the potential influence of cultural differences on the use of persuasion strategies in online health communication. The intriguing question will be: Will the differences in cultural values, beliefs, and principles between the Egyptian and British societies influence their use of persuasion in Facebook posts?

Since the current study draws upon models of persuasion and cross-cultural differences, the following section will briefly report on the model of persuasion used in the current study which was developed by Dontcheva-Navratilova et al. (2020) and other cross-cultural models. This will be followed by a survey of the relevant literature and a list of our research questions. Then, the methods will be detailed, the results will be reported and interpreted, and pertinent conclusions will be drawn.

2 Theoretical Framework

The current study employs a typology of rhetorical strategies to examine how departments of health persuade the public to make use of the departments’ services and adopt healthy behaviours. This typology, which was proposed by Dontcheva-Navratilova et al. (2020) based on corpus research, has its origins in Aristotle’s three appeals of persuasion, namely, ethos, logos, and pathos. According to Aristotle, ethos refers to the communicator’s credibility, logos refers to the use of facts, logic, and arguments, and pathos refers to appeals to emotion. These appeals are fundamental to persuasion and are found in different forms of communication (Perloff, 2010). The typology used in the current study elaborates on these three appeals by attaching specific strategies and relevant linguistic resources to each persuasive appeal. In fact, Dontcheva-Navratilova et al. (2020) proposed four models of persuasion in relation to academia, business communication, religion, and technical English. The academic model relates to academic discourse, such as research articles, while the business model relates to communication among business entities, such as companies and corporations, and the religious model is relevant to religious discourse, including religious sermons. The fourth model, which is adopted in the present study, is related to technical discourse. Since this study explores the persuasive patterns in health communication, the technical model proved the most relevant because technical discourse comprises the use of language for science communication. Further details on this technical model can be found in the methodology section below.

In addition to the persuasive appeals, three models of cultural differences are relevant to the current study which compares the use of persuasive appeals in two different cultures. First, Hofstede’s (2001) individualism–collectivism index classifies cultures based on the degree to which people in a society are integrated into groups. According to the model, individualistic cultures, including Western cultures, encourage everyone to look after themselves and, thus, are characterized by loose ties among individuals. On the contrary, collectivistic cultures, including the Arab countries, prioritize forming strong and cohesive in-groups. Second, Hall (1976) distinguishes between low-context cultures, including Western cultures, which prefer the use of explicit verbal messages and tend to be confrontational, and high-context cultures, including the Arab World, which prefer using indirect and implicit messages. Third, Brown and Levinson (1978, 1987) proposed a politeness theory that considers certain speech acts, such as advising and requesting, as face-threatening acts. Individuals avoid using these acts or try to mitigate their effect when they have to use them because these acts constitute a form of imposition on individuals. This perspective towards the so-called face-threatening acts may be specific to Western cultures that highly value individualism and independence (Mao, 1993). Other cultures may not share the same face concerns as Western cultures (Spencer-Oatey, 2008). These cultural models will be relevant to the interpretation of our results.

3 Literature Review

Several researchers have used Aristotle’s appeals to investigate the realization of persuasion in different genres, including advertisements (e.g., Talaue, 2022; Yaseen et al., 2022), religious sermons (e.g., Adam, 2017), political speeches (e.g., Boginskaya, 2023; Putri et al., 2024), reports (e.g., Alkaraan et al., 2023; Higgins & Walker, 2012), research abstracts (e.g., Mohamad, 2022), tourist guidebooks (e.g., Skendo, 2024), and students’ writing (e.g., Al-Momani, 2014; Farnia et al., 2019; Krishnan et al., 2020). However, the current survey of literature will focus on the studies that employed these appeals in examining the realization of persuasion in online communication only due to their relevance to the current study which focuses on the use of persuasion in Facebook posts. In this regard, a number of studies have examined the use of persuasive appeals in different types of videos. A case in point is Rabab’ah et al. (2020) who examined the use of persuasive appeals by telecommunication companies in Jordanian and Algerian television commercials. The study included an analysis of 12 television commercials extracted from YouTube. The results showed that almost all appeals were found in the commercials of both countries but to varying degrees. The results also showed that the commercials exhibited some degrees of sensitivity to the unique culture of the target community.

Other video studies focused on the investigation of digital political persuasion. For example, English et al. (2011) examined the effect of YouTube clips on consumers of political information. To this end, a total of 233 undergraduates took part in a three-cell post-test-only experimental design study. The participants watched three YouTube clips about health care, each clip containing a different persuasive appeal (source or ethos, logic or logos, and emotion or pathos). The results showed that the participants were most influenced by the ethos appeal as it ranked as the most credible appeal, followed by logos and pathos. This result indicated that the participants resisted being swayed by emotion (pathos) or hard numbers (logos). In the same vein, Zamora-Medina et al. (2023) examined the use of persuasive appeals in 372 videos posted on the official TikTok profiles of political parties and leaders in Spain and Poland. The results showed a stronger reliance on rational resources (logos) in the case of political parties, whereas political leaders exhibited a stronger tendency to use emotional resources (pathos) for persuasion. Notably, the personality of the political actors (ethos) was rarely emphasized, which indicated that ethos is not commonly used as a digital persuasion strategy on TikTok in the concerned countries.

In addition to videos, scholars have investigated the use of persuasive appeals in different forms of online communication. For example, Hill (2020) analyzed the webpages of British undergraduate fashion marketing degrees to explore any potential distinctions in the use of persuasive appeals between types of universities. The results revealed clear distinctions among different types of universities. While the Russell Group and Specialist universities relied more on appeals to ethos (credibility) and logos (fact/date) to market their courses, 92 institutions relied more heavily on appeals to emotion (pathos) and giving more focus to “value for money.” Another case in point is Fahmy and Ibrahim (2021) who examined the use of persuasive appeals in 1,000 viral Twitter memes with the hashtag #MeToo. The results showed a significantly higher number of pro-MeToo memes than anti-MeToo members on Twitter. Additionally, the results showed that the anti-MeToo members employed the emotional appeal significantly more frequently than the pro-MeToo memes which relied more heavily on the logos and ethos appeals.

Some studies on persuasive appeals have also examined online reviews and responses to these reviews. For example, Amos et al. (2022) examined the consumers’ trustworthiness and usefulness perceptions of the persuasive appeals in online restaurant reviews. They employed a full-factorial between-subjects design to evaluate 14 restaurant reviews on trustworthiness and usefulness perceptions. Overall, the results indicated that the participants exhibited greater perceptions of trustworthiness and usefulness in the reviews featuring logos, rather than ethos or pathos. Another relevant study is by Bonfanti et al. (2016) who explored how hotel managers preferred to respond to their guests’ online reviews. The study included an analysis of 447 responses provided by hotel managers belonging to an international chain. The findings showed that the hotel managers tended to employ a company-focused or a customer-focused style in their responses. The findings also showed that hotel managers handled the logos dimension of the response more effectively than the ethos and pathos dimensions.

In addition to the aforementioned studies, some scholars examined the use of Aristotle’s appeals in Facebook posts and tweets. Regarding Facebook, a relevant study was conducted by Samuel-Azran et al. (2015). In their study, the researchers examined Israeli politicians’ Aristotelian rhetoric on Facebook and how the public responded to this rhetoric during the 2013 election campaign. The results showed that ethos-based appeals were the most frequently used on the politicians’ Facebook walls, while the public seemed to respond most positively through “likes” to pathos-based appeals. As for the examination of tweets, a most relevant study to our current work is El-Dakhs (2022) which examined the persuasive strategies employed by the Saudi and Australian departments of health to encourage the public to take the COVID-19 vaccines. El-Dakhs (2022) analyzed 200 tweets using an adaptation of Dontcheva-Navratilova et al.’s (2020) model of technical persuasion. The results showed that Australians employed logo-based appeals more frequently than Saudis, while the latter were the only ones who employed pathos strategies. The results also showed that both departments of health employed a similar number of ethos-based appeals although their use of relevant strategies varied. In addition, the findings included some qualitative observations such as the more frequent use of questions by Australians and the notable inclusion of religious discourse by Saudis.

The current study extends the work of El-Dakhs (2022) to a new context. We focus on the persuasive strategies employed by the Egyptian Ministry of Health and Population versus the ones used by the British Department of Health and Social Care to explore if similar findings will emerge when the two departments of health are functioning in normal times, not at a time of crisis as was the case in El-Dakhs (2022) which focused on health communication at the time of the COVID-19 pandemic. In addition, while the earlier study examined the tweets of the Australian and the Saudi departments of health, the current study examines the Facebook posts of the British and the Egyptian departments of health. Thus, findings of the current study will allow us to discover if the findings of El-Dakhs (2022) extends to a new social media platform and other collectivistic (i.e., Egypt and Saudi Arabia) versus individualistic (i.e., the United Kingdom and Australia) cultures. Our findings will also greatly contribute to our understanding of the use of persuasion strategies in online health communication.

4 Research Questions

The current study addresses the following research questions:

1. What persuasive strategies does the Ministry of Health and Population in Egypt use to promote its services?

2. What persuasive strategies does the Department of Health and Social Care in the United Kingdom use to promote its services?

3. Are there significant differences in the persuasive strategies employed by the Egyptian Ministry of Health and Population and the British Department of Health and Social Care?

5 Methodology

6 Results

This section is divided as per our research questions.

7 Discussion

The current study examined the persuasive strategies used in 400 Facebook posts by the Egyptian Ministry of Health and Population versus the British Department of Health and Social Care. Overall, the two departments of health employed a similar pattern of persuasive strategies as they employed ethos the most frequently, followed by logos and then pathos. This reflects prioritizing a focus on the credibility of the source of the messages in online health communication before the use of logical arguments and emotional appeals. This finding comes in line with El-Dakhs (2022) which examined online health communication on Twitter as represented by the tweets of the Australian and the Saudi departments of health. Similar to the current study, El-Dakhs (2022) found that Australians and Saudis prioritized the use of the ethos appeal before the use of logos and pathos. This finding is also aligned with the findings of English et al. (2011) who found that the participants are most influenced by the ethos messages in healthcare clips on YouTube, and the findings of Samuel-Azran et al. (2015) who found that politicians primarily rely on the use of the ethos appeal in their Facebook posts. However, it must be noted that other platforms and domains prioritized other appeals. For example, online restaurant reviews (Amos et al., 2022) and responses to hotel reviews (Bonfanti et al., 2016) tended to use the logos appeal more often, and the pathos appeal was more highly emphasized in the Twitter memes in relation to the #MeToo movement.

Regarding the use of individual persuasive strategies, both departments of health preferred similar strategies. Under the ethos appeal, the two departments used the strategies of direct appeal to the audience and appeal to the sense of community most often. As for the logos appeal, the two departments prioritized the use of logical reasoning and the use of facts and statistics, although to varying degrees. The British posts also included several instances of the proof by exemplification strategy. Regarding the pathos appeal, the Egyptians preferred exhibiting care and responsibility to the readers, while the British rarely used the appeal. These findings are aligned with the results of El-Dakhs (2022) which similarly found that the Saudi and Australian departments of health prioritized the use of direct appeal to the audience and creating a sense of community under the ethos appeal and the use of logical reasoning and facts/statistics under the logos appeal. Our findings are also similar to El-Dakhs (2022) regarding the use of pathos since the Saudis, who were the only ones to employ pathos-based strategies, tended to create a sense of care and responsibility more than any other strategies under the pathos appeal. Thus, it seems that certain persuasive strategies are preferred in the domain of online health communication although additional research is still needed to further confirm these results.

With respect to the quantitative comparisons between the two departments of health, some interesting differences were found. Under the ethos appeal, the Egyptians directly appealed to the audience more often than the British, while the British referred to expert opinion and employed the sense of community more often than the Egyptians. These differences can be explained in terms of cultural differences between the two communities. As a collectivistic community (Hofstede, 2001), the Egyptians expect the health authority to perform its duty through providing the public with relevant directions and guidelines, so the Egyptian Ministry of Health and Population found it normal to use a great deal of imperatives (El-Dakhs, 2022). The British, however, may have preferred to minimize the use of imperatives because individualistic communities prefer freedom of imposition (Brown and Levinson, 1978, 1987; Hofstede, 2001). In addition, the British employed the strategies of reference to expert opinion and creating a sense of community more often than the Egyptians because the British attempted to persuade the public through reliance on the credibility of important individuals in the society and acknowledging the presence of individual readers, which is again aligned with the individualistic nature of the British society (Hofstede, 2001).

Under the logos appeal, it was found that the Egyptians employed more logical reasoning than the British, while the latter referred to statistics and facts, employed exemplification, and provided evidence more often than the Egyptians. The more frequent use of logical reasoning by Egyptians can be explained in terms of the tendency of the Arabic language to make intersentential relations more explicit through the use of logical connectives (e.g., “wa” = and “fa-” = and/so). It is widely acknowledged that the Arabic language exhibits a more dense use of interclausal and intersentential connectors than the English language (Dickins, 2017). In contrast, the British preferred to persuade the public through providing them with diverse sources of information, including statistics and facts, examples, and different types of evidence, to encourage them to take the right decision. Again, the British focused on the individualistic nature of the British community (Hofstede, 2001) which emphasized the value of taking individual decisions based on logic and facts. Additionally, as a low-context culture, the British made a more extensive use of exemplification to be more explicit in their messages (Hall, 1976).

Under the pathos appeal, the Egyptians employed more pathos-based strategies than the British. This is particularly the case with the strategy of creating a sense of care and responsibility. This finding again comes in line with El-Dakhs (2022) in which the Saudis, a similar collectivistic community to the Egyptians, used more pathos-based strategies than the Australians, an individualistic community which is similar to the British. Thus, it seems that the appeal to the public’s emotions is more common in collectivistic communities in which in-group relations and caring about family members are more strongly emphasized (Hofstede, 2001). It must be noted though that the pathos-based strategies were the least frequently used by the Egyptians among other strategies, which reflects an influence of the health communication domain with its strong emphasis on the use of ethos-based strategies as explained earlier (e.g., El-Dakhs, 2022; English et al., 2011; Fahmy & Ibrahim, 2021).

In addition to the quantitative findings, we also made some qualitative observations. It is obvious that the posts of both departments employed several means of communication with the public, including hotlines, websites, and social media. The posts also conformed to the nature of social media through the use of several emojis. Both departments also attempted to mitigate imposition through justifying their directives to the public. However, some differences were noted. The individualistic nature of the British society (Hofstede, 2001) was exhibited through a frequent use of surveys to examine the public’s opinion, the provision of information about the diseases to help the public take the right health decisions, and the explicit use of examples to clarify the provided information. The collectivistic nature of the Egyptian society was exhibited in the frequent emphasis on the importance of taking care of the elderly by their family members and by the repeated directives to make best use of the health services. The Egyptian posts also repeatedly emphasized that the health services offered were free of charge, which reflects the difficult economic situation in Egypt in which the public struggles to receive good health services that do not incur huge fees.

The results of the current study highlight that online health communication has its own distinctive characteristics while also being amenable to cultural variation (e.g., El-Dakhs, 2022; Rabab’ah et al., 2020). Based on the results of the present study and earlier research (e.g., El-Dakhs, 2022; English et al., 2011), it seems that online health communication heavily relies on the appeals of ethos, followed by logos. Health communication also seems to prefer certain individual strategies, such as the use of statistics and facts, direct appeals to the audience, and logical reasoning. However, the influence of cultural variation is also apparent. Clear differences in the persuasion strategies were noted due to cultural differences between the Egyptian and British societies. For example, Egypt as a collectivistic society used more pathos-based strategies than the British and exhibited clear collectivistic behaviour (Hofstede, 2001), such as emphasizing taking care of the elderly by family members and giving directives to fulfil the duty of the health authority towards its people. In contrast, the British posts showed several individualistic tendencies (Hofstede, 2001), including the use of surveys, the fewer uses of directives, and the emphasis on the importance of seeking further information by the public themselves. Similarly, the British were more sensitive to imposition than the Egyptians (Brown & Levinson, 1978, 1987) as reflected in the British preference to use fewer directives. However, it must be noted that the two departments of health tried to mitigate imposition through the provision of justifications.

8 Conclusion

The current study compared the use of persuasive strategies by the Egyptian Ministry of Health and Population and the British Department of Health and Social Care in Facebook health communication. The results have highlighted that the two departments of health preferred the use of the ethos appeal, followed by the logos appeal. The results also showed that health communication is influenced by cross-cultural differences. These findings provide important implications for online health communication. First, it is important to ensure the credibility of the source of messages in health communication. The ethos of the messages should be emphasized to build the audience’s trust. Second, it is recommended to use the logos strategies to enhance the impact of the messages on the audience. This can be achieved through the use of relevant strategies, such as the use of facts and statistics, exemplification, and evidence. Third, online health communication must be sensitive to the culture of the target audience. For example, individualized cultures will not welcome too much imposition in the messages. Instead, they welcome individual success stories and role models and the provision of sources of information to learn more about diseases and explore medical options. On the contrary, collectivistic societies are highly likely to welcome emotional appeals to the audience and focus on group solidarity.

In terms of research directions, it must be noted that the findings of the present study contribute to a relatively recent line of research that is concerned with online health communication on social media. This research direction is still in need of further studies to explore the use of persuasion strategies across different online platforms, health providers, languages, and cultures. It is particularly recommended to examine how persuasion is realized by comparable health providers/institutions in different cultures in order to explore the specific features that characterize online health communication and identify any potential differences in relation to the cultural backgrounds of the target audience. In the current study, the focus was on Egypt versus the United Kingdom. Comparisons across other cultures will be equally valuable and providing relevant case studies to demonstrate the application and effects of different strategies in practice will constitute important contributions. Additional studies are also needed regarding the effect of persuasion strategies on the public and how the public perceive and respond to these strategies. The public responses can be assessed through different online features, such as likes, reposting, and engagement rates. The responses can also be measured through other means, including surveys and behavioural experiments. Further research is also needed on how persuasion is realized in different types of discourse, including academic, religious, and business discourse. This direction of research will be supported by the development of new models of persuasion (e.g., Dontcheva-Navratilova et al., 2020) which specify relevant strategies and linguistic resources for the three main appeals to persuasion, i.e., ethos, logos, and pathos.