Social Media Peer Communication and Cholera Risk Perception During the 2024 Outbreak in Lagos, Nigeria: A Health Belief Model Analysis

Abstract

Background: Cholera remains a persistent and deadly global public health challenge. Recent resurgences have caused large-scale outbreaks. Due to gaps in public health risk awareness, effective risk communication using the HBM is now critical for cholera control and prevention. During the 2024 cholera outbreak, Lagos Island residents mainly relied on social media peers to exchange risk information. This study examined cholera risk perception among residents in the hotspot areas, established how the six HBM constructs were used in the cholera-related social media peer interactions, identified dominant cues to action in social media peer interactions, and established the association between exposure to peer-generated cholera messages and risk perception and the adoption of preventive behaviours. Methods: This is a cross-sectional study that combined a survey of social media users on Lagos Island and a quantitative content analysis of Facebook and X posts during the outbreak. A total of 350 Lagos Island residents were surveyed using a multi-stage cluster sampling strategy; 540 Facebook posts and 894 X tweets were content-analysed from a large corpus of data scraped from the platforms. Results: Findings showed high exposure to peer-generated cholera messages and cues to action on X and Facebook. HBM constructs appeared in varying proportions across platforms. ANOVA results and Games–Howell post-hoc comparisons showed a statistically significant difference in average engagement across the HBM constructs [p < 0.05]. Chi-square tests indicated a significant association between exposure to peer-generated cues to action and the adoption of cholera health behaviours [p < 0.05]. Conclusions: The study concluded that social media peer communication was significantly associated with residents’ understanding and perception of cholera risk during the outbreak. Health agencies should identify influential local voices on X and Facebook and assimilate them into public health communication strategies to strengthen the relevance, resonance, and effectiveness of digital health messages in outbreak contexts.