Commentary on "The effect of sexually transmitted disease education via Instagram on the knowledge and attitudes of university students: a pilot study"

Dear Editor,

We read with great interest the article titled "The effect of sexually transmitted disease education via Instagram on the knowledge and attitudes of university students: a pilot study" by Gürkan et al. The authors deserve recognition for addressing a timely and critical issue in public health: sexual education among young adults. Their efforts to incorporate a contemporary and youth-oriented medium such as Instagram represent an important initiative in digital health promotion.

While the study offers promising insights regarding the potential of social media in health education, we wish to contribute several reflections that may be valuable for the interpretation and development of future research in this area.

First, the use of a knowledge scale with a Kuder-Richardson-20 (KR-20) reliability score of 0.60 raises concerns about internal consistency. According to psychometric standards, a reliability coefficient below 0.70 may limit the credibility of an instrument's results and its ability to measure the intended construct effectively¹.

Second, while the study successfully assesses short-term attitudinal changes, it does not make use of validated instruments such as the Condom Use Self-Efficacy Scale or the Sexual Health Literacy Scale for Young Adults. Without psychometrically rigorous tools, it becomes difficult to compare outcomes with the prior literature or to ensure reproducibility². Moreover, behavioral outcomes were not measured, which limits conclusions about real-world impact beyond knowledge and perception.

Third, the absence of discussion around user engagement metrics and Instagram's algorithmic behavior is a notable gap. Variables such as content reach, interaction frequency, and video view duration have been shown to influence learning and behavior change in similar digital interventions³. Prior research demonstrates that incorporating these metrics can improve the targeting and personalization of health messages⁴.

Additionally, focusing exclusively on Instagram may reduce the broader applicability of the findings. Platforms such as TikTok and YouTube are also commonly used by adolescents and young adults for health information. McCashin et al., for example, found that the TikTok content related to mental health generated high engagement, though it varied in accuracy⁵. Similarly, Lupton emphasized the importance of YouTube as a primary channel through which youth seek peer-generated health content⁶. Future studies might benefit from comparing platform effectiveness in reaching and influencing health behaviors.

Another area that merits consideration is digital health literacy. As outlined by Walton and Richardson, the ability to critically evaluate and act on online health information is essential for the success of any digital intervention⁷. Including a measure of digital health literacy in future studies would add depth and improve the contextual understanding of participants’ responsiveness.

In conclusion, we appreciate the authors’ efforts in exploring a modern, digital avenue for sexual health education. Their study adds value to a growing field and lays the groundwork for larger, more comprehensive investigations. By integrating validated tools, platform-specific metrics, and a broader scope of digital behavior, future research can offer more robust and generalizable insights.

• Funding:
  none.

DATA AVAILABILITY STATEMENT

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

REFERENCES

• ¹ Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ. 2011;2:53-5. https://doi.org/10.5116/ijme.4dfb.8dfd
  » https://doi.org/10.5116/ijme.4dfb.8dfd
• ² Santelli JS, Grilo SA, Choo TH, Diaz G, Walsh K, Wall M, et al. Development and validation of a sexual health literacy scale for young adults. Sex Res Soc Pol 2019;16(3):361-72. https://doi.org/10.1007/s13178-018-0346-7
  » https://doi.org/10.1007/s13178-018-0346-7
• ³ Dehghani M, Niaki MK, Ramezani I, Sali R. Evaluating the effectiveness of Instagram as a platform for health education: a content analysis of evidence-based posts. Health Educ Res 2020;35(6):515-22. https://doi.org/10.1093/her/cyaa018
  » https://doi.org/10.1093/her/cyaa018
• ⁴ Mo PK, Xie L, Lee TC, Li AYC. Use of behavior change techniques in digital HIV prevention programs for adolescents and young people: systematic review. JMIR Public Health Surveill. 2025;11:e59519. https://doi.org/10.2196/59519
  » https://doi.org/10.2196/59519
• ⁵ McCashin D, Murphy CM. Using TikTok for public and youth mental health - A systematic review and content analysis. Clin Child Psychol Psychiatry. 2023;28(1):279-306. https://doi.org/10.1177/13591045221106608
  » https://doi.org/10.1177/13591045221106608
• ⁶ Lupton D. Young people's use of digital health technologies in the global north: narrative review. J Med Internet Res. 2021;23(1):e18286. https://doi.org/10.2196/18286
  » https://doi.org/10.2196/18286
• ⁷ Walton G, Richardson J. Digital health literacy: a review and implications for health education. Health Educ J 2022;81(2):111-25. https://doi.org/10.1177/00178969211011161
  » https://doi.org/10.1177/00178969211011161

Edited by

• Scientifıc Editor:
  José Maria Soares Júnior https://orcid.org/0000-0003-0774-9404

Publication Dates

• Publication in this collection
  09 Jan 2026
• Date of issue
  2025

History

• Received
  23 June 2025
• Accepted
  12 Aug 2025