Virality and trending, though often used interchangeably to describe popular content on social media platforms, bear distinct characteristics. Trending typically denotes topics or content that sustain prolonged visibility and generate significant attention, often associated with slogans or phrases relevant to current events. In contrast, virality refers to the rapid and widespread attraction of attention to a singular post, such as a meme, appreciated for its quality, relatability, or humor (Nahon; Hemsley, 2013). A trend is defined as “a simplified description of an overarching development that results from the interactions of a content core with its environment that persists over a period of time of relevance in the respective context” (Blechschmidt, 2022, p. 10). For many, it is mostly manifested either fashion designs (Blechschmidt, 2022) or a hashtag on a specific platform.

Likewise, hashtags, represented by the symbol ‘#’, function akin to Google searches within most social media networks, operating exclusively within their public profile database, driving the trending and dissemination of topics in public fields (Arom, 2018). A hashtag functions as a keyword attached to social media posts, facilitating search and playing a significant role in organizing discussions or posts related to specific topics or events (Ma; Sun; Cong, 2012; Tsur; Rappoport, 2012).

In the meantime, why and how a piece of information, a post, or a theme goes viral has provoked debate in academia, compelling researchers to articulate the factors behind it. In one case, Kim (2015) tried to put the reasons for the virality of health news under scrutiny. The results showed that news with specific characteristics, such as controversial, emotionally evocative, familiar content, and novelty, is more likely to be shared and go viral. Asur et al. (2011) found that the connection between content and social media users significantly influences the emergence of trends. Additionally, a significant portion of trend-setting content originates from conventional media outlets, while social media serves as a discerning amplifier for such content.

Social media exposes an array of users every day to hashtags or trends (Varol et al., 2017). In diverse forms, scales, and contexts — from important healthcare announcements to final football games — it has become a major driver of information flow. To illustrate, the hashtags are suggested to share health-related information and target specific communities of interest to serve as an accessible source of information and facilitate the dissemination of health-related content (Katz et al., 2019). Reasonably, scholars contributed to characterizing different dimensions of trends and detecting emerging contexts (Naaman; Becker; Gravano, 2011; Sakaki; Okazaki; Matsuo, 2010; Sankaranarayanan et al., 2009).

Social media usage varies across generations, with Millennials and Gen Z being frequent users, while Gen X engages with a broader range of platforms. Gen Z typically uses 2-3 platforms daily, such as YouTube, Instagram, and TikTok (Kamble, 2023). There are a multitude of platforms that offer diverse services, all of which are generally referred to as social media. However, this study only focuses on three ubiquitous social media platforms used by undergraduate and master’s students: Instagram, TikTok, and YouTube. Moreover, we decided included X due to its prominent role in tracking trends and its widespread use for following trending events.

Considering variations in social media platforms, we considered two major criteria for choosing these networks: first, popularity among Gen Z, and second, the influence of the network on trends and viral contents. The majority of TikTok users are youth between the ages of 18 and 24 (Howarth, 2024). Also, the age group distribution of Instagram users worldwide as of January 2023 shows that almost 30.8% of users were aged between 18 and 24 (Statistica, 2024). In the case of YouTube, nearly one- third of the total number of users is younger than 34 (YouTube Age Demographics, c2015-2025. Although X is not as popular among youth as the other three platforms, it was included because of its importance in tracking hot topics and viral content and understanding real-time sentiment (Aboulhosn, 2021).

Cutting-edge technologies and artificial intelligence are implied in all four platforms that aim to personalize, protect, and boost connectivity. In the case of TikTok, its algorithm prepares individually customized video feeds and can potentially influence how we perceive reality and how we interact with each other (Klug et al., 2021). X also uses an algorithm to identify popular subjects tagged with a mark, namely hashtag #, on varying scales, which may be appropriate for users based on different criteria such as their following, interests, and location (Twitter Trends FAQ […], c2025). The same function is exploited by YouTube to recognize trends according to how many likes, comments, and views a content has (Andry et al., 2021).

The purpose of using social media varies. As for Gen Z in the US, for example, according to Global Web Index (GWI), by December 2023, they stated a variation from Finding content (27.0%) to Filling spare time (37.5%) to Avoid missing out on things (17.4%) to Seeing what’s trending / what’s being talked about (25.3%). Another report by GWI clearly shows the desire to follow hot trends among different generations. 32% of Gen Z users, 30% of Millennials, and 27% of Gen X users express that their main purpose of using social media is to see what’s trending or being discussed (Social Media by Generation, 2023). Following trends comes with potential advantages and drawbacks.

While trending topics spread information across diverse social circles, allowing messages to reach a broad audience beyond one’s usual connections and exerting influence over the trend for good reasons like education or raising awareness about an issue, manipulating is an emerging and progressively perilous method of persuasion in the realm of social media. In fact, nefarious individuals can exploit trends to disseminate their messages through diverse media forms and across various platforms, with the aim of securing coverage in mainstream media (Prier, 2017).

The OHISB could and would be influenced by various stimuli. For example, health anxiety significantly impacts individuals’ tendencies to search for health-related information online (Lagoe; Atkin, 2015), characterized by a persistent fear of illness and misinterpretation of bodily symptoms as indications of severe health issues (Jones; Hadjistavropoulos; Gullickson, 2014). Besides, an experiment unveiled how emotional states (like fear, hope, contentment, interest, and inspiration) during online searches and social cognitive factors influence outcomes such as attitudes towards health-related behavioral intentions and intentions to share health information (Myrick, 2017). However, stimuli can occasionally have unintended consequences and lead to health information avoidance. Research using the Stimulus, Organism, and Response framework demonstrated that individuals with increased social media exposure tend to experience higher levels of information overload and anxiety during health crises (Soroya et al., 2021). Another study used internet search data in the States to get a better understanding of health information behavior during the last pandemic. The results revealed that there was a correlation between the numbers of US COVID-19 confirmed cases and searches for the disease (Vijay et al., 2021). Exposure to buzz news and information related to COVID-19 information functioned as a trigger, prompting individuals to seek health information online. Wang et al. (2019b) (X. Wang et al., 2019) tried to identify the reasons for the virality of cancer information on social media. They found that both the sender and the content play a role in shaping how information spreads.

As demonstrated by Ali et al. (2019) and Dăniasă et al. (2010), whether confirmed or unconfirmed, viral content circulating on social media has the potential to exert various influences on users, ranging from evoking emotions such as fear to stimulating engagement and even prompting adoption. Considering the role of perceived health risks in shaping OHISBs as indicated by Deng and Liu (2017), it makes sense that trends that evoke emotional responses could similarly affect OHISB.

The existence of misinformation or unverified information related to health on topics of interest is one of the possible concerning impacts of trends. A study on the prevalence of unverified health- related information by Sanz Suárez-Lledó and Álvarez Gálvez (2021) showed that health misinformation is highly pervasive on social media, especially on current trends like vaccines. To address the issue, Bautista, Zhang and Gwizdka (2021) suggested that healthcare professionals must actively interfere to correct widespread misinformation on social media. Notwithstanding, not all trends and viral contents are unverified. It might be hard to exactly measure the effect of widespread content and trends on users, though there have been cases where trends literally influenced health-related decision-making. For instance, the amplification of skepticism about vaccines reduced the public consensus on the efficiency of vaccines (Broniatowski et al., 2018).

In the increasingly complex digital landscape, digital literacy has become indispensable equipping individuals with skills beyond operating applications and enabling them to effectively navigate and contribute to digital environments, fostering better communication, creativity, and critical thinking (Eshet, 2004). It is also linked to the ability to seek health-related information so as combat a disease or a health issue (Arias López et al., 2023) and can improve overall wellbeing (Kennedy; Yaldren, 2017). Ideally, digital literacy can help individuals critically assess the credibility of viral trends and the accuracy of information shared on social media (Diepeveen; Pinet, 2022; Polizzi; Taylor, 2019), including health-related trends. For example, students with higher digital literacy are less likely to be swayed by misinformation and more adept at identifying credible sources (Anthonysamy; Sivakumar, 2024).

The proliferation of health-related misinformation on digital platforms threatens health decisions and public trust, prompting digital literacy efforts as a countermeasure (Okoro et al., 2024). Therefore, digital literacy acts as a mediating factor that can potentially shape OHISB (Lee et al., 2021; Noh, 2016).

While the significance of trends and their impacts has been widely acknowledged, their implications for OHISB have been largely overlooked. Despite numerous discussions on trends and viral content, primarily within marketing contexts (Sajid, 2016), their potential influence on HISB remains unexplored. Therefore, this area warrants further research, particularly given the escalating ubiquity of trends globally.

Q1-4: Gender, Age, Level of education, Academic year. Participants provided demographic information including gender, age, study level, and academic year. The data indicated that 54.2% identified as male, while 45.8% identified as female. Most respondents (52.3%) were in the 18-20 age range. Regarding academic level, 79.4% were pursuing bachelor’s degrees, 11.2% master’s degrees, and 7.5% Ph.D. programs. Academic year distribution showed that the highest representation was among Year 3 students (40.2%), followed by Year 1 students (37.4%).

Q5-6: Which of the following social media do you currently use? Which one do you use the most? Please indicate with numbers 1 to 4 (1=the most and 4=the least). The data suggests that Instagram and YouTube are the most popular social media platforms among respondents, with roughly 80% recently using them. Following closely are X and TikTok, with around 59% and 57% respectively indicating recent usage. However, when asked which platform they use the most among Instagram, YouTube, X, and TikTok, appears to be the least favored, with only a small percentage of respondents selecting it. In contrast, Instagram, YouTube, and TikTok are more evenly distributed, with each garnering around 28% of respondents selecting them as their most used platform.

Q7: On average how much time do you spend on social media daily? A significant portion spends 1-2 hours (approximately one-third) or 2-4 hours (more than one-quarter), while smaller percentages engage for shorter periods, with 25% spending 30-60 minutes and 55% spending less than 30 minutes.

Q8: What are your main purposes of using social media? Conversely, only a few respondents allocate over 4 hours to social media daily. The primary reasons for social media use include entertainment (85%), staying updated with news and friends, finding information, socializing, and engaging with trends and viral content (27%).

Q9: How many followers do you have on your accounts that you most frequently use? The data indicates that most students have fewer than 1000 followers on social media, with the largest group falling between 500 and 1000 followers. Additionally, a significant number of students have more than 1000 followers.

Q10 and Q11: Regarding social media activity and content sharing habits. Around a quarter of surveyed students post content daily, while the majority do not. Posting frequency varies, with some students posting multiple times per day, up to more than 25 posts daily for a few respondents. The surveyed population predominantly shares personal life updates on social media (72 respondents), followed by entertaining content like funny videos and memes (39 respondents), content related to ideas and beliefs (26 respondents), and viral content (14 respondents).

Q12: What sorts of people do you follow on social media? Celebrities attract the largest following among respondents, with nearly 62% having celebrities as followers. Influencers also have a considerable following, along with science disseminators, trainers/teachers, and friends/acquaintances.

Q13: Do you use your social media accounts to obtain information? The data indicates that a significant majority of respondents use social media as a source of information, with only a small minority stating they never do so. About one-third rely on social media very often, while an additional 42% often use it for information. A smaller portion rarely or never utilize social media for information.

Q14: Are you interested in following viral contents or trends? Moreover, over 70% of respondents demonstrate some level of interest in following trends and viral content. Among students surveyed, a substantial number actively seek out viral content, with varying degrees of frequency. While some students consistently engage with trends, others do so less frequently.

Q15: Which platform do you usually use to find out about daily viral? The surveyed population utilizes various social media platforms to stay updated on trends, with TikTok and X being the most popular; each relied upon by around 40% of respondents. Instagram is also significant, with 30.8% of respondents using it for trend information, while YouTube is utilized by 21.5% of respondents.

Q16: Are you interested in actively take part or react (such as like, dislike, comment, share, etc.) to viral contents or trends? Most respondents, over half, express interest in engaging with viral content and trends to differing extents. However, nearly 47% of respondents reported seldom or never reacting to trends on social media.

Q17: Have trends in general affected your opinion about any subject? Around 30% of respondents believe trends could influence their opinions on a subject, while nearly 44% feel trends are unlikely to affect their views. The rest remained neutral on the matter.

In this section, we delve into the specific dynamics of OHISB among the surveyed population. As social media platforms continue to play a pivotal role in shaping how individuals access and engage with health-related information, understanding the patterns of seeking, interpreting, and trusting such information becomes crucial. We explore the platforms chosen for health information, the ease of comprehension, decision-making based on obtained information, and the influence of trends and hashtags on health-related information seeking. These insights shed light on the evolving landscape of health information consumption in the digital age.

Q18: Participants were asked whether they had ever sought healthcare information from any source on social media. If so, they were queried about the platform they primarily relied on for such information. Additionally, participants were asked to assess the ease or difficulty of making a choice from the available information, using appropriate words or hashtags to find relevant information, and finding the specific information they were seeking. In detail, a considerable proportion of the respondents (57%, n=61) actively sought healthcare information from various sources on social media platforms. This is consistent with previous findings showing significant reliance on social media. Instagram emerged as the preferred platform for healthcare information, with 36.0% of the respondents relying on it for healthcare information. YouTube follows closely, with 24.6% of the respondents using it as a source. X and TikTok also serve as platforms for healthcare information, being utilized by 21.3% and 11.5% of the respondents, respectively. Other sources on social media, which include various platforms not specified, account for 6.6% of the respondents’ healthcare information searches (Figure 1). Understanding health information sourced from social media is crucial. Among the 61 individuals who sourced healthcare information from social media, about 85.0%, stated that it was either easy or very easy for them to understand the health information they received. Conversely, only roughly 15.0%, found it hard to comprehend the information. Regarding decision-making based on the health information obtained from social media, approximately 39.0%, found it very easy or easy to make choices or decisions. On the other hand, roughly 61.0%, found it hard or very hard to make decisions based on the health information they received from social media. Among the surveyed population who used social media for healthcare information, approximately 67.0%, thought it was very easy or easy to find proper hashtags or keywords to obtain relevant information. Conversely, about 33%, found it hard or very hard to find appropriate hashtags or keywords. In terms of obtaining the expected information from social media, roughly 43.0%, found it very easy or easy to obtain the desired information. However, approximately 57.0%, found it hard or very hard to obtain the information they were looking for.

Q19: In general, how much would you trust healthcare information from social media? Regarding the trustworthiness of social media as a source of healthcare information, approximately 47% of the respondents expressed varying levels of trust, using a scale ranging from ‘Always’ to ‘Rarely.’ The scale values assigned to trustfulness were as follows: ‘Always’ (n=1), ‘Very Often’ (n=6), ‘Sometimes’ (n=49), and ‘Rarely’ (n=45). Among the respondents, six individuals indicated that they never trust healthcare information obtained from social media.

Q20: Have you ever been curious to look for relevant information about a hot hashtag (#) after encountering it on social media? The engagement with health-related hashtags demonstrates a nuanced response. Among the surveyed population, the presence of hashtags (#) on social media acts as a significant trigger for seeking additional information. Approximately 22% of the respondents indicated that they either always or very often search for more information when encountering hashtags. Additionally, around 31% mentioned that they sometimes engage in further information-seeking in response to hashtags. In contrast, 29% of the respondents stated that they rarely pursue additional information when coming across hashtags, while approximately 20% indicated that they never do so.

Q21: If the trend in last question is a health-related trend of any kind like warning about a specific product or benefits of consuming an herb, is there a possibility to look for more about it? When health-related hashtags such as #MonkeyPox or #seasonalflu are involved, the propensity of the surveyed population to seek additional information is slightly higher compared to general hashtags. The data shows that 2% of the respondents always feel compelled to look for further information in such cases, while 14% indicated that they very often engage in additional information-seeking. Additionally, 34% mentioned that they sometimes seek more information, whereas 40 % rarely do so. Finally, 17% of the respondents indicated that they never feel the need to search for further information when encountering health- related hashtags.

Q22: Have you ever taken part of a health-related trend, for instance Sarcoma breakout, in any possible ways such as like, dislike, comment, share, etc.? Being exposed to a health-related hashtag such as #COVID-19_Vaccines_sideeffects, it was found that approximately one third of the surveyed population felt persuaded to engage with the hashtag in various ways, such as liking, disliking, commenting, sharing, and more. The breakdown of responses is as follows: Always: 2 respondents, Very often: 9 respondents, Sometimes: 23 respondents. On the other hand, for the remaining respondents, the health-related hashtag may not have been compelling enough to elicit engagement. Specifically: Rarely: 24 respondents, never: 49 respondents.

Q23: Imagine needing information about a trend, like a Dengue trend. Where would you go first? How important is it that the information is from official sources, verified, and includes different, even controversial, opinions? In an imaginary situation where respondents encounter a viral health-related hashtag and have a strong need for information, most of them, up to 76 respondents, would first refer to search engines like Google. Additionally, 22 respondents tend to rely solely on the platform where they encountered the trending hashtag. Furthermore, 18 respondents consider other social media platforms as their primary source of information, indicating that they may rely on multiple social media platforms for their health-related information needs. Additionally, 12 respondents mentioned considering other mediums like television as sources of information. It is worth noting that some respondents may use multiple methods simultaneously, combining two or three of the mentioned approaches to gather the desired health-related information in this imaginary situation. When considering health-related information, a substantial proportion of the respondents placed significant importance on the official source of information. Specifically, 73 respondents consider it very important, while an additional 25 respondents find it rather important. Conversely, only 8 respondents find the source of information to be rather not important, and only 3 respondents stated that it is not at all important. The acknowledgment of the importance of official sources and fact-checking websites underscores the significance of verified, accurate information. Similarly, when it comes to the verification of information by fact-checking websites like www.FactCheck.org, a considerable number of respondents express its importance. A total of 35 respondents considers it very important, with an equal number of 35 respondents finding it rather important. On the other hand, 34 respondents consider the verification aspect to be rather not important, while only 8 respondents stated that it is not at all important (Figure 2).

Moreover, regarding the comprehensive coverage of the subject, forty-six respondents consider it especially important, and an equal number of forty-six respondents find it important. In contrast, 16 respondents consider the comprehensive coverage to be rather not important; while a mere 3 respondents stated that it is not at all important.