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Abstract

Objective

To explore the underlying motivations that prompt healthcare professionals (HCPs) to engage in social-media health communication and to construct a competency framework explaining how they develop and sustain this activity.

Methods

We employed grounded theory and qualitative content analysis, conducting semi-structured in-depth interviews with 28 verified HCPs on major Chinese platforms (Douyin, Weibo, Zhihu, Xiaohongshu). Open, axial and selective coding mapped the resulting categories onto the classic Onion Model.

Results

Coding generated 237 initial concepts, 33 first-order categories, and eight axial competencies, which were organized into a three-layer competency framework: Motivation layer highlighting intrinsic drivers such as achievement motivation, mission-driven purpose, and constructive responses to burnout; Personal Identity & Roles layer encompassing key traits, evolving role identities, and collaborative teamwork; and Professional Competencies layer covering medical expertise, digital skills, information literacy, and communication proficiency. This framework clarifies how HCPs sustain effective engagement despite tightened regulation and limited financial return.

Conclusion

HCPs’ presence on social media is driven by intrinsic motivation and enabled by a layered mix of personal and trainable competencies. The proposed framework offers actionable guidance for hospitals, professional bodies and platform operators seeking to design training, recognition and policy mechanisms that foster high-quality, trustworthy digital health communication.

Keywords

Health communication healthcare professionals (HCPs)social media competency framework grounded theory

Introduction

Social media has transformed various communication sectors. In healthcare—especially within China's fast-growing digital ecosystem—the public's demand for timely, accurate, and accessible health information continues to rise dramatically.¹ Healthcare professionals (HCPs) have adapted to this shift, actively utilizing social media to showcase their expertise, disseminate health knowledge, and interact directly with patients.^2,3 The COVID-19 pandemic accelerated this trend by significantly restricting offline healthcare services, making social media an indispensable channel for real-time health information and patient-provider communication.^4,5 During this period, verified information shared by healthcare organizations and professional healthcare providers became particularly important.⁶

However, the perception that participation in social media can lead to significant financial gains for HCPs is largely exaggerated. While media headlines occasionally sensationalize stories of “social media doctors” earning high incomes, these cases represent a minority. In reality, recent regulations by social media platforms and authorities have sharply reduced direct financial incentives for HCPs. For instance, since 2022, Douyin (Chinese TikTok) has prohibited medical professionals from engaging in live commerce, and fan-group functions were discontinued in 2023. Additionally, the Chinese National Health Commission announced strict monitoring and restrictions on public hospital doctors’ participation in pharmaceutical advertising, live commerce, and disguised medical promotions.

Despite these stringent regulations and limited economic rewards, the number of verified HCP accounts on social media continues to rise. By March 2023, more than 35,000 Grade III-A doctors were actively verified on Douyin (Data from: https://www.rmzxw.com.cn/c/2023-04-11/3328354.shtml). This phenomenon prompts critical questions: Why do HCPs remain committed to engaging in public-health communication online despite tightening restrictions and minimal economic return? Furthermore, what specific competencies enable these professionals to successfully navigate and influence the digital health communication environment?

Previous literature has broadly acknowledged social media's potential in enhancing health information dissemination,⁷ improving public health literacy, and supporting health education initiatives. Dumbrell and Steele emphasized the growing importance of individual-driven communication via social media, which has significantly altered how health information is disseminated.⁸ Studies during the COVID-19 pandemic underscored social media's crucial role in rapid information sharing, although recognizing its double-edged effect regarding misinformation and vaccine hesitancy.^9,10 Nesbitt et al. further highlighted the utility of platforms like Twitter in managing public health emergencies through rapid, wide-scale communication.¹¹ In parallel, numerous studies have emphasized the beneficial role HCPs play in using social media to enhance patient engagement, support continuous patient interactions, and combat health misinformation.^12–15

Nonetheless, the literature has not extensively explored why individual HCPs voluntarily take on these digital roles without significant economic incentives, nor has it identified clearly which competencies facilitate effective and impactful online communication by HCPs. This gap is especially pronounced in China, where the doctor-patient relationship has historically faced unique tensions and challenges. Social media platforms thus offer Chinese HCPs novel opportunities to redefine their professional identity and foster a more direct and potentially more positive relationship with the public and their patients.

Further literature on HCPs’ use of social media reveals that digital platforms have become integral to modern healthcare communication, significantly impacting both HCPs and the public. For instance, a US-based study found that among 366 surveyed HCPs, 87.9% actively used social media for professional purposes.¹⁶ During the COVID-19 crisis, these platforms provided critical real-time support systems, allowing healthcare workers to share experiences, relieve stress, and disseminate vital public health guidance.^17,18 HCPs utilize social media not only for professional networking and knowledge exchange but also as platforms to educate the public on disease prevention and health management.¹⁹ By leveraging their professional credibility, healthcare providers effectively counteract misinformation, enhance public trust, and improve the healthcare profession's overall image.^14,20

However, social media engagement is not without its challenges. Balancing online health communication activities with primary clinical responsibilities often proves difficult, potentially leading to stress and even social media addiction.²¹ Furthermore, interactions characterized by misinformation, negative comments, or excessive information overload have been linked to increased anxiety, stress, and burnout among HCPs.^22,23 Yet, despite these negative implications and minimal direct incentives, increasing numbers of HCPs choose to maintain active online profiles dedicated to public health education and advocacy.

Thus, understanding the motivations behind HCPs’ voluntary engagement in digital health communication becomes crucial. Clarifying these motivations can help in developing targeted strategies and support systems to ensure sustainable and effective online health practices. To address this, our study employs a competency-based approach. Competency has long been a central focus in psychology and management research, originally conceptualized by R.W. White as personal characteristics associated with high performance and motivation.²⁴ Building upon this, McClelland redefined competency to include knowledge, skills, abilities, traits, and motives that predict job performance beyond traditional intelligence measures.²⁵ Competency models have since evolved, incorporating broad definitions that capture knowledge, skills, and behavior essential to effective professional performance.^26–28

Competency frameworks have found applications in diverse sectors, including management, education, and healthcare, emphasizing emotional intelligence, decision-making, and specialized skills required for professional effectiveness.^29–31 In healthcare specifically, competencies typically focus on clinical skills, professional knowledge, teamwork, and communication capabilities necessary for high-quality patient care.^32–34 With the growing influence of digital technologies in healthcare, research has increasingly emphasized digital competencies as critical areas requiring deeper exploration.

Classic competency frameworks such as the Iceberg Model and the Onion Model provide foundational structures for understanding professional effectiveness. The Iceberg Model distinguishes competencies visible above the surface (skills, knowledge) from those hidden beneath (traits, attitudes).^35–37 Meanwhile, the Onion Model presents competencies as layers ranging from core motivations at the center, expanding outward to skills and knowledge, thereby offering a more holistic approach.

Applying the Onion Model to social media health communication enables a comprehensive exploration of competencies necessary for HCPs’ digital effectiveness. Successful digital health communicators must possess traditional clinical expertise, robust internal motivation, digital literacy, and sophisticated communication strategies. Adopting such a layered perspective can help clarify why certain HCPs are particularly suited to social media, offering valuable insights into how they can be effectively trained and supported.

Addressing these gaps, this study utilizes grounded theory methodology to identify and analyze the intrinsic motivations and competencies enabling HCPs to successfully navigate digital communication environments. By conducting in-depth, semi-structured interviews with 28 Chinese healthcare providers actively involved in online health communication, the study aims to build a nuanced, empirically-grounded competency framework tailored specifically to social media settings. The findings of this research offer theoretical contributions to the literature on digital health communication and practical implications for training, supporting, and developing HCPs in digital environments.

Methods

Research design

This study adopted a qualitative inductive approach using grounded theory methods, specifically following Strauss and Corbin's approach,³⁸ due to its suitability for exploratory research contexts where mature theoretical frameworks are lacking. Grounded theory allows researchers to systematically build theory from empirical data through iterative coding, comparison, and theoretical abstraction.^39,40 Initially, our primary objective was to investigate HCPs motivations for engaging in health communication on social media. However, as semi-structured interviews progressed, additional research questions emerged organically from the data, prompting the exploration of not only motivations but also the competencies that contribute to effective health communication online.

Participant selection criteria

We employed theoretical sampling to ensure data richness and saturation, rather than aiming for statistical generalizability. Participants were selected according to the following inclusion criteria:

Verified HCPs actively engaged in health communication through social media platforms;

HCPs demonstrating clear communication and analytical abilities to articulate their experiences;

Representation across diverse geographic locations, specialties, professional ranks, hospital grades, and follower counts to capture the complexity of digital health communication environments.

To gain a comprehensive understanding of the digital health ecosystem, our inclusion criteria were pragmatically extended to include one professional in health informatics (P7). This participant's role in developing and managing the digital systems used by clinicians provided a crucial technical perspective on the study's subject matter.

Explicit exclusion criteria included: HCPs without official verification from social media platforms, ensuring authenticity and reliability of professional background; Individuals unwilling or unable to commit to the research process due to scheduling conflicts. Participants were recruited between March and July 2022 via publicly posted invitations on popular Chinese social-media platforms, including Douyin, Weibo, Zhihu and Xiaohongshu. Additionally, direct private messaging was used to contact more than 500 active HCPs identified through their public profiles. Of the 49 professionals who responded, 21 declined to participate or were unavailable, resulting in a final sample of 28 interviewees. Participants represented diverse regions, hospital grades (III-A, III-B, II-A, II-B), medical specialties (dentistry, surgery, pharmacy, nursing, dermatology) and follower bases ranging from several thousand to over two million. The predominance of Grade III-A doctors (22/28) reflects verification rules—for example, Douyin currently grants its “verified-HCP” badge only to clinicians from top-tier (III-A) hospitals, a policy intended to prioritize highly qualified doctors, improve information accuracy, and reduce public-health risk. A comprehensive demographic breakdown of the interview sample is provided in Table 1.

Table 1.

Demographic and professional information of interview participants.

Participants	Gender	Position	Hospital grade^a	Department
P1	Female	Dentist	III-A	Dentistry
P2	Male	Clinical Pharmacist	III-A	Pharmacy
P3	Male	Radiology Resident	III-A	Oncology
P4	Male	Intern Doctor	III-A	Radiology
P5	Female	Pharmacist	III-A	Pharmacy
P6	Male	Resident Doctor	III-A	Pediatrics
P7	Male	Medical Information Engineer	II-A	Information Center
P8	Female	Deputy Chief Physician	III-A	Psychiatry
P9	Female	Attending Physician	III-A	Emergency
P10	Female	Nurse Supervisor	III-A	Gastroenterology
P11	Male	Associate Chief Physician	III-A	Orthopedics
P12	Female	Dentist	III-A	Dentistry
P13	Male	Chief Physician	III-A	Thoracic Surgery
P14	Male	Chief Physician	III-A	Vascular Surgery
P15	Female	Chief Physician	III-A	Ophthalmology
P16	Male	Licensed Physician	III-A	Urology
P17	Male	Chief Physician	III-A	Vascular Department
P18	Male	Director and Chief Physician	III-B	Medical Examination Center
P19	Female	Ophthalmologist	III-A	Ophthalmology
P20	Male	Infectious Disease Physician	III-A	Infectious Diseases
P21	Male	Deputy Chief Physician	III-A	Dentistry
P22	Female	Chief Physician	II-A	Neurosurgery
P23	Female	Attending Physician	III-A	Dermatology
P24	Male	Chief Physician	II-B	Dentistry
P25	Male	Intern Doctor	III-A	Respiratory Medicine
P26	Male	Deputy Chief Physician	III-A	Internal Medicine
P27	Male	Attending Physician	II-A	Obstetrics & Gynecology
P28	Male	Deputy Chief Physician	III-A	Emergency Surgery

Hospital levels in China rank from Grade III-A, III-B, II-A, II-B, to Grade I hospitals. Grade III-A representing the highest tier of comprehensive hospitals.

Data collection

Data was collected using semi-structured, in-depth interviews between April and October 2022. Each interview was conducted remotely using Tencent Meeting, a widely-used video conferencing software, and lasted approximately 60 to 90 min. The interview guide (Supplementary File 1) was developed based on existing literature, research objectives, and preliminary conversations with participants. Interviews focused on exploring motivations, professional competencies, personal experiences, communication strategies, and risk perceptions related to online health communication.

All interviews were audio-recorded with explicit permission from participants. The recordings were transcribed verbatim into Chinese, anonymized to protect confidentiality, and subsequently translated into English, resulting in a dataset of approximately 210,000 words.

Ethical considerations

Ethical approval was obtained from the Ethics Committee of the School of Business and Management at Shanghai International Studies University (Approval Number: 2024BC066). The study adhered to the ethical guidelines outlined in the Declaration of Helsinki. Participants provided written informed consent prior to participation, were assured of anonymity, and informed of their right to withdraw from the study at any time without consequence. All sensitive information (e.g., participant names, hospital affiliations) was anonymized. Participants were assigned unique identifiers (P1–P28 in Table 1). This study is reported in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ); the completed 32-item checklist is available in Supplementary File 2.

Data analysis

Data analysis was conducted using NVivo software, following the grounded theory procedures of open coding, axial coding and selective coding proposed by Strauss and Corbin.³⁸ The Gioia method also guided part of the analytical process, allowing for systematic and transparent data interpretation.⁴¹

Open Coding: Interview transcripts were reviewed line by line to identify initial concepts. This phase identified 237 initial concepts, which were categorized into 33 first-order concepts, such as medical expertise, achievement drive and passion, and sense of mission.

Axial Coding: Links between the initial codes were explored to identify broader categories. This process resulted in 8 main categories: Motives, Traits, Identity and Roles, Teamwork, Knowledge, Skills, Information Literacy, and Communication Skills. These categories align with established competency frameworks, including the Onion Competency Model.

Selective coding: During selective coding, integrative dimensions were developed to synthesize and analyze the data at a higher level of abstraction. The process culminated in a theoretical framework that comprehensively outlines the competencies of HCPs engaged in social media health communication and highlights their primary motivations. The Onion Competency Model was referenced again to categorize competencies into core, middle, and outermost layers.

To ensure methodological rigor and transparency, iterative analysis was conducted through constant comparison and validation of concepts and categories, achieving theoretical saturation after the first 23 interviews, with subsequent interviews confirming no new concepts emerged. Additionally, researchers maintained detailed memos throughout the data collection and analysis processes, enhancing reflexivity and conceptual accuracy. NVivo software was employed to systematically manage data, improving coding accuracy, traceability, and transparency, while the Gioia method⁴¹ was integrated to further validate conceptual coding and ensure robust data interpretation.

Results

Motivation (core layer)

The core layer of the onion competency model is motivation, which represents the internal drivers prompting HCPs to engage in social media health communication. In our analysis, motivation emerged as the core category during selective coding, integrating various “motives” identified through axial coding.

Motives

Achievement drive and passion

Many HCPs mentioned an expectation of achieving success as verified professionals on social media platforms and expressed a passion for health communication. This reflects their intrinsic motivation to share expertise and find fulfillment in professional achievements outside traditional clinical settings. The desire to make a meaningful impact often surpasses financial considerations, aligning with their passion for advancing public health awareness. One interviewee shared:

I believe that educating the public about medical knowledge not only helps them but also enhances my own learning and mastery of these subjects. […] the medical profession is unique—it's about helping others. Even if it doesn’t pay much, spreading health information is something I think I can do and make a difference in public health. (P12)

Another noted:

Sharing knowledge online feels rewarding. It's about creating a broader impact that extends beyond the patients I see in the clinic. (P26)

Sense of mission and responsibility

A strong sense of mission and professional responsibility motivates HCPs to engage in social media health communication. Many of the interviewees expressed frustration with the ubiquitous health-related misinformation online and felt a sense of mission to disseminate accurate health information and counter misinformation on social media, viewing their roles as educators and advocates for public health. This commitment often extends beyond personal gain and focuses on making meaningful contributions to their field and the broader community. One respondent shared:

I'm not a fan of chasing views or followers, […] for me, it's about a sense of mission to promote my specialty and genuinely serve and educate the public. (P5)

Another noted:

At first, I noticed a lot of false health information online, and I couldn’t just stand by. As a doctor, I felt it was my responsibility to correct it and share accurate knowledge. (P19)

Job burnout and exploration

While burnout is often viewed as a negative state, in this context, it also serves as a trigger for HCPs to engage in social media. It reflects the dissatisfaction and exhaustion experienced in their primary roles, which drive them to explore alternative platforms for renewal, expression and impact. The exploration aspect aligns with doctors’ intrinsic need to find purpose and fulfillment beyond the confines of their primary job. Burnout and exploration represent an internal motivation stemming from dissatisfaction with the status quo and a desire for renewal or reinvention. One interviewee shared:

We work at least 10 h per day, and during busy days, 16-h shifts are common. The financial pressures on hospitals and the workload on healthcare staff are things not many people were aware of. […] I initially started my social media account as a way to take a breather from the high demands of my job[…] it led to a second wind in my career, something I hadn't anticipated. (P6)

Another reflected:

Working in the hospital can be overwhelming—endless paperwork, and constant pressure. It's exhausting both physically and mentally. I started feeling like I couldn’t make the impact I wanted within those walls. Social media became a way to reconnect with why I became a doctor in the first place. Sharing health knowledge online let me help people on a broader scale, even when I felt burned out at my job. (P24)

Personal identity and roles (middle layer)

The middle layer of the Onion Competency Model represents the characteristics of HCPs in social media health communication. This layer bridges personal and professional identities and includes traits, teamwork, identity and roles, which are difficult to train quickly but enable HCPs to adapt to the challenges of social media while staying true to their core values and responsibilities.

Traits

Resilience and adaptability

Resilience and adaptability allow HCPs to navigate the pressures of their primary roles while engaging effectively on social media. This trait reflects their ability to persevere under challenges and embrace change to maximize their impact. One interviewee explained:

Before, getting involved in social media healthcare communication could be challenging due to resistance from hospitals, […] worried about risks and stuff. But now, as long as we're doing it right and legally, we're good to go online and share our knowledge. My hospital even recognizes this work in our yearly reviews-it's a great move. (P8)

Another reflected:

It really takes an adaptable mindset to do this kind of work. We've seen even some Traditional Chinese Medicine doctors in their 70 s and 80 s who are still learning how to post videos on Douyin. I have a lot of respect for them, they're fantastic. (P16)

Innovative consciousness

Creative thinking allows HCPs to adjust their approach in response to changes in the way the public consumes health information. By refining strategies and learning from audience feedback, HCPs are helping to shape the future of digital healthcare communications. HCPs are creatively using social media to meet the public's need for accessible, accurate, and credible health information, bridging the gap between specialized knowledge and the public's health literacy, while allowing for real-time countering of misinformation and promotion of prevention efforts. As one interviewee shared:

Initially, I focused on writing articles and answering questions, then I realized that many people tend to watch videos now, and I gradually shifted to creating video content, like on Bilibili. Video production takes much more time and effort, […] but I persisted because explaining medical knowledge to the public helps me learn and master it better. (P11)

Self-awareness and reflection

Self-awareness and reflection are critical for professionals in shaping their online roles while remaining authentic. By evaluating their strengths, weaknesses, and interactions with followers, HCPs can refine their communication strategies to ensure both accuracy of the information and alignment with their professional standards. One respondent noted:

I feel it's my job to talk about Traditional Chinese Medicine, even though it can be a sensitive topic and sometimes people get critical about it. […]negative comments are part of the deal, and I’ve gotten used to it. Over time, I’ve become much better at checking in on myself and ensuring I’m presenting information the right way. (P2)

Emotional regulation

Emotional regulation enables HCPs to maintain a calm and optimistic presence online, despite challenges like negative comments or stressful situations. This trait reflects their resilience and ability to focus on their role as educators and communicators. One respondent explained:

Keeping cool is super important. You can't just stop educating people because someone decides to throw shade in the comments. […] Being a doctor for so long, I've learned how to keep negative vibes in check. Most folks online are actually alright – I don't really get a lot of hate comments nowadays. (P1)

Self-confidence

Confidence is an important trait for HCPs to pursue their goals and embrace opportunities in the digital space. They believe in their expertise and competence, which drives them to be proactive, innovative, and persistent in advancing public health through social media. This inherent confidence enables them to face challenges and overcome obstacles without hesitation. As one doctor expressed:

Before I started creating content, I just knew it would be popular. […] in many international institutions within our field, I'm often the only Chinese representative. That gives me a sense of confidence about the impact and relevance of my work. (P14)

Another noted:

I'm really confident in my medical skills and passionate about improving public health through medical educational work. (P23)

Empathy

Empathy is a fundamental trait that enables HCPs to make deep, compassionate connections with patients, respect their dignity, and meet their needs. This deep understanding not only strengthens the doctor-patient relationship, but also helps close the gap between professional expertise and public communication. Empathy enables HCPs to sense and share the feelings of others, fostering the trust and openness that is essential to effective healthcare delivery - whether face-to-face or through digital platforms. One doctor shared a touching story:

About 10 years ago, I was attacked by an angry patient with a knife and nearly lost my life. That time, I was on the news everywhere, since it shocked many people. […] At that time, doctor-patient conflicts were intense due to significant issues in the Chinese healthcare system. Imagine being a doctor, constantly in contact with patients, dealing with situations like full hospital beds and seriously ill patients who can't be admitted. Whoever is on duty faces the brunt of patient frustration, even though the systemic issues are beyond our control […] Despite my injury, I deeply empathized with the patients-some travel long distances to big cities for treatment, only to find no help. It's truly a helpless situation for them. These experiences shaped my understanding of what patients go through. And I realized that much of their anger and frustration stems from fear and lack of understanding. […] So six months later, as I recovered, I decided to take action in a different way. I began creating educational content on Weibo to address misinformation and help patients better understand health knowledge-the medicine is not a magical cure-all and that doctors cannot treat every illness. It was my way to rebuild trust between doctors and patients. (P18)

Teamwork

Collaborative teamwork and leadership

Active participation and effective leadership are essential for managing the complexities of social media health communication. HCPs must balance their expertise with the ability to coordinate and guide others toward common goals, reflecting their personal identity as collaborative professionals. One interviewee shared:

After my account got some visibility, I realized the importance of having a team. It's impossible for one person to handle everything alone, especially since I still have my daily responsibilities at the hospital. You need someone to drive the initiatives forward, someone to lead, and it's vital to have an organized plan in place. […] Now, I have assistants to help me manage these tasks. Their support is important to the success and growth of my digital presence. (P13)

Another emphasized the value of leadership within teams:

Good teamwork requires not just coordination but also vision. As a team leader, I prioritize setting clear goals and ensuring everyone understands their role. That's how we maintain consistency and professionalism in what we deliver online. (P20)

Resource integration

Resource integration involves gathering and leveraging resources to expand the impact of social media health communication. For HCPs, this meant using human and institutional resources to create reliable and meaningful content. One respondent described:

I’m not actually a medical practitioner—but I work at a hospital. I work closely with doctors and have witnessed their struggles and sometimes unfair treatment they face. I want to share their work and their dedication. While my account focuses on conveying these truths, I also work with a team of professionals, including those with a health commission background and media platforms, to spread accurate health knowledge together. The main purpose of my content is to share my resources—not for fame or traffic. (P7)

Interdisciplinary cooperation

Interdisciplinary collaboration expands the scope and impact of health communication, reflecting HCPs’ identity as members of a team that values collective expertise. This collaboration stems from their commitment to holistic patient care and public health education. One interviewee explained:

I'm now in the Medical Examination Center, we emphasize that prevention over cure. […] in China, most people have very low health literacy, which hinders their ability to take proactive health measures.[…]therefore I often invite doctors from various departments, such as cardiology, oncology, and radiology, to join me in creating educational content. By working together, we can provide a more complete health and prevention knowledge. (P18)

Virtual team collaboration

In the digital context, teamwork often involves virtual collaboration with diverse professionals, including content creators and digital strategists, which differs from the traditional in-person teamwork in clinical environments. From live-streamed educational surgeries to nationwide virtual conferences, digital platforms enable professionals to share expertise on an unprecedented scale.

As one respondent noted:

We're increasingly using virtual tools like organizing large-scale conferences with participants from across the country. […] A key feature is live-streaming surgeries as educational cases, providing real-time learning opportunities for peers. This method seamlessly integrate with our social media medical education efforts, extending valuable insights to a wider audience, including both professionals and the public. (P22)

Identity and roles

Professional identity

Professional identity represents the intrinsic connection HCPs have with their core values, expertise, and responsibilities as medical practitioners. When they enter the digital space, this identity guides their actions and ensures the authenticity of their online engagement. HCPs view social media activity as an extension of their medical practice, adhering to the same standards of accuracy and ethical responsibility. One interviewee reflected:

I see myself as a doctor first, no matter the platform. Everything I share online is an extension of my responsibility to provide accurate and meaningful health information. If I can clear up a patient's doubts before they even come to the hospital, I’m doing my job. (P5)

Another added:

Although I’m just an intern right now, the white coat represents trust and professionalism. I carry that same mindset to my social media work—whether I’m creating a post or answering a comment, it's all about helping patients feel informed and supported. (P25)

Online persona

Developing an online persona requires HCPs to humanize their expertise while maintaining professional boundaries, thereby fostering trust and engagement with their audience. It involves deliberate choices of tone, style, and interaction by the social media HCPs to strike a balance between professionalism and accessibility. It resonates with different audiences and effectively engages and educates the public. One doctor explained:

On social media, I aim to be approachable but still professional. Patients want a real person who can explain complex medical terms in simple language. That balance is key to building trust. (P8)

Roles as educator and advocate

In the digital space, HCPs often assume dual roles as educators and advocates. As educators, they simplify complex medical concepts, deepen public understanding, and promote health literacy. As advocates, they promote public health issues, counter widespread social media misinformation, and influence public health behaviors positively. These roles give them the ability to extend their influence beyond the clinic and contribute on a larger scale. One interviewee explained:

I see myself as a health educator on social media, breaking down complex topics like chronic disease management, or vaccinations into content that everyone could understand. It's about helping people make informed decisions about their health. (P27)

Another emphasized their advocacy role:

There's so much misinformation online—it's frustrating. As a doctor, I have a duty to correct it. I’ve worked on campaigns about vaccine awareness and debunking health myths because it's not just about individual patients anymore; it's about protecting public health. (P20)

Professional competencies (outermost layer)

The outermost layer consists of professional competencies—the observable and measurable skills and knowledge that HCPs apply in social media health communication. These competencies can be developed through education and training, enabling HCPs to work effectively and credibly in the digital environment.

Knowledge

Medical expertise

The credibility of HCPs on social media is fundamentally dependent on their specialized medical knowledge. This expertise allows them to provide accurate, reliable, and actionable health information to the public. This expertise is essential for building trust with audiences. As one interviewee emphasized:

As a doctor in vascular surgery, I emphasize professional knowledge. […] This specialty is relatively small, so many patients fail to recognize their vascular diseases, and doctors in smaller hospitals may not even have a doctor in vascular surgery. […] so using social media to disseminate knowledge about vascular health is an excellent solution, as it allows reaching a broader audience and addressing delays in diagnosis and treatment. (P17)

Another explained:

Many patients from rural areas don’t have the means to consult specialists directly. Through social media, I can share information that helps them identify potential issues early on and seek appropriate care. (P25)

Scholarly literacy and proficiency

The ability to apply specialized knowledge in a practical context, synthesize complex academic knowledge, and communicate it effectively is a key professional competency. This competency bridges the gap between cutting-edge research and public understanding, ensuring that nonspecialists are informed of the latest medical advances. One interviewee shared:

In my field, retinal diseases, most patients are older adults who rarely read academic papers. With the increasing use of short video platforms by the elderly, I aim to convey the latest academic knowledge in layman's terms to this demographic. It's about making scholarly information accessible and understandable. (P15)

Disciplinary enthusiasm and constant learning

A commitment to lifelong learning and keeping abreast of the latest medical discoveries is essential to maintaining professional competence. This enthusiasm enhances the expertise of HCPs and enables them to share valuable insights with their audience. As one respondent noted:

Engaging with social media helps prevent my professional knowledge from becoming outdated. It's about learning new things to keep the mind active and sharing that with others. (P6)

Another added:

My field of study is oncology, but my work, including dealing with lung nodules, often involves radiology. […] I have a keen interest in learning about 3D imaging. While I learn, I also use social media to share some knowledge with the public about, as there's a high demand for it, especially during and after COVID. […] You can see from my comments that people always ask me to help interpret their medical images. (P3)

Skills

Organizational and planning skills

Effective management of time and resources is critical for creating consistent and impactful social media content. This specialized competency enables HCPs to balance their clinical responsibilities with online engagement, ensuring that they are able to stabilize their output and consistently deliver valuable content. . One interviewee explained:

I outline key topics to cover over a month—for example, starting with chronic diseases like diabetes and hypertension, then moving to exercise, nutrition, and cancer. Audience feedback helps me refine the schedule to meet their needs. In China, intern doctors have to work for many years, so I feel that this process also helps me improve and quickly become a qualified doctor. (P4)

Research and inquiry skills

Critical research skills enable professionals to ensure the accuracy and relevance of the health information they share. These skills support their ability to address specific patient inquiries. As one respondent shared:

Before responding to patients’ consultations on line, I always take time to do some research to better understand their conditions. I believe there are long-term benefits, both in terms of learning and audience growth. (P16)

Execution skills

Strong execution skills are key to sustaining high-quality content creation amidst the demands of clinical work. Professionals must balance creativity with consistency to maintain their online presence. One interviewee reflected:

At first, I tried to do health education on platforms like Douyin 2 years ago, but I gave up because I felt I didn’t have enough time. What seems like a simple 30-second video actually takes a lot of time and effort.[…]it requires creativity and dedication. I restarted my social media account during the pandemic lockdown and realized that execution skills are key to sustain. Done is always better than perfect. Even though I’m just a nurse, many people appreciate the nursing content I share and tell me they’ve learned a lot from it. (P10)

Social Media policy and regulation competency

Policies on platforms change rapidly, so HCPs need the ability to stay informed about social media policies and regulations, which is critical for maintaining compliance and credibility. This specialized competency ensures HCPs adhere to legal and ethical standards in their online activities. One interviewee described:

Sometimes, the policies of social media platforms change too quickly. […] Only by staying updated with these ever-evolving policies can we effectively provide beneficial health information to the public. (P9)

Creative content design

Innovation in content strategy and presentation helps HCPs engage diverse audiences and enhance their impact. This professional competency includes using creativity to develop relevant and more engaging health communication messages. An interviewee shared:

[…] including using technology to analyze social media content. My students identify topics that currently interest the public and optimizes our posting times. This analysis enhances the professionalism and effectiveness of our content on social media platforms. (P23)

Information literacy

Information filtering and processing

The ability to efficiently identify, evaluate, and manage information is crucial for maintaining accuracy and credibility. While some Multi-Channel Network (MCN) companies may prioritize trending topics over accuracy, HCPs focus on expertise and evidence-based content. One interviewee explained:

[…] When I write about topics like renal or prostate cancer, I focus on gathering and selecting credible data to support my articles. […] My primary goal is to provide professional and well-researched information to my audience, ensuring it meets their real needs. (P16)

Another added:

With so much misinformation online, filtering through reliable sources is half the battle. It's about …what I share is both accurate and actionable. (28)

New Media technology and operational strategies

Proficiency in the use of social media technologies is critical for creating high-quality content and protecting patient privacy. This competency includes technical skills in content creation tools and knowledge of platform functionality. Strategic approaches to content production enable professionals to engage audiences effectively. One interviewee highlighted:

Some doctors create videos of patient consultations, which attract many viewers. These videos require digital techniques to obscure patient identities, such as pixelating faces and altering voices. […] Over time, I’ve become proficient in applying these privacy measures, ensuring that my content is both professional and respectful of patient confidentiality. (P11)

Digital marketing awareness

Understanding the marketing and strategic aspects of social media helps HCPs maximize their reach and impact. By analyzing their audience's preferences, they can adapt their content to resonate with their followers while maintaining professional integrity. One respondent explained:

We’re exploring what makes certain doctors more popular or influential on social media platforms. It's not just about gaining followers—it's about creating meaningful impact and connecting with more audience in this digital landscape. (P24)

Communication skills

Linguistic proficiency

The ability to communicate clearly and effectively is essential for engaging with patients and audiences online. This competency includes the use of plain and appropriate language to convey complex information in a way that is more easily understood by the public. One interviewee shared:

Nowadays, patients often come loaded with information they've searched, but you can't trust everything online right? […] So, for us doctors who do health education on social media, it's really important to talk with patients and clear up any wrong ideas they might have. This kind of videos helps patients understand better. […]Good communication smooths out doctor-patient relationships, even before they step into a hospital. (P21)

Coordination capability

Coordination Capability refers to the practical skills needed to effectively organize collaborations, manage interdisciplinary projects, and ensure seamless communication among team members. Unlike the inherent teamwork trait in the middle layer, coordination is an observable and measurable professional competency focusing on the application of communication skills. This includes delegating tasks, coordinating activities, and facilitating collaboration in a professional context. One interviewee explained:

I often collaborate with experts from other departments—radiology, pathology, oncology—to create content that's accurate and well-rounded. Just recently, I invited a friend from infectious diseases to talk about vaccines on my channel. Collaboration like this ensures the audience gets high-quality information. (P13)

Precision in expression

HCPs must convey complex medical concepts accurately. This professional competency ensures that the audience fully understands the information, and it is also a sign of protection. Given the abundance of online content, it's essential to ensure that your message is clear and not open to misinterpretation by your audience. One respondent noted:

Explaining concepts clearly is critical for doctors, especially for someone like me, a resident still learning. If I can explain something simply and clearly, it shows I’ve truly understood it. This has motivated me to continuously learn and produce better content. (P6)

Digital communication strategies

HCPs successful on social media can tailor their communication approaches to different platforms, increasing audience engagement and reach. This competency includes adapting postdelivery, headlines, posting times, keeping up with current events, etc., and different strategies to suit different platforms and audiences. One respondent shared:

Initially, my videos were very long, but I realized that viewers preferred shorter content. I adapted my strategy to focus on concise, easy-to-understand videos that resonate with younger audiences. Using expressions and styles popular with them has made my communication more effective. (P3)

Construction of the competency model

This study explores the hierarchical structure of competencies among HCPs engaged in social media health communication, guided by the Onion Model framework. Through in-depth interviews with 28 HCPs and using grounded theory and qualitative content analysis, we identified 237 initial concepts, which were categorized into 33 first-order categories and consolidated into eight axial competencies. These competencies were organized into three layers: Motivation (core layer), personal identity and roles (middle layer), and professional competencies (outermost layer), resulting in a comprehensive competency model for social media HCPs (Figure 1). Conceptual definitions for each layer are summarized in Table 2.

Figure 1.

Competency framework.

Table 2.

Selective and axial structure of HCPs’ social media competencies.

Selective codes	Axial codes	Meaning
Motivation (core layer)	Motives	The intrinsic driving forces that underpin HCPs engagement in social media, including passion, mission, and purpose.
Personal identity and roles (middle layer)	Traits	Personal characteristics, such as resilience, openness, and self-awareness, shaping how individuals interact with others.
	Identity And Roles	The self-concept and roles professionals adopt, such as being an educator, advocate, or leader in health communication.
	Teamwork	The collaborative mindset and internal willingness to engage with others in interdisciplinary or virtual team settings.
Professional competencies (outermost layer)	Knowledge	The specialized expertise and understanding required for effective health communication, including medical and scholarly literacy.
	Skills	Practical abilities, such as planning, executing, and designing creative content for social media health campaigns.
	Information Literacy	The ability to filter, process, and strategically use information from social media platforms for effective communication.
	Communication Skills	The capacity to express, coordinate, and connect with diverse audiences using precise language and digital tools.

The Onion Model describes competencies as a hierarchical structure progressing from the innermost layer to the outermost. The core layer represents Motivation, reflecting the internal drivers behind behaviors and engagement. The middle layer consists of Personal Identity and Roles, focusing on personal traits and roles that shape interactions and influence online engagement. The outermost layer includes professional competencies, which are observable and trainable knowledge and skills, directly linked to effective performance in health communication.

Building upon the Onion Model's framework, the study's findings offer a layered understanding of HCPs’ navigation in social media health communication. The core layer (Motivation) explains why HCPs engage, driven by intrinsic motivations like achievement, mission, and social impact. The middle layer (Personal Identity and Roles) explains how HCPs grow, shaped by traits, self-concept, and roles that enable them to present themselves authentically and develop in the digital space. The outermost layer (Professional Competencies) focuses on how HCPs continuously optimize their social media health communication efforts, leveraging knowledge, skills, and communication expertise to improve the quality and reach of their content.

Case study of Dr Z (P18)

To illustrate the operation of this model, we analyze the case of Dr Z (P18), one of the most compelling cases from the interviews conducted in this study. Although Dr Z has consented to having his real name and past experiences used in the paper, to protect his identity and adhere to academic guidelines, we refer to him anonymously as “Dr Z.”

Dr Z, now director of a Grade III-B medical-examination center in Beijing, turned to social-media health education after surviving a violent assault as an emergency physician 11 years ago. The attack left him physically and emotionally exhausted yet sharpened his conviction that better public medical literacy could prevent future doctor–patient conflict. Today his Kuaishou channel, followed by ≈200 000 users, exemplifies the three-layer framework:

Motivation (Core Layer–why enter): A mission-driven desire to raise national health literacy—intensified by personal burnout—propels his sustained online engagement.

Personal Identity and Roles (Middle Layer–how grow): Resilience, empathy and an educator-advocate persona enable Dr Z to handle criticism and shape a trustworthy “health-check-up expert” image. With a small cross-disciplinary team he produces accessible videos and live streams that steadily expand his reach.

Professional Competencies (Outermost Layer–how optimize): Deep clinical knowledge, strong information-literacy skills and polished digital communication allow him to translate complex screening guidelines into plain-language content, quickly correct misinformation and iteratively refine material from audience feedback.

Dr Z's experience shows how intrinsic mission, supportive identity work and continually upgraded skills combine to convert clinical burnout into influential, sustained digital health communication—validating the study's three-layer competency model.

Discussion

Online health information varies widely in accuracy, so the active participation of platform-verified HCPs provides a trustworthy source for the public.¹⁶ During the COVID-19 pandemic, when demand for virtual care surged, these professionals’ social-media engagement proved especially valuable.⁴² Earlier mass-media work on heart-disease prevention already showed that timely communication can shift population behaviour⁴³; the present study confirms this insight in a mobile-first era.

This study explored the motivations and competencies that sustain HCPs’ digital health communication. Using grounded theory and qualitative content analysis, we interviewed 28 Chinese HCPs and derived a three-layer competency framework—Motivation (core), Personal Identity & Roles (middle), and Professional Competencies (outermost)—modelled on the Onion Competency structure.

At the core layer, intrinsic drivers such as professional achievement, a sense of mission, and social responsibility initiate engagement. Our results echo Kaplan and Haenlein's social-media affordance model,⁴⁴ showing that perceived reach and interactivity amplify doctors’ sense of mission. Notably, burnout—traditionally viewed only as a risk factor—also surfaced as a catalyst, prompting some doctors to move online to rediscover meaning and autonomy. This extends motivation theory by showing how negative affect can be channeled into positive competence development. Placing our analysis in China's tightly regulated, historically strained doctor-patient context further broadens a literature still dominated by Western settings. The middle layer highlights the importance of resilience, emotional intelligence, evolving online role identities and multidisciplinary teamwork. These elements help HCPs navigate hostility, sustain audience trust and maintain consistent, high-quality output.

The outermost layer encompasses observable, trainable skills: medical expertise, platform-specific communication, digital marketing awareness and advanced information literacy. Mastery in these domains enables HCPs to design engaging content, comply with shifting platform rules and counter misinformation quickly.

Practical implications follow directly. Individual clinicians can cultivate intrinsic motivation and use real-time audience feedback to reinforce engagement. Hospitals should recognize digital outreach as legitimate workload, offer media-skills training and provide psychological support for online communicators. Platforms can boost the visibility of verified HCPs and create rapid debunking channels, while regulators can use our framework to craft certification schemes that reward high-quality, noncommercial medical content.

Limitations and future work. Findings rely on a purposive sample of 28 HCPs from mainland China, so cultural and regulatory idiosyncrasies may limit generalizability. The evidence is qualitative and self-reported; larger, mixed-methods studies could quantitatively test the three-layer model and examine how each competency predicts measurable outcomes (e.g., follower growth, engagement, misinformation-correction rates). Longitudinal research is also needed to track how motivations and skills evolve as platform policies or career stages change.

By clarifying how intrinsic motivation, identity work and trainable skills interact, this study offers a roadmap for capacity-building initiatives that directly advance the Healthy China 2030 goal of delivering trustworthy, patient-centered digital health services.

Conclusion

This study develops a comprehensive, multi-layered competency framework that enhances our understanding of HCPs’ effective engagement in digital health communication. By highlighting the importance of intrinsic motivation, a clearly established identity as educators and patient advocates, and robust professional competencies, our findings clarify how and why certain HCPs transition successfully “from clinics to clicks.” Understanding this interplay enables stakeholders to provide more targeted support: hospitals can formally recognize digital outreach as part of clinical duties and offer relevant skills training; social media platforms can amplify verified medical content and swiftly address misinformation; and regulators can develop incentive mechanisms that encourage transparent, ethical, and noncommercial online health communication. Collectively, these measures can translate individual HCPs’ online efforts into significant public health advancements—strengthening public trust, combating misinformation, and ultimately improving doctor-patient relationships in the digital era.

Supplemental Material

sj-pdf-1-dhj-10.1177_20552076251377845 - Supplemental material for From clinics to clicks: Investigating the motivations and competency framework of healthcare professionals on social media

Supplemental material, sj-pdf-1-dhj-10.1177_20552076251377845 for From clinics to clicks: Investigating the motivations and competency framework of healthcare professionals on social media by Deli Kong and Jiayin Qi in DIGITAL HEALTH

Footnotes

Acknowledgments

We thank all interview participants for their time and their ongoing contribution to public-health education.

ORCID iD

Deli Kong

Contributorship

DK conceptualized the study, developed the methodology, collected and analyzed the data, and drafted the initial manuscript. JQ conceived and supervised the project, secured the funding, and critically revised the manuscript. Both authors read and approved the final manuscript.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics approval

Ethical approval for this study was obtained from the Ethics Committee of the School of Business and Management at Shanghai International Studies University (approval number: 2024BC066). Written informed consent was obtained from each participant, and informed of his/her right to withdraw from the study at will without any consequences.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Major Projects of National Natural Science Foundation of China, “Research on Privacy Data Protection and Iatrogenesis Decision of HIS” (grant number: 72293583).

Guarantor

JQ.

Availability of data and materials

The data that support the findings of this study are not publicly available due to anonymity reasons but are available from the corresponding author on reasonable request with permission of premium.

Supplemental material

Supplemental material for this article is available online.

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