# Instagram and WhatApp in Health and Healthcare: An Overview
## 4 Discussion
### A Plethora of Options  
Despite similar functionalities being offered on the main Facebook platform, e.g., photo- and video-sharing with hashtags on timelines, and private multimedia chat and messaging with single contacts or groups, there are still very many millions of users worldwide who prefer Instagram and/or WhatsApp over Facebook (or use Instagram and/or WhatsApp in addition to Facebook), particularly on smartphones. In a large sample of 2418 users, [PERSON] et al. [60] recorded WhatsApp behaviour over a four-week period. Their data showed that the use of WhatsApp accounted for almost 20% of all smartphone behaviour compared with Facebook, which accounted for less than 10% of all recorded behaviour in the same study. In another survey conducted in 2015 [61], only 2% of UK doctors and 4% of US doctors reported using WhatsApp to communicate with patients in the month preceding \begin{table}
\begin{tabular}{l c} \hline \hline \multicolumn{1}{c}{**Theme**} & **References** \\ \hline \multicolumn{3}{c}{**Instagram**} \\ \hline Alcohol and tobacco (negative uses of Instagram in marketing and promoting them) & [15; 16; 17] \\ Diet, exercise and fitness, including negative uses & [18; 19; 22; 23] \\ Public health concerns and alerts, including uses by organizations such as the US CDC & [10; 24; 25; 26] \\ Nonsuicidal self-injury and mental health related & [20; 50] \\ Visual-social information-sharing & [12; 13; 14; 21] \\ \hline \multicolumn{3}{c}{**WhatsApp**} \\ \hline Tobacco treatment and control & [28] \\ eLearning & [46; 47] \\ Enhanced communication and social interaction & [29; 30; 32; 36; 37; 38; 35; 38] \\ Exercise and fitness & [44] \\ Medicological aspects & [33; 34] \\ Nurses & [45] \\ Teleconsultation and Surgical & [27; 30; 35; 37; 39; 41; 42; 43] \\ Visual-social information-sharing & [31; 35; 40] \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Instagram and WhatsApp in health and healthcare: select themes from this review. the survey, compared to 87% in Brazil, 61% in Italy and 50% in China (in China, WeChat is used as WhatsApp's equivalent). Going beyond Facebook, Inc.'s offerings, several other tools and services exist, such as Skype (does not enforce account tying to user's cellular mobile number, [62]), WeChat (tied to user's cellular number--[9]), Viber (tied to user's cellular number, [63]), etc., but some of these alternative options are seen as more complex to use, offering less immediacy and spontaneity. Immediacy has been identified as one of the key affordances for successful learning and information dissemination in digital environments [36; 64]. On the other hand, some of the available alternative options feature unique functionalities that might be useful in certain scenarios, e.g., Skype Translator applied to patient care [65]. Furthermore, encryption levels vary across these different options, which might be a decisive factor in preferring one service over the other, e.g., encrypting private messages only when they are in transit between a user's device and company servers, where they are stored and can be handed over if required by law (as in the main Facebook platform, for example) vs. end-to-end encryption, with the company not storing messages on its servers (as in WhatsApp, for example). As with many other things in life in which there are many options and models to choose from (e.g., cars, smartphones, computers, etc. ), it is an advantage to see Facebook embracing alternatives within its own portfolio of services and to have other options from different providers as well. Competition produces better services, and the availability of a number of options to select from enables end users to choose the service that best matches their individual and local needs, though this can, at times, be a confusing task to some people. However, with trial and error and by learning from the experiences of others (e.g., reports in the published literature as covered in this article), most users and teams will be able to find the tool(s) and protocols that best work for them.