Date of Award


Document Type

Campus Access Thesis

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Laura L. Hayman

Second Advisor

Lingling Zhang

Third Advisor

Jean Connor


The objective of this dissertation is to explore and describe the presence of Pender’s Health Promotion Model’s (HPM) modifying factors in social media and demonstrate the feasibility of health promotion. The first manuscript aims to demonstrate social media health can be enhanced by expanding the use of the HPM to the social media environment. The paper offered 2 contributions with 5 supporting premises to support this aim: healthcare will benefit from applying health promotion to social media, and Pender’s HPM should be applied to social media. The application of Pender’s HPM to social media provides a framework to actualize human health potential and promote well-being in social media. The second manuscript, Chapter 3, a systematic review, aims to assess the presence of modifying factors in academic literature related to cardiac heterotaxy content in YouTube videos. This chapter narrows the dissertation's focus to the heterotaxy population and the social media platform YouTube. A PRISMA systematic review of heterotaxy literature and YouTube yielded 14 articles. All categories of modifying factors were captured in the article’s outcomes or limitations. The presence of modifying factors in heterotaxy related YouTube studies demonstrates the feasibility of a mixed-method systematic cardiac heterotaxy YouTube video review. The third manuscript, Chapter 4, aims to describe the presence of modifying factors in cardiac heterotaxy YouTube videos through a convergent mixed-method systematic review of YouTube videos. The quantitative phase captures the frequency of modifying factors in the social media videos, while the qualitative phase provides a thematic analysis of the modifying factors. All modifying factor categories were present in the cardiac heterotaxy videos, and themes pushing boundaries, barriers, fear, and normalcy in the videos emerged from the social media content. The study shows modifying factors are present in social media and provides a critical step towards applying health promotion to the social media environment. Throughout the dissertation, the manuscripts have progressively built a foundation for the next phase of the dissertation. Collectively, they demonstrate the presence of Pender’s HPM’s modifying factors in social media and support the application of the HPM to the social media environment.


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