Commentary on “The effect of sexually transmitted disease education via Instagram on the knowledge and attitudes of university students: a pilot study” - Letter to the editor

Sep 30, 2026

Letter to the editor responding to a pilot study on using Instagram for sexually transmitted disease education among university students. The author commends the public-health relevance and youth-focused digital approach, but raises concerns about the knowledge scale’s KR-20 reliability, the lack of validated instruments for attitudes and sexual health literacy, and the absence of behavioral outcomes. Additional gaps include missing user engagement and Instagram algorithm considerations, limited platform scope, and the need to assess digital health literacy for improved interpretation and generalizability.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Letter to the Editor

Key concerns about measurement reliability

Limitations of instruments and missing behavioral outcomes

Engagement metrics and algorithmic behavior

Platform scope beyond Instagram and digital literacy considerations

Conclusion and future research direction

LETTER TO THE EDITOR [https://doi.org/10.1590/1806-9282.20251009](https://doi.org/10.1590/1806-9282.20251009) Commentary on “The effect of sexually transmitted disease education via Instagram on the knowledge and attitudes of university students: a pilot study” Buğra Çetin1* 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 aKuder-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 asTikTok 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. DATA AVAILABILITY STATEMENT The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. 1Altınbaş University Medical Park Bahçelievler Hospital, Department of Urology – Istanbul, Turkey. *[Corresponding author: cetinbugra@yahoo.com](Corresponding a

FAQs

What strengths does the author recognize in the pilot study?

The author highlights the timely public-health focus and the initiative to use a contemporary, youth-oriented medium like Instagram for digital health promotion.

What measurement-related concerns are raised?

The author questions internal consistency due to a KR-20 reliability of 0.60 and notes that validated tools were not used, making comparison and reproducibility harder.

Which gaps are identified for future research?

The author calls for including user engagement metrics and algorithm-related factors, expanding beyond Instagram to other platforms, and measuring digital health literacy to improve interpretation and generalizability.

Sep 30, 2026

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