How public health agencies communicate with the public on TikTok under the normalization of COVID-19: A case of 2022 Shanghai's outbreak

Objective: As life with COVID-19 became a norm in 2022, the public's demand for and perception of COVID-19-related information has changed. This study analyzed the performance and responses of Healthy China and the public at various stages of COVID-19 normalization using the crisis and emergency risk communication (CERC) theory. Methods: This study was based on the 2022 Shanghai COVID-19 outbreak and data from “Healthy China,” the official TikTok account of the National Health Commission of the People's Republic of China (NHCC). First, we divided the Shanghai lockdown into five stages in accordance with the CERC. Second, the videos released by Healthy China were open-coded. Third, to understand the distribution of strategies across the stages, we used counts and percentages to summarize the categorical variables. Fourth, we investigated the distribution of public participation indicators using descriptive statistical analysis. Finally, the relationship between stage and communication strategy was examined using the chi-square test and negative binomial regression. Results: (1) Healthy China adopted a more flexible approach to communication strategies; (2) new cases per day was the commonly used substrategy for uncertainty reduction; (3) there was a significant difference in the strategies used by Healthy China at different stages; (4) public participation was highest in the pre-crisis period; and (5) the stage had a significant positive impact on the number of views, favorites, likes, and shares. Conclusions: This research provides insight into effective communication strategies for the government or public health agencies to employ during COVID-19 normalization.