Dialogue Pathways and Narrative Analysis in Health Communication within the Social Media Environment: An Empirical Study Based on User Behavior — A Case Study of China

Xinke Wang¹XINCHEN LENG^2*

• ¹Zhongnan University of Economics and Law, Wuhan, China
• ²Monash University, Melbourne, Australia

Social media has transformed health communication from one-way expert dissemination into a dynamic process shaped by user-generated content and interactions. While this openness promotes engagement, it also accelerates the spread of misinformation that threatens public health. Existing studies have examined dialogue paths and narrative analysis independently, yet limited attention has been given to their interactive effects and contextual heterogeneity across platforms, user groups, and emotions. To address these gaps, this study analyzes China’s social media landscape using a multi-method approach. Between January 2023 and December 2024, over 50,000 health-related data points were collected from Weibo, WeChat, Xiaohongshu, and Douyin, from which 300 valid cases were selected for structural equation modeling (SEM). Complementary survey data from 300 respondents captured user perceptions and behaviors. Guided by health communication theory and narrative persuasion frameworks, SEM was conducted in two stages: measurement model validation through confirmatory factor analysis (CFA) to ensure convergent and discriminant validity, and structural model analysis to test hypothesized relationships among dialogue path, narrative structure, engagement, and behavioral outcomes. Results show that both dialogue pathways and narrative strategies significantly affect health behaviors. Dialogue depth exhibited the strongest positive effect on information sharing, while narrative consistency was closely associated with feedback intentions. Measurement properties demonstrated strong validity, and multi-group analysis revealed platform-level differences, with Weibo users displaying more emotionally driven interactions compared to WeChat users. The findings highlight dialogue coherence, emotional narrative style, and engagement as key predictors of health-related behavioral intentions, with engagement functioning as a mediating mechanism linking dialogic and narrative features to outcomes. This research underscores the mechanisms by which digital health communication operates, emphasizing the synergistic role of interactive dialogue and emotionally resonant storytelling. Practically, the study suggests that health communication strategies on social media should integrate emotionally impactful narratives and maintain coherent dialogic exchanges to foster positive behavioral change. By unifying dialogic and narrative processes within an SEM framework, this study advances theoretical understanding and offers actionable insights for enhancing digital health initiatives in increasingly algorithm-driven communication environments.