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This study analysed the social media engagement of nonprofit organisations in the health sector on the mobile photo sharing app Instagram as well as their ethical guidelines and considerations. The Instagram accounts of leading nonprofit organisations in the U.S. health sector were examined through a content analysis over a three-month period in the spring of 2014. In addition, social media managers at the health nonprofit organisations were interviewed on ethical challenges caused by Instagramfatcat:6iylol7vkfbyrho6hpejyurx5a