5 Fictions About Social Media for Public Health and Healthcare

“We can reach and change the behavior of our target audience through social networking sites like Facebook and Twitter.”

This sentence captures the prevailing sentiment I find whenever two or more public health people gather to discuss their interest in social media and using it to advance public health goals. Notwithstanding the fact that their enthusiasm for these methods outpaces the development of an empirical literature to support their use, while also recognizing that the majority of US adults and teens are active users of these media, the sentence illustrates at least five misperceptions about the nature of social media and working in this space.

Fiction #1. We can reach audiences with social media

Many actors in the social media space, and this extends to users far beyond public health and the public sector, think of social media as another channel through which they can deliver messages to audiences. They view social media in much the same way that they have used broadcast and print media: as a tube through which they can deliver messages that will stick with and persuade people to change behaviors, purchase products or use services. They also greatly simplify the challenge, for example, by thinking of social media as consisting of only social network sites (SNS). As the chart Fred Cavazza created a few years ago shows, the social media landscape is more complex. Indeed, it is difficult to imagine that someone would undertake a television project believing that they can reach people by relying on CBS and FOX as their only outlets, but the analogy of using just Facebook and Twitter is lost on many.

Diving deeper into the Twitterverse - something Brian Solis and Jess3 have just mapped out - it is clear that each of the current social media darlings become even more complicated.

One reaction to all these opportunities is to be simply overwhelmed by them; and that's the point! Social media is not a new way to “reach” people - it is an 'attract and join' space. It is not a space with people sitting on a couch waiting to be entertained; this is a place where people actively seek out their own entertainment, and more importantly connect with their family, friends and people with whom they share similar interests.

The people we wish to engage with around specific issues need to be understood in the context of how they construct their social media space, not by how we construct it for ourselves. This idea became crystal clear to me during a project in which we were interviewing young, low-income women about their use of social media. Because we were already contemplating recruiting peer counselors, or evangelists, as part of a social marketing program to increase use of family planning services, we deliberately constructed focus groups consisting of women from this priority group who are currently enrolled in 2-year nursing or other health professional education programs. What we heard from these women was that they were now creating Facebook  profiles because they felt they needed a more professional identity. These women had all been MySpace users and insisted they would continue being active there as well. Their comments solidified my POV, and reinforced what is reported by others and work being done on Personas at the MIT Media Lab: that many people use social media to create a variety of personas (I have a least 7 by their analysis).  Most interesting in the research was the women's perception that having a Facebook profile signaled their transition into a new stage of their work life or career.

There are also circumstances in which public health people believe that there are groups who are not involved with social media. While there is some truth to this rumor, it is less veridical than many presume. The chart from the Pew Internet & American Life Project shows more than 50% of online adults between the ages of 18-55 use social network sites (SNS). More importantly, SNS are among the fastest growing online activities among 34-73 year-olds.

Fiction #2: We can change people with social media

This assumption is predicated on the idea that persuasive messages can be developed and delivered intact through social media to all of the people we wish to influence.  This assumption often leads to the concern of "How do we ensure that our message is delivered as we want it to be?”  Such people are used to the security of putting words onto a printed page, into a PDF format  or a prerecorded radio or television spot where tampering with the message is designed out of the  process. Indeed, the great leap that people must make when working with social media is designing content with the expectation that it will be passed on by others, perhaps edited or amplified, perhaps an opinion will be attached to it, mashed up with other content or even be responded to - rather than simply consumed.

Another underlying assumption is that people are active in social networks to learn things and are open to changing their behaviors. What we do know from surveys by the Pew Internet & American Life Project is that most people on the Internet are there to tap into their social networks. And people do not choose to be friends with people, or organizations, because of a promise that 'we are here to change you (or sell you something).' If we are to honor the notion that relationships through common interests are the basis on which social networks are developed, then we also must recognize that people on SNS are not looking for people to change them. To return to the 'attract and join' position, the early experiences we have using SNS for behavior change efforts in these networks and communities tend to attract like-minded people who are either looking for ways to support their own change efforts that are underway, or to discover resources they can use or to help others make the same change - for example, people who are attempting losing weight or who have quit smoking.

The third variable in the 'change' presumption is that it will occur through individual, or psychological, mechanisms. This perspective overlooks the value of working in the social media space: that is, directly addressing some of the social variables that influence behavior, as well as improving social connections and social capital in online communities. I've written quite a bit about social influences, social networks  and health behaviors. My bottom line is that we are being forced by the explosion of social media to face the reality (and some might say - "again") that social networks frame the opportunities and constraints for change.

Fiction #3: Health behaviors are the focus of our social media efforts

Many people who undertake social media efforts targeted at behavior change assume that people interact with social media much like they do with broadcast media - that is, very little. People on social media sites are not sitting in front of a computer screen simply switching channels or adjusting the volume. They are reading news and updates from friends, searching for information, sharing with others, making new friends, rating products and services, tagging content, posting and uploading content, linking to content as well as retweeting it - to name just a few behaviors that will affect their ability, as well as ours, to effectively engage with each other for a common purpose of learning and acquiring new behaviors. Overlooking these component skills may be the greatest risk to public health programs that are delivered via social media.
 
To briefly illustrate this point, we must understand that segmentation is not just about the behaviors that are of interest to us, our organizations or society. Rather, we also need to include in our segmentation schemes the fact that there are social media behavioral segments that need to be incorporated into the design of our programs. For example, Forrester Research (2006) has identified six segments they label as Inactives (over half of US adult online users), Spectators, Joiners, Collectors, Critics and Creators.

Preece & Schneiderman (2009) have a similar behavioral segmentation scheme they call the “Reader-to-Leader Framework" which should be required reading for designers of  behavior change programs in SNS or online communities. In their paper they give a number of both technological and social prompts that can help guide people through the process of moving from a Reader to a Contributor, Collaborator and Leader role.

What both of these segmentation strategies highlight is that many people who are on SNS or online health communities participate at very low levels of activity. This finding should make some people pause and question their assumption that behavior change through social media is simply presenting the right message, at the right time, to the right audience.

Fiction #4: We have target audiences who use social media

At a superficial level, this assertion it is true. However, the presumption that a target audience is waiting for us to reach, touch, engage them or otherwise treat them as passive consumers is a sure route to failure. As most people soon learn, in the social media space the targets can shoot back.



So it is little wonder that when organizations intend to use social media that much of the early planning centers around questions of how open the organization will be to comments and participation, whether and how to create content that people can modify - or not, whether to involve people formerly known as the audience as co-creators of content and whether to design program elements that allow people to actively reach out and engage people in their own social networks in the change process (that is, become extenders or evangelists for the cause).

Thinking of people in SNS or online communities as “target audiences” also fails to acknowledge that in the social media world it is not about audiences, but communities. I see this bias arise when agencies begin thinking about creating their own communities before understanding whether there might be existing online communities that they could join.

The most important opportunity that letting go of the “target audience” mindset provides us is that we can leverage and facilitate the interpersonal, or word-of-mouth, communication that naturally occurs in these networks and communities. If we approach social media without a “consumer” frame, we can then think about how we can utilize the most significant influencer for new learning and behavior change - interpersonal communication.  Adopting this perspective makes it easier to understand why we have to let go of our content, unlock the formatting keys and make the content accessible to people who can then pass it along to others. (More on The consumer as participant rather than target audience - pdf).

Have you truly thought for all these years that people either heard or saw your content and said nothing to anyone else, or if they did repeated it perfectly? Only with the advent of social media, and the ability to experience these second- and third-hand transactions, does the question seem relevant. But that does not change the fact that people have been talking about our messages and content for years; we just weren't able to watch or hear it (maybe we just weren't interested - or now we think we can be held accountable for what they say).

Fiction #5: To use social media effectively we need to be on Facebook and Twitter

The prevailing wisdom is that using Facebook and Twitter are the keys to success in the social media world. In most cases, this presumption is based on the numbers of visitors that go to these sites rather than any understanding of whether our priority groups do or whether those sites are the best place to try and engage them in behavior change or community building activities.

Once you get beyond the popularity contest numbers, there are many different types of SNS sites that people visit. I have been particularly impressed by how many health communities I can find on Ning for example. And of course this list does not include the many SNS and online communities dedicated to health topics.

It is also important not to rush past other Internet assets just to be part of the social media dance. As John Mack of Pharma Marketing Blog illustrated from a recent Accenture survey, social media sites are the ones health information seekers are least likely to visit - lagging behind online patient communities, pharma websites and general and medical websites such as Wikipedia and WebMD. This calls for carefully considering your objectives and the way your priority group uses the internet and SNS before jumping to the Facebook and Twitter default.



Decisions about where to focus your social media resources may also contribute to widening health awareness, information and status gaps among users who use the sites and those who don't. It is also well worth considering whether sites like Facebook deserve the attention of public health organizations at all. For example, when one looks at the groups of people most deserving of public resources, and among whom some health problems may be more prevalent, MySpace may be more important. danah boyd noted several years ago that 'MySpace has most of the kids who are socially ostracized at school because they are geeks, freaks, or queers.' MySpace has always been the habitat for people outside the mainstream and ignoring that fact, and that there are millions more of teens and adults like them in various ways, lends an urgency to getting answers to questions of 'how can we attract and join with people who hang out on SNS to promote and support more healthy choices in our everyday lives?'

Now that we have these five fictions on the table, what would you like to do next?

References

Forrester’s NACTAS Q4 2006 Devices & Access Online Survey, Forrester Research, Inc.

Preece, J. and B. Shneiderman (2009). The Reader-to-Leader Framework: Motivating Technology-Mediated Social Participation. AIS Transactions on Human-Computer Interaction, (1) 1, pp. 13–32.

Photo Credits

People are doing things on these sites - Lynetter

The deer now have guns - Lynetter

Comments

[Tiffany Sutter Straus]

Interesting findings. I agree more research should be done in this area.

[www.google.com/accounts/o8/id?id=AItOawms4EzPoUe-wdE4iv36f_4vNt9UUSpeod4]

Intelligent & Insightful. Thanks!

Eric Neblung, Ph.D.
www.eric-neblung-phd.com

[RedbirdComms]

Some great points touched on here. "Social media is not a new way to “reach” people - it is an 'attract and join' space." That is a great way to put it.

I think marketers, even social marketers, often forget that most people outside of communications jobs don't see social media as a channel. It is part of their private life. You have to tread carefully and not just try to take advantage of the "free" space.

That's why your advice about "the great leap that people must make when working with social media is designing content with the expectation that it will be passed on by others" is really effective.

Thanks,

James
Redbird Communications
(an agency that specializes in changing behaviour and awareness campaigns)