THE IMPACT OF SOCIAL MEDIA
ON PUBLIC HEALTH RESEARCH
AND PRACTICE
a conversa*on with Gonzalo Bacigalupe
Technology developments are moving us towards the predominance of cloud
compu7ng, collabora7ve exchange, and social networking over the use of
technology as just storage, mul7tasking, and faster ways of carrying on
business as usual. These developments s7mulate new ways of collec7ng data,
developing messages, and sharing informa7on. No7ons of exper7se, control,
hierarchy, acquisi7on of knowledge, locality, iden7ty, privacy, etc. are all in
flux as social media is adopted by popula7ons worldwide. We explore some
of these technologies and how they may reshape public health prac7ce.
gonzalo.bacigalupe@umb.edu

Personal Health Technology: Future?
hIp://video.msn.com/video.aspx?vid=083e1117‐9f61‐40e1‐aea4‐b31e7baa8f13

What is public health?
•

The effect of Web 2.0 on medical pracGce and educaGon:
Web 2.0 is a term describing new collabora7ve Internet
applica7ons. The primary difference from the original
World Wide Web is greater user par7cipa7on in
developing and managing content, which changes the
nature and value of the informa7on.
Key elements of Web 2.0 include: Really Simple
Syndica7on (RSS) to rapidly disseminate awareness of new
informa7on; blogs to describe new trends; wikis to share
knowledge; and podcasts to make informa7on available
\"on the move\".
Increasing role in providing health informa7on \"any 7me,
any place\".
McLean, R., Richards, B. H., & Wardman, J. I. (2007). The effect of Web 2.0 on the future
of medical prac7ce and educa7on: Darwikinian evolu7on or folksonomic revolu7on?
Medical Journal of Australia, 187(3), 174‐177.

Web 2.0 Social soKware in health and health care educaGon
Web 2.0 sociable technologies and social soeware: enablers in health and health
care, for organiza7ons, clinicians, pa7ents and laypersons.
They include social networking services, collabora7ve filtering, social
bookmarking, folksonomies, social search engines, file sharing and tagging,
mashups, instant messaging, and online mul7‐player games.
The more popular Web 2.0 applica7ons in educa7on, namely wikis, blogs and
podcasts, are but the 7p of the social soeware iceberg.
Web 2.0 technologies represent a quite revolu7onary way of managing and
repurposing/remixing online informa7on and knowledge repositories, including
clinical and research informa7on, in comparison with the tradi7onal Web 1.0
model. (…) tools presented in this review look very promising and poten7ally fit
for purpose in many health care applica7ons and scenarios, careful thinking,
tes7ng and evalua7on research are s7ll needed in order to establish 'best
prac7ce models' for leveraging these emerging technologies to boost our
teaching and learning produc7vity, foster stronger 'communi7es of prac7ce', and
support con7nuing medical educa7on/professional development and pa7ent
educa7on.
Kamel Boulos, M. N., & Wheeler, S. (2007). The emerging Web 2.0 social soeware: an
enabling suite of sociable technologies in health and health care educa7on. Health Info
Libr J, 24(1), 2‐23.

E‐learning way of e‐learning
A wide range of social soeware has become readily available to young
people. There is increasing interest in possibili7es of using social
soeware for undergraduate medical educa7on.
To iden7fy the nature and extent of the use of social soeware by first
year medical students. Structured self‐administered ques7onnaire
survey.
Over 90 percent used instant messaging and social networking sites
were highly used (70 percent). No significant difference between males
and females. Blogs were read by about a fieh of students and a small
number (8%) wrote their own blogs. A fieh of males stated that they
were users of media sharing and contributed to wikis. Social
bookmarking was rarely used by either sex.
Medical educators need to recognize the poten7al of social soeware in
undergraduate medical educa7on but it is essen7al that students
maintain the informality and privacy of these sites. The challenge for all
medical educators is how to integrate social soeware into current
curricula and ins7tu7onal Virtual Learning Environments.
Sandars, J., Homer, M., Pell, G., & Croker, T. (2008). Web 2.0 and social soeware: the
medical student way of e‐learning. Medical Teacher, 1‐5.

Scaling the Skills Learning

Public Health Research

Federal Government Social Media
Federal health agencies relied
heavily on social media to inform
the public about the recent
outbreak of salmonella tainted
peanut buIer, possibly reducing
the number of death and injuries
caused by the illness, according to
federal health officials.
\"The response has been really
amazing,\" said Janice Nall,
director of the division of eHealth
marke7ng at CDC, on the public's
reac7on to her agency's social
media campaign. \"We look at
social media as addi7onal
channels to reach people where
they are.”
GAUTHAM NAGESH 02/09/2009
hIp://www.nextgov.com/nextgov/
ng_20090209_7840.php

PrevenGon

Social markeGng / Social Media
Users control communica7on in second genera7on of Internet‐based
applica7ons, holding promise to significantly enhance promo7onal efforts
within social marke7ng campaigns:
• directly engaging consumers in the crea7ve process by both producing and
distribu7ng informa7on through collabora7ve wri7ng, content sharing,
social networking, social bookmarking, and syndica7on.
• enhancing the power of viral marke7ng by increasing the speed at which
consumers share experiences and opinions with progressively larger
audiences.
Because of the novelty and poten7al effec7veness of Web 2.0, social
marketers may be en7ced to prematurely incorporate related applica7ons
into promo7onal plans.
But as strategic issues such as priority audience preferences, selec7on of
appropriate applica7ons, tracking and evalua7on, and related costs are
carefully considered, Web 2.0 will expand to allow health promo7on
prac77oners more direct access to consumers with less dependency on
tradi7onal communica7on channels.
Thackeray, R., Neiger, B. L., Hanson, C. L., & McKenzie, J. F. (2008). Enhancing promo7onal
strategies within social marke7ng programs: use of Web 2.0 social media. Health Promot
Pract, 9(4), 338‐343.

Social Marke7ng

Knowledge intermedia7on:
source credibility not enough
As a result of the social process of disintermedia7on enabled by digital media, tradi7onal
intermediaries are replaced by apomediaries: tools and peers standing by to guide
consumers to trustworthy informa7on, or adding credibility to informa7on.
For apomedia7on to be an aIrac7ve and successful model for consumers, the recipient has
to reach a certain degree of maturity and autonomy. Different degrees of autonomy may
explain differences in informa7on seeking and credibility appraisal behaviors.
In this environment, tools, influen7al peers and opinion leaders are the primary conveyors
of trust and credibility. Apomediary credibility may become equally or more important than
source credibility or even message credibility.
Network analysis could be useful to study the dynamics of apomediary credibility in a
networked digital world. There are prac7cal implica7ons of the apomedia7on model for
developers of consumer health websites which aspire to come across as \"credible”:
Consumers need and want to be able to be co‐creators of content, not merely be an
audience who is broadcasted to. Web2.0 technology enables such sites. Engaging and
credible Web sites are about building community and communi7es are built upon personal
and social needs.
Eysenbach, G. (2007). From intermedia7on to disintermedia7on and apomedia7on: new
models for consumers to access and assess the credibility of health informa7on in the age
of Web2.0. Studies in Health Technology and Informa*cs, 129(Pt 1), 162‐166.

Social networking can shape services
We report on a thread discussing the controversial
decision to use hormone replacement therapy (HRT)
following prophylac7c oophorectomy (PO). Two
main groups of women posted: (1) Women who
were BRCA+, had completed PO, and were deba7ng
or adjus7ng their HRT op7ons in terms of op7mizing
both quality and quan7ty of life. (2) Women who
were BRCA+, were contempla7ng PO, but wanted to
beIer understand the poten7al physical and
psychological consequences of surgical menopause
before deciding. Frustrated by physicians' lack of
knowledge and contradictory media ar7cles about
the long‐term consequences of HRT in BRCA+
women, they sought resources, emo7onal support
and specific experien7al knowledge from each other
and generated a unique sense of community and a
high level of trust.
Kenen, R. H., Shapiro, P. J., Friedman, S., & Coyne, J. C. (2007). Peer‐support in coping with medical uncertainty: discussion of oophorectomy
and hormone replacement therapy on a web‐based message board. Psycho‐Oncology, 16(8), 763‐771.

Web‐based self‐help interven7on: RCTs
Four weeks Web‐based course: Among all par7cipants, the interven7on was effec7ve in reducing
symptoms of depression and anxiety as well as in enhancing quality of life. A higher percentage of
pa7ents in the interven7on group experienced a significant improvement in symptoms. The course was
less effec7ve for work‐related stress, but par7cipants in the interven7on group recovered more oeen
from burnout than those in the control group. Sta7s7cal and clinical significant effects on symptoms of
depression and anxiety. These effects were even more pronounced among par7cipants with more
severe baseline problems and for par7cipants who fully completed the course. Effects on work‐related
stress and quality of life were less clear.
CigareTe smoking is a major risk factor for many chronic and fatal illnesses. Stopping smoking directly
reduces those risks. The primary outcome measure was prolonged abs7nence from smoking.
Secondary outcomes were point‐prevalence abs7nence, number of cigareIes smoked, and incidence
of quit aIempts reported at follow‐up assessments. Effec7ve web‐based programs can poten7ally help
large numbers of smokers to quit, thus having a major public health impact.
Kramer, J. J., Willemsen, M. C., Conijn, B., van Emst, A. J., Bruns7ng, S., & Riper, H. (2009). Effec7veness of a web‐
based self‐help smoking cessa7on interven7on: protocol of a randomised controlled trial. BMC Public Health, 9, 32.
van Straten, A., Cuijpers, P., & Smits, N. (2008). Effec7veness of a web‐based self‐help interven7on for symptoms of
depression, anxiety, and stress: randomized controlled trial. J Med Internet Res, 10(1), e7.

Empowering health consumers
Consumer health informa7cs has
emerged as a strategy to inform and
empower pa7ents for self management
of their health. The emergence of and
explosion in use of user‐generated online
media (e.g., blogs) has created new
opportuni7es to inform and educate
people about healthy living. Under a
preven7on research project, we are
developing a website that u7lizes social
content collabora7on mediums in
conjunc7on with open‐source
technologies to create a community‐
driven resource that provides users with
tailored health informa7on.
Khan, S. A., McFarlane, D. J., Li, J., Ancker, J. S., Hutchinson, C., Cohall, A., et al. (2007).
Healthy Harlem: empowering health consumers through social networking, tailoring and
web 2.0 technologies. AMIA Annu Symp Proc, 1007.

Access to clinicians

Challenges

Health Policy BoIom Up Approach

Google Uses Searches may be able to detect
regional outbreaks of the flu a week to 10 days
before they are reported by the CDC

www.google.org/flutrends

Mashup Technology: not just for play
hIp://irevolu7on.wordpress.com/2008/09/03/mapme‐applica7ons‐for‐humanitarian‐mapping

Disaster Management
If we are to make good on the UNISDR’s call for a
shi[ towards people‐centered early warning,
then flood early warning/response systems
ought to empower local communi*es to get out
of harm’s way and minimize loss of livelihood.
This shi[ in discourse and opera*onal mandate
is an important one in my opinion. Centralized,
state‐centered, top‐down, external responses to
crises are apparently increasingly ineffec*ve.
hIp://irevolu7on.wordpress.com/2008/09/07/mumbai

Flood Warning, Mobile Phones and Dynamic
Mapping in India (September 7, 2008)
• Today, one in four Indians has a mobile phone. […] From the villager
siwng atop his half‐drowned hut calling for help in flood‐hit Bihar,
to the kabadiwallah who eagerly hands you his number, it’s mobile
networking like never before.“
• […] the mobile phone’s ‘greatest impact [will] be on those people
with professions that are 7me, loca7on and informa7on sensi7ve.
[…] fishermen wan7ng a weather update or the loca7on of the best
catch; hospitals contac7ng pa7ents without a permanent address;
SMSes on the Sensex.”
• “It is true that network coverage and mobile penetra7on are s7ll
limited to certain areas. But, interes7ngly, as a study by the Center
for Knowledge Socie7es (CKS) showed in Maharashtra, Up and
Karnataka, many new mobile users belong to poorer areas with
scarce infrastructure, high levels of illiteracy and low PC and
internet penetra7on.”
hIp://irevolu7on.wordpress.com/2008/09/07/mumbai

Mobile Phones for Change

Website Collabora7ve Mashups

Humanitarian Crises: Kenya Example

A changing work environment