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Beyond ROI: Measuring Digital Health Content's Full Economic Benefits


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[Note: Downloading this PDF is recommended for the best viewing experience.] This ebook provides marketers and communicators with a simple and flexible method for justifying investments in digital …

[Note: Downloading this PDF is recommended for the best viewing experience.] This ebook provides marketers and communicators with a simple and flexible method for justifying investments in digital health content. Proving digital health is worth it economically is essential. This is the only way the health industry will move from digital laggard to leader.

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  • 1. Ju$tifying th€ Digita£ HealthContent InvestmentWhy It Matters | How to Do It
  • 2. Use Statement and AcknowledgmentUse StatementEnspektos, LLC is licensing this content under the Creative Commons License, Attribution-ShareAlike 3.0( Please feel free to use material in this ebook in blogs,podcasts, presentations, and other content. You may also e-mail it to your colleagues and othersyou think will benefit from it.AcknowledgmentWe would like to thank Jane Sarasohn-Kahn of THINK-Health for her invaluable assistance in helping us to refine ourwork on quantifying the economic benefits of behaviors activated or sustained by digital health content. Informationabout THINK-Health is below.About THINK-HealthTHINK-Health is a strategic health consultancy founded in 1992. Focusing at the nexus of health care andtechnology, the firms toolkit includes environmental analysis, scenario, strategic and business planning, forecasting,and health policy analysis.THINK-Health assists every segment of the health care industry, including technology and medical device companies,educational institutions, pharmaceutical manufacturers and distributors, health care providers, payers and plans,consumer products companies, non-profits and financial services firms.Learn more about THINK-Health at Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 2
  • 3. Just What Is Digital Health Content?In this ebook, well spend a lot of time talking about digital health content so heres abrief definition.Digital Health Content: Information about health, medicine or wellness distributed andconsumed via digital technologies, such as the Internet and social and mobile media.This includes sites like WebMD, Facebook, Twitter, mobile apps and more. Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 3
  • 4. The Bottom Line: Health Marketers and CommunicatorsMust Justify Investments in Digital Health ContentIn 2005, Harris Interactive found that 58% of online What Are the Economic Benefits of Digital Health Content?adults reported going online "sometimes or often" tofind health or medical information. (1) By 2011, 73%of online adults were frequently turning to Dr. Web foradvice, content and support. (Part of this increase maybe attributable to cost-shifting from payers toconsumers as they seek to reduce medical costs.)As the Internet has increased in importance forpatients, medical providers, caregivers and others, thehealth industry has taken notice — and action. Forexample, government agencies like the U.S. Food andDrug Administration (FDA) and the U.S. Department ofHealth and Human Services are increasingly leveragingonline and social media technologies. Government has Moreover, many are not tying social media activities tobeen joined by hospitals, pharmaceutical companies and standard measures of return on investment (ROI), such asothers in the private sector. increased sales, revenues and profits.However, many health organizations have hesitated to The public sectors enthusiasm has also been temperedaggressively use these technologies. One reason is because of uncertainty about whether and how digitalregulatory uncertainty. Pharmaceutical companies have content activates changes in health behavior.not received clear guidance from the FDA on how toemploy social media in a compliant fashion. Hospitals For digital health evangelists, this caution has beenand managed care organizations have concerns about frustrating. Many fear the industry will fall further behindviolating HIPAA regulations. as patients and other stakeholders embrace these technologies.Another contributing factor is a lack of clarity aboutwhether investing in digital health content is worth the Convincing the industry to act will require demonstratingeffort. The health industry is not alone in this regard. digital health content investments are economicallyFor example, according to a January 2012 survey justifiable. Assertions that the health industry must getproduced by Wildfire, most marketers lack a standard involved because "everyones doing it" are unpersuasive.metric for social media success. (2) Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 4
  • 5. The Bottom Line: Health Marketers and CommunicatorsMust Justify Investments in Digital Health ContentHeres the bottom line: The health industry wont move Our approach to justifying investments inforward unless we prove producing, curating and digital health content is behavior-centric.distributing digital health content is worth the effort.This is equally true for the public and private sectors. Health marketing communications initiatives are not just about increasing revenue.Our Goal Encouraging people to begin or sustain behaviors that lead to long, active lives isWe developed this ebook to provide marketers and vital.communicators with a simple and flexible method forjustifying digital health content investments. This is not just a "feel good" perspective. Activating behavior change has manyOur suggested approach is behavior-centric. Unlikeother industries, health-related marketing and economic benefits for health organizationscommunications activities are not solely designed to and revenue and profits. Instead, a major objective isto change or sustain positive health behaviors so people Health is different. Existing metricscan live long, active lives. This is not just about doing undervalue digital health content. Because ofthe right thing. Activating behavior change can have this, weve developed a new one.significant economic benefits. In this ebook, we will do the following:We believe quantifying the economic impact of digitalhealth content investments on behavior can help in • Illustrate why focusing on behavior change in digitalthese ways: health is important • Address whether digital health content can change • Ensure marketing communications efforts are behavior evaluated based on their overall economic benefits • Discuss the important but misunderstood art of ROI — not just on organizational profitability measurement • Encourage communications and marketing • Outline why calculating ROI is not enough in health professionals to think more strategically about • Introduce a new method for quantifying the their digital health content initiatives economic impact of digital health content on • Drive widespread adoption of digital technologies behavior within the health industry Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 5
  • 6. A Single CDC Blog Post Captured the Worlds Attention,but Did It Change Behavior? Figure 1.Just prior to the 2011 hurricane season, the Office of Did OPHPRs Post Impact Preparedness Behaviors?Public Health Preparedness and Response (OPHPR)published a somewhat tounge-in-cheek blog postfocusing on the importance of preparing for a ZombieApocalypse. (3) The post was designed to raiseawareness about the importance of being prepared fordisasters.CDC was unprepared for the massive reaction the postreceived. Soon after a tweet announcing it waspublished to Twitter, the agencys website wasinundated with visits. Unprepared for the traffic, theCDCs website crashed for a brief period.Although the publics response to the post wasunanticipated, its creation was well planned. Accordingto OPHPRs Margaret Silver:"CDC’s Joint Information Center [JIC] was activelymonitoring social media to track conversation about the[2011 Japan Earthquake] and provide accurateinformation where appropriate. JIC noticed that peoplewere responding to questions about what disasters theywould prepare for with zombies.In our planning sessions about how how to get peoplethinking about preparedness as hurricane seasonapproached, we talked about the possibility of doingsomething around zombies." (4)After OPHPRs director, Rear Admiral Ali S. Khan, signed Source: Enspektos, LLC, © 2012off on the idea, the famous post went live. Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 6
  • 7. A Single CDC Blog Post Captured the Worlds Attention,but Did It Change Behavior? Figure 2. Daigles query highlights a question sometimes asked OPHPR Achieved Its Goal of Generating Awareness before, during and after digital health content initiatives. Web and social media have the potential to reach billions of people. But does reach translate into changed hearts and minds? In the case of the Zombie Apocalypse post, convincing more people to prepare for hurricanes could have had a significant economic and human impact. A few months after the post was published, the Eastern U.S. was pounded by Irene, one of the worst tropical storms on record. Irene was expected to do more damage to the coast, but hit inland areas such as upstate New York and Vermont hard. Many people in these regions were unprepared for the storms ferocity. However, because of CDCs Zombie Source: Enspektos, LLC, © 2012 Apocalypse post, did some in these areas prepare? If so, what would have been the economic benefits of theseOverall, OPHPR was pleased by the success of the blog preparedness activities? It is likely they would have beenpost. For a modest $87 investment (plus staff time), it significant.generated tremendous awareness — especially via siteslike Twitter (Figure 2). This demonstrates the power of The Zombie Apocalypse story illustrates why it is sosocial media to quickly spread information globally and important we begin to routinely measure the behavioralgenerate a massive response. impact of digital health content initiatives. If we dont, well never know the economic value generated by a single,However, OPHPR wanted to know more. Shortly after massively popular blog post.the post appeared, the agencys Dave Daigle remarked:"Measuring hits and views is great, but did people make Until now we have assumed digital health content can playa plan, did we really affect behavior?" (Figure 1) a role in behavior change. Below well address whether this is truly the case. Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 7
  • 8. Can Digital Health Content Change Behavior?Convincing people to stop long-held unhealthy Evidence suggests digital health contentbehaviors such as smoking, poor eating and inactivity is can activate behavior change.incredibly difficult. Given this, it makes sense to askwhether content encountered online or in social mediacan truly get people to change. According to the 2011 Edelman Health Barometer study, respondents said they wouldOver the past few years, the public relations firm be motivated to change negative healthEdelman has been exploring this question via its global behaviors because of the following:Health Barometer. (5) In the 2011 edition of the study,Edelman conducted an analysis of data it collected • Reading or hearing about benefits [ofamong people reporting they engage in negative healthactivities (such as eating poorly). When asked which behavior change] in the newsfactors would motivate them to change behaviors, • Using tools and technologiesrespondents highly ranked the following: • Joining a support network • Knowing their long-term health would improve BJ Fogg, director of Stanford Universitys Persuasive Tech • Changes in physical appearance Lab, is perhaps the worlds foremost expert on how • Reading or hearing about benefits in the news machines such as computers and mobile devices influence • Joining support networks human behavior. • Using supportive tools and technologies In 2003, Foggs book, Persuasive Technology: UsingThe results of this study suggest a combination of Computers to Change What We Think and Do, wasfactors can motivate people to change behavior. Social published. In the book, Fogg described a new concept heinfluences such as support groups clearly play a role. coined in 1996 called "captology." He defined captology asHowever, delivering health information digitally via the a focus "on the design, research, and analysis ofnews or informational articles may also have an interactive computing products created for the purpose ofinfluence on behavior. changing peoples attitudes or behaviors. [Captology] describes the area where technology and persuasionKnowing digital health content has the potential to overlap." (6)change behavior is only the first step. Understandinghow is the next. Since the books publication, Fogg has continued to refine the captology concept in a range of ways. Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 8
  • 9. Can Digital Health Content Change Behavior?In 2009, Fogg introduced the Fogg Behavior Model in What are the types of behavior digital health content canorder to further describe how persuasive technologies influence? We answer this question below.change behavior (Figure 3). In the model, Foggsuggests behavior is a "product of three factors: Figure 3.motivation, ability, and triggers." (7) In order for The Fogg Behavior Modelbehavior change to happen (or be sustained), all threefactors must be present.In brief: • Motivation refers to willingness to engage in the behavior; motivation can be manipulated • Ability is whether someone can actually perform the behavior; perceived ability can be changed • Triggers are reminders or cues to engage in the behavior, such as text messages or on-screen alertsDigital health content can support behavior change bydelivering information triggers that motivate andincrease perceived ability at the right time (Figure 4).Fogg has suggested the following best ways to activatebehavior change: • Place "hot triggers" in the path of motivated people, i.e., starting with those who want to change first (8) • Reduce perceived difficulty level by making a task easier to complete or suggesting ways behavior change can be simple to achieve (8) Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 9
  • 10. Can Digital Health Content Change Behavior? Figure 4. How Digital Health Content Supports Behavior Change Source: Enspektos, LLC, © 2012 Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 10
  • 11. Can Digital Health Content Change Behavior?On the next page, we outline a framework called the They can use the Matrix to determine how difficultHealth Behavior Levels Matrix (Figure 5). It is designed behavior change will be to achieve. (Higher levelto outline the types of behavior those producing digital behaviors are harder to activate.) They can also use it tohealth content can activate or sustain. Behaviors plan how best to evaluate digital health content initiatives.indirectly and directly related to health are included inthe matrix because they are activated in the context of In the next section of this ebook, we outline a method forthis topic. The Matrix describes four levels of behavior: justifying digital health content investments. As we will discover, in the field of health, using ROI as the sole • Level I: Engagement or activity behaviors method of evaluation is often inappropriate. commonly associated with consumption of online health content. These can include watching The Health Behavior Levels Matrix is designed videos or sharing a Twitter post. to help those developing digital health • Level II: Purchase or donation behaviors initiatives to: activated by online health content, including decisions to seek or prescribe medication or • Understand the types of behavior they donate to a cause. seek to influence • Use the appropriate levels of • Level III: Short-term health behaviors which do measurement for their activities not require a long-term commitment such as • Determine how difficult it will be to getting screened for heart disease or being vaccinated. activate or sustain behavior change • Level IV: Long-term health behaviors which require a significant commitment such as taking medication for life or maintaining an exercise program.The Health Behavior Levels Matrix can be useful forhealth marketing and communications professionalsworking on online initiatives. Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 11
  • 12. Can Digital Health Content Change Behavior? Figure 5. The Health Behavior Levels Matrix Source: Enspektos, LLC, © 2012 Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 12
  • 13. ROI: Important, but Often Misunderstood andMisappliedThe debate over return on investment (ROI) has been Return on Investment is purely a financialone of the most heated in the digital world. One major metric. It measures whether an investmentreason for the argument is that ROI is misunderstood.According to a 2012 survey of corporate marketing (such as using financial and human resourcesdecision makers produced by the Columbia School of to produce social media content) results in aBusiness Center on Global Brand Leadership: (9) return (profits or donations) to an organization. • 82% of respondents did not realize "ROI consists of both financial return and spending" Many people substitute measures such as • 37% did not define ROI as a measure of financial increased awareness (visits, advertising outcomes equivalency value) or engagement (Web • 31% believe determining ROI begins and ends with measuring audience reach traffic, Facebook Likes, retweets) for ROI. This is not appropriate.It is important to understand that ROI is purely afinancial metric. It is used to determine if an These non-financial metrics can be useful.investment (such as a social media campaign) results in However, quantifying the impact of awarenessreturns (profits or donations). As Columbia University and engagement on profits (or donations) isfound, many people substitute easier-to-calculate required to calculate ROI.metrics such as online awareness (clicks) andengagement (Facebook Likes, retweets) for ROI. Thesemetrics are useful, but unless they are linked to However, the decision about whether ROI is an appropriatefinancial return, they are not relevant to the ROI metric also depends on the investments time horizon.conversation. To clear up confusion about ROI, we have Some activities must yield a return immediately. Others,provided a guide below on how to calculate the metric such as building relationships online or experimentation,(Figure 7). can boost or protect profits in the future. In these cases, it will take longer to demonstrate positive ROI.Another part of the debate centers on whether it isappropriate to evaluate digital and social media using Having a clear understanding of the investments timeROI. Revenues or donations are the lifeblood of an horizon is important. This can prevent efforts to use ROIorganization. Given this, they have no choice but to analysis to inappropriately and prematurely canceldetermine if these tools yield positive financial returns. worthwhile projects. Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 13
  • 14. ROI: Important, but Often Misunderstood andMisapplied Figure 7. Calculating ROI Source: Enspektos, LLC, © 2012 Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 14
  • 15. Why Focusing on ROI Is a Mistake in HealthWeve spent a lot of time defining ROI and talking aboutits importance, but using ROI as the sole means of Figure 8. ROI-Oriented Thinking:evaluating digital health content investments is a How Do Benefits Flow to Us?mistake. Health is different. Heres why.Promoting health is not just about increasingprofits. The ultimate goal of any marketing orcommunications initiative is to convince people tochange or sustain positive health behaviors.Government, pharmaceutical companies and managedcare alike have a shared goal of helping people livelonger and more productive lives. They disagree on howto get there, but there is a shared consensus thatimproving health can deliver significant economicbenefits to society.Moreover, health organizations are beingfinancially incentivized to demonstrate theyimprove overall health and wellness. For example: • Pharmaceutical companies: Private and public sector payers have the most influence on drug firms financial fortunes. To succeed, companies must prove their medications (and support activities) deliver economic benefits to society. • Hospitals: Increasingly, hospitals with high in- hospital infection rates, readmissions and poor- quality care are being financially punished. Source: Enspektos, LLC, © 2012 • Government: Programs that fail to improve health are being eliminated. Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 15
  • 16. Quantifying Digital Health Contents Economic BenefitsIn this context, health organizations cannot afford to A new metric for evaluating digital healthengage in ROI-oriented thinking (Figure 8). For theprivate sector, having executives evaluate digital health content: Return on Health Behavior.content investments solely on whether benefits areflowing from customers and stakeholders to the Developed by Enspektos, LLC, ROhB quantifiescompany is a mistake. More importantly, turning a profit the aggregate economic benefits associatedisnt what motivates organizations such as non-profit with activating and sustaining positive healthhospitals, government and charities. behaviors via digital content.If ROI isnt appropriate, what metric should we use?We suggest the health industry adopt a metric called Figure 9. ROhB-Oriented Thinking: How Do Benefits Flow Between Us and Others?Return on Health Behavior or ROhB. ROhB wasdeveloped in 2012 by the health marketingcommunications innovation consultancy Enspektos, LLC.It measures the aggregate short- and long-termeconomic value associated with activating andsustaining positive health behaviors via digitalhealth content. ROhBs benefits include the following: • ROhB recognizes the new financial reality: It quantifies how the economic benefits of digital health content flow between organizations and society (Figure 9). • Both the public and private sectors can use ROhB: It allows the public and private sectors to speak the same language when quantifying digital health contents benefits. • ROhB encourages innovation: It can help justify experimental or long-term investments. Positive ROhB = worthwhile activity. Source: Enspektos, LLC, © 2012 Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 16
  • 17. Quantifying Digital Health Contents Economic Benefits Figure 10. The Pros and Cons of ROIROI, ROhB and Health BehaviorTo help you understand why ROhB is a moreappropriate metric for digital health content, we discussit in the context of the Health Behavior Levels Matrixintroduced earlier (Figure 6).As outlined in Figure 10, ROI is primarily designed tohelp organizations determine if people are buying ordonating. Because of this, it is best suited formeasuring Level II health behaviors associated withmaking purchases or donations.To properly calculate ROI, one has to accuratelyattribute digital content consumption directly to apurchase or donation. Digital attribution analysis is acomplex subject, but companies like Adobe and IBMhave designed tools to help organizations conduct itmore easily. (10, 11)However, ROI does not provide information on whetherdigital health content impacts short- and long-termnon-purchase health behaviors. As discussedpreviously, understanding this is an imperative for thehealth industry.ROI is also being used inappropriately. There areinstances where the immediate goal is not to driverevenue. However, if a project does not demonstrateshort-term ROI, a worthwhile initiative may be endedprematurely. Moreover, ROI is not an appropriatemetric for non-profits and government. Source: Enspektos, LLC, © 2012 Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 17
  • 18. Quantifying Digital Health Contents Economic BenefitsROhB is a more flexible metric, as described in Figure Figure 11. The Pros and Cons of ROhB11. Most importantly it does the following: • Recognizes Financial Reality: ROhB does not ignore the fact that private sector organizations must turn a profit. • Refocuses Non-Profits and Government from Evaluations Based on Activity to Economic Benefit: Sometimes non-profits and government executives are rewarded based on how much they produce and distribute. ROhB realigns the focus from what was made to health outcomes with proven economic benefits. • Justifies the Use of Digital Media to Shape the Market and Build Relationships: ROhB enables health organizations to quantify activities such as relationship building or shaping the market. For example, proving that building an online community boosts medication compliance has many economic benefits, including these: - Preventing illness (reducing medical costs) - Improved adherence (increasing drug revenue) - Improved productivity (boosting profits)See Figure 12 for a sample ROhB calculation. Profitsplus quantified economic benefits to society arecompared to digital health contents costs to generate aROhB figure. Source: Enspektos, LLC, © 2012 Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 18
  • 19. Quantifying Digital Health Contents Economic Benefits Figure 12. Calculating ROhB (Thanks to Jane Sarasohn-Kahn of THINK-Health for Assistance with This Calculation) Source: Enspektos, LLC, © 2012 Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 19
  • 20. Measuring Digital Health Contents Behavioral ImpactYou may agree it is important to link digital healthcontent to health behavior change. You could also Figure 12. Few Studies Illustrateaccept the argument that ROhB is a more appropriate Digital Health Contents Impact on Behaviormetric for evaluating health online and social mediainitiatives. The question is how?The first place some turn to for answers is in academicliterature. In 2010, Peel Public Health in Canadacommissioned a literature review examining theeffectiveness of social media on health. (12) Theconcern was that public health organizations and otherswere embracing these technologies with little proof theywork.The authors found there were few peer-reviewedstudies demonstrating social media was effective atincreasing issue-related awareness and promptingadoption of desired behaviors (Figure 12).In other words, theres little evidence social mediadrives health behavior change. However, the Peel PublicHealth paper has done little to dampen enthusiasm forsocial media in the health industry. People are usingthese technologies, so health organizations feel theymust follow suit.If weve hit a dead end with the academic literature,then what to do? This is another area where the HealthBehavior Levels Matrix can be helpful (Figure 6). TheMatrix stratifies digital-influenced behaviors by type.Measuring these behaviors requires different techniquesand technologies, as outlined below. Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 20
  • 21. Measuring Digital Health Contents Behavioral ImpactUse Web and Social Analytics to Measure Level I In the case of surveys, asking people how they heardBehaviors about an event or why they redeemed a coupon can reveal a lot about what is driving purchase behavior.The first goal of any digital health content initiative is todrive awareness and engagement. Level I of the Matrix Customer relationship marketing (CRM) programs can beaccounts for these behaviors. These can be measured leveraged to provide a range of data on the following:using a range of technology, as described below. • Acquisition: How potential customers are acquiredWeb Analytics: Web analytics platforms can provide a (via newsletters, Web content or other means)wealth of information about how people arrive at and • Conversion: Which touchpoints (such as e-mail,consume health content on a website. This data can events, white papers, in-person detailing, etc.)also be used to examine the types of content that move people from consideration to purchaseimprove awareness and sales. • Social Media Impact: Social media being used by customers and prospects, and which content drivesSocial Analytics: There are many technologies that online purchase behavior (clicks, likes, additionalreveal how people engage with (Likes, tweets, retweets) sales)and may perceive (sentiment) online content. Measuring Level III and IV Behaviors:Measure Level II Behaviors with Digital Analytics, A New FrontierSurveys and CRM Platforms Existing techniques and technologies do a good job ofIgnoring sales, revenue and profits is perilous, providing data on Level I and II behaviors. However,especially for private sector organizations like teasing out how digital content influences Level III and IVpharmaceutical companies and hospitals. actions is more difficult.Digital analytics and surveys can reveal how online The authors of Peels literature review of health and socialhealth content is driving hospital visits and coupon media tackled this question. (12) They wrote: "Whenredemptions. It can also help organizations properly controlled research included an evaluative component,attribute social media to increased revenues and profits. the results were often confounded by a failure to isolate the [social media] intervention from other communication strategies." Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 21
  • 22. Measuring Digital Health Contents Behavioral Impact Requirements for successfully quantifying theClearly, measuring the behavioral impact of digital impact of earned digital content on healthhealth content is a difficult task. However, as discussed behavior:above, doing so is critical. Isolating Digital Inputs: Analyzing digitalMany existing platforms fall down when it comes to inputs separately allows for directmeasuring Level III and IV behaviors. Content activity, comparison. For example, health contentsentiment and engagement data dont provide received via Facebook may perform differentlyinformation about health behavior. than information posted to a blog.In the paid content arena, technology is moreadvanced. For example, in 2011, Westat partnered with Accounting for Offline Effects: Behavior isLotame to examine how online advertising impacted influenced by many factors. What is thehealth behavior. Amelia Burke, Senior Director of relative role of online content versus offlineDigital Media for Westat, reported: influencers?"[D]ata were analyzed from audience engagementwith . . . banner advertisements and surveys . . . [and] Controlling for Motivation and Ability: Howmetrics such as increase in awareness, intent, and does content perform among individuals withlikelihood to recommend to a friend [were examined]. high versus low motivation and ability?Across recent public health campaigns, specific . . .results included increases in intent of upwards of 24% Understanding the Full Digital Environment:and increases in likelihood to recommend to a friend/ People do not consume digital health contentfamily member of upwards of 16%." (13) in isolation. What else are they seeing online? Does this information contain positive orHowever, much of the health content people consumeonline is earned, or non-advertising. How can we negative messages? How is this contentmeasure its performance? This is the next frontier in influencing behavior?health behavior measurement. To the right are somekey requirements for projects or technologies developed Right-Time Data: Digital media is ever-to tackle this problem. moving. Is data provided at the right time? Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 22
  • 23. Measuring Digital Health Contents Behavioral ImpactMobile, Big Data and Health Behavior Change Much of the promising work in this area is being conducted to understand patients real-world clinicalIn the mobile arena, a range of companies and outcomes. For example, data can be mined from socialorganizations are tackling the health behavior change media channels to understand the following:problem firsthand. • What medication-related decisions consumers areFor example, in March 2012, Johns Hopkins University makinglaunched an effort to rigorously evaluate mobile health • Why patients made these choices — e.g., because(mHealth) apps. These applications are being tested to of medication side effects or other factorsdetermine if they help people begin or sustain behaviorssuch as exercising, quitting smoking and improving Two companies, Prism Ideas and dMetrics, launched aeating habits. (14) partnership in 2012 to analyze "social media to determine patient actions and insights, profiling patientIn addition, a few companies are leveraging mobile to needs, symptoms and response to treatment."determine how multiple influencers, including contentreceived via SMS and e-mail, reflect or predict health Despite these advances, more work is required. First,behavior. One firm is, which has developed a many consumers in various health stages (pre-mobile behavioral analytics platform. The company diagnosed, recently diagnosed, considering treatment,"taps into the continuous sensor data from . . . mobile etc.) are not actively discussing their conditions[s] and other devices to predict individual Second, the Web is changing constantly. We need abehavior changes and identify aggregate trends." (15) better understanding of how ever-evolving digitalWhile not designed to activate behavior change, information triggers influence the vast majority ofGinger.ios technology can help us better understand the people consuming rather than creating digital content.factors influencing a range of health choices. This information can be used to help people:There is much excitement about the potential of BigData to revolutionize our understanding of a range of • Understand how individual pieces of digitalsubjects, including health. Big Data refers to the ability content influence health behaviorto automatically process and analyze large amounts of • Provide the appropriate level of evidence requiredinformation using sophisticated algorithms. A major to accurately calculate ROhBsource of data currently being analyzed comes from theWeb and social media. Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 23
  • 24. Demonstrating ROhB: A Competitive AdvantageDigital technologies will only grow in importance aspatients, health providers and other stakeholders Health organizations that measure ROhB willembrace them. Because of this, health organizations have a significant competitive advantage.will continue to invest in these tools. They will become hubs for innovation and understand how to produce digital healthBut the private and public sectors will not be well served content initiatives that deliver maximumby simply focusing on the low-hanging fruit of digital economic benefit.measurement: revenues and content engagement.We predict organizations that invest in demonstratingpositive ROhB will be at a significant competitiveadvantage. They will be more likely to innovate. Theseorganizations will also reap the economic rewardsassociated with consistently delivering effective andengaging digital health content.We hope this ebook serves as a roadmap for thoseorganizations ready, willing and able to understand thefull value of their digital health content investments. Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 24
  • 25. End Notes1. The Growing Influence and Use Of Health Care 8. BJ Fogg’s 5 Secrets of Behavior Change, Sachin Information Obtained Online, Harris Interactive, Rekhis Blog, May 13, 2011,, September 15, 2011,, Accessed March 3, 2012 Accessed March 22, 2012 9. Marketing ROI in the Era of Big Data, Columbia2. Measuring the Business Impact of Social Media, Business School, Center on Global Brand Leadership, Wildfire, January 19, 2012,, March 2012 Accessed March 22, 2012 10. Why marketers aren’t giving social the credit it3. Social Media: Preparedness 101: Zombie deserves, Adobe Digital Index Report, Adobe, March Apocalypse, Public Health Matters Blog, May 16, 2012 2011, zombies_blog.asp, Accessed March 1, 2012 11. Appropriate Attribution: Addressing the Dramatic Inaccuracies Associated with Last-Based Campaign4. Revisiting CDC’s Zombie Apocalypse: It Sparked a Attribution in Digital Analytics, IBM Coremetrics, Web Global Conversation, But Did it Change Behavior?, Analytics Demystified, 2011 Walking the Path Blog, March 16, 2012, http://, Accessed March 17, 2012 12. R. Schein, K. Wilson, J. Keelen, Literature review on effectiveness of the use of social media, Peel Public5. Edelman Health Barometer 2011: Global Findings, Health, 2010 Edelman Public Relations, October 2011, http://, Accessed March 25, 2012 13. Finally! Identifying and Setting Social Media Benchmarks for Public Health Campaigns, Walking6. B.J. Fogg, Persuasive Technology: Using the Path Blog, September 7, 2011, Computers to Change What We Think and Do, mYwvbK, Accessed March 26, 2012 2003 14. Hopkins researchers aim to uncover which mobile7. B.J. Fogg, A Behavior Model for Persuasive Design, health applications work, Baltimore Sun, March 14, 2009 2012,, Accessed March 27, 2012 15. The Science, Website, 2012, http://, Accessed March 27, 2012 Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 25
  • 26. End Notes16. Prism Ideas and dMetrics Launch Pioneering Service Analysing Patient–Reported Action, Get More Insight Behaviours and Outcomes with Social Media, Prism Ideas/dMetrics Press Release, January 25, In September 2012, Enspektos, LLC launched 2012 digihealth pulse. This is the worlds first ongoing tracking study investigating the impact of online and social media health content on the perceptions and behaviors of active digital health consumers (or e- patients). Visit for more information about the study. Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 26
  • 27. About EnspektosFounded in 2005, Enspektos, LLC is a digital health marketing communications innovation consultancy. We work with arange of health organizations, including pharmaceutical companies, payers, non-profits and government agencies.We exist to help our clients (and the broad health industry) use digital technologies to inspire patients, caregivers andothers to take action around health and wellness. We achieve this goal by developing and deploying a range of productsand services, including enmoebius, a patent pending digital surveillance and behavioral measurement engine thatreveals the link between digital health content and behavior change.Learn more about Enspektos at Ju$tifying th€ Digita£ Health Content Investment | Enspektos, LLC | April 2012 Page 27