Digital Health Departments: Using New Media for Greater Engagement and Impact


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New media is revolutionizing how people communicate about health issue. US State and Local Health Departments are beginning to use new media to help better reach and engage their constituents with important health messages. This presentation explores ways that Health Departments can improve their use of new media to achieve their goals. It was presented in Chicago, Illinois on September 24, 2013 at the Annual Training Symposium of the National Public Health Information Coalition (NPHIC) as their annual Berreth Lecture to honor the memory of Don Berreth, founder of NPHIC.

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  • In 2012, Thackeray and colleagues found that 60% percent of SHDs reported using at least one social media application. Of these, 86.7% had a Twitteraccount, 56% a Facebook account, and 43% a YouTube channel.
  • Researchers looked at connections among health departments by searching the friend/like or follower list of each state health department’s Facebook or Twitter account. A total of 37 state health departments were connected to each other on Twitter, while only 24 were connected to each other on Facebook. Researchers found that state health departments using Twitter were more likely to follow other state health departments in the same geographic region, this was not the true for Facebook. The size of the circles is proportional to how many state health departments are friends or followers of a health department.
  • In 2012, researchers looked at 2,565 local health departments nationwide and found that only 24% had Facebook, 8% Twitter, and 7% had both.
  • Researchers found that the numberof local state health departments who have adopted Facebook and Twitter increased between 2007 and 2012.
  • Researchers collected a sample of 4,779 twitter followers from 59 randomly selected local health departments in the United States. The twitter followers were coded by type (individual versus organization), location, health-focus, and industry. Results showed that local health departments’ twitter accounts were followed by more organizations than individuals. The organizations tended to be health-focused, located outside the state from the local health being followed, and from education, government, and non-profit sectors. Individuals were likely to be local and not health-focused. Having a public information officer on staff, serving a larger population, and tweeting more frequently was associated with having a higher percentage of local followers.
  • Researchers collected tweets from 210 local health departments. 56.1% of the tweets were related to personal health while 39.5% were related to the organization.Of the personal health related tweets, 58.5% involved factual information and 41.4% encouraged action. Of the tweets related to the organization, 51.9% were one-way communication about the organization and its services and events, 35% of the tweets related to the organization tried to engage followers in conversation, and 13.3% encourage action to benefit the organization.
  • I need [the] (Initiative Name) initiative to engage (Audience)with (Content) to get them to (Objective).I will achieve my overall goal with (Weekly Staff Hours) staff hours,(Monthly Budget), and be ready to begin in (Lead Time). The duration of the initiative will be (Initiative Duration).
  • 5) International travel to developing countries (Kibera, Asia, etc.):
  • 3) Technology inspires me – apple 2 to todays and tomorrow’s breakthroughs
  • 9) BIG changes inspire me – think big, dream big, e.g., Biggest Loser, rags to riches, MLK, iPod, etc.
  • Digital Health Departments: Using New Media for Greater Engagement and Impact

    1. 1. @jaybernhardt Digital Health Departments: Using New Media for Greater Engagement & Impact Jay M. Bernhardt, PhD, MPH Professor and Director DONALD A. BERRETH LECTURE SEPTEMBER 22, 2014 CHICAGO, ILLINOIS
    2. 2. @jaybernhardt Center for Digital Health and Wellness • CDHW Mission – To save lives, prevent illness, and promote wellbeing through creative and innovative digital health research, training, practice, an d partnerships. • Selected Programs – Digital Health Communication Exchange (DHCX): – Graduate Certificate in Digital Health and Wellness:
    3. 3. @jaybernhardt Berreth Lecture 2013 Overview • New media usage and trends – In the US and around the world – In US health departments • New media best practices – For selected platforms – Evaluation strategies – Overcoming barriers
    4. 4. @jaybernhardt Definitions and Terms • New Media: digital stuff that isn’t “old media” • Social Media: internet applications where users create, share, and exchange information • Social Networks: relationship structures among and between individuals and organizations • Web 2.0: digital sites that leverage user content, open source principles, and network effects • These terms will be mostly used interchangeably • So will website, site, channel, platform, tool, app
    5. 5. @jaybernhardt New Media Use and Trends By the numbers…
    6. 6. @jaybernhardt Social Media Use by Age in US, 2005-2012
    7. 7. @jaybernhardt
    8. 8. @jaybernhardt
    9. 9. @jaybernhardt Mobile Phones Before and After the iPhone (2006 vs. 2012) Source:
    10. 10. @jaybernhardt
    11. 11. @jaybernhardt
    12. 12. @jaybernhardt Consumer Health Apps 2012
    13. 13. @jaybernhardt Trend 1: Creating & Participating Misc. From Trend 3: Mobile Internet of Everything (IoE) Trend 2: Shrinking Screens
    14. 14. @jaybernhardt Trend 4: Digital Health Startups are Exploding!
    15. 15. @jaybernhardt Take Home Message: Health communication is now digital and social. Question: How well have State and Local Health Departments kept up?
    16. 16. @jaybernhardt State Health Departments: Adoption and Use Thackeray, R., VanWagenen, S., Koch Smith, A., Neiger, B., Prier, K. (2012). Adoption and use of social media among public health departments. BMC Public Health, 12(1), 242-247.
    17. 17. @jaybernhardt Connections Among State Health Depts. Harris, J. (2013). The network of web 2.0 connections among state health departments: new pathways for dissemination. Journal Of Public Health Management & Practice, 19(3), E20-4.
    18. 18. @jaybernhardt Local Health Departments: Adoption and Use Harris, J. K., Mueller, N. L., & Snider, D. (2013). Social Media Adoption in Local Health Departments Nationwide. American Journal Of Public Health, 103(9), 1700-1707.
    19. 19. @jaybernhardt Local Health Department: Adoption and Use Harris, J. K., Mueller, N. L., & Snider, D. (2013). Social Media Adoption in Local Health Departments Nationwide. American Journal Of Public Health, 103(9), 1700-1707.
    20. 20. @jaybernhardt Local Health Department: Twitter Followers Harris, J., Choucair, B., Maier, R., Jolani, N., Bernhardt, J. (under review). Are public health organizations tweeting to the choir? Understanding LHD Twitter followership. • More organizations than individuals • Organizations – Health-focused – Located outside the state – Education, govt, and non-profits • Individuals – Local – Not health-focused • Higher percentage of local followers – Having a PIO on staff – Serving a larger population – Tweeting more frequently
    21. 21. @jaybernhardt What are LHDs tweeting about? Neiger, B., Thackeray, R. Burton, S. Thackeray, C., Reese, J. (2013)Use of Twitter Among LHD’s: An Analysis of Information Sharing, Engagement, and Action. JMIR, 15(8), 177. 56% 40%
    22. 22. @jaybernhardt Top 5 Most Social Media Friendly State Health Departments for 2013 • Arizona Dept of Health Services – Almost 5M YouTube views* • California Dept of Public Health – Almost 8k Twitter followers • Florida Department of Health – Almost 2.5k Facebook likes • Michigan Dept of Comm Health – Almost 5k Twitter followers • Alaska Dept of Health & Social Svc – More than 125k YouTube views* More than 4.5M from other sources
    23. 23. @jaybernhardt New Media Use in SHDs and LHDs • Increasing numbers of HDs using new media • Very low numbers of users relative to pops • Not necessarily reaching targeted audiences • Predictors of greater new media success – Having expertise (e.g., public information officer) – Sharing updates with greater frequency – Repurposing other people’s content
    24. 24. @jaybernhardt New Media Best Practices Lessons for Health Departments to go from 0.0 to 3.0
    25. 25. @jaybernhardt New Media Requires Strategy! • New media is a tactic, that requires strategic planning to use correctly and effectively • Questions to answer when planning strategy: – Who are the intended audience and key segments? – What are the goals, objectives, and outcomes? – What products and messages will be used? – What resources are available (budget, expertise, personnel time, lead time, audience involvement)? Adapted from CDC SocialMediaWorks
    26. 26. @jaybernhardt What is SocialMediaWorks? A social media strategy tool to improve: Methodology: planning, organizing and education. Connection: promote listening and forum activity. Recommendations: prioritize social media channels and metric use.
    27. 27. @jaybernhardt source:
    28. 28. @jaybernhardt Facebook & Online Social Networks • Facebook • More than 1B users • Highly sharable content • Highly targeted ads • Extensive user data • Mobile access common • Hard to get followers • Closed data system
    29. 29. @jaybernhardt Facebook Best Practices • 0.0: Inform Design from the Best-in-Class Pages • 1.0: Posts = Frequent, Interesting, Sharable, Hip • 2.0: Generate followers and shares through cross-promoted content and targeted ads • 3.0: Engage in two-way communication and analyze social media data streams for trends
    30. 30. @jaybernhardt source:
    31. 31. @jaybernhardt Twitter and Microblogging • Twitter • More than 500M users • ≤140 characters per tweet with photos, videos, links • Hashtag (#) categorization • Aggregators are essential • Open access to all info • Live tweeting TV & events • Great professional resource • You all should use Twitter!
    32. 32. @jaybernhardt Twitter Best Practices • 0.0: Follow peers and other professionals • 1.0: Posts = Timely, Hashtagged, Interesting, Noteworthy, Graphical, Frequent, Repeated • 2.0: Attract followers through creative content, live tweeting, and constant promotion • 3.0: Engage in two-way communication and analyze social media data streams for trends
    33. 33. @jaybernhardt
    34. 34. @jaybernhardt YouTube and Streaming Media • YouTube • >1B users per month • 100 hours uploaded/minute • Professional & User Generated • Embeddable and sharable • >25% watched on mobile • Other platforms: – Vimeo, Vevo, Veoh, etc. – Netflix, Amazon Prime, etc.
    35. 35. @jaybernhardt YouTube Best Practices • 0.0: Create your own YouTube Channel • 1.0: Leverage your content and share other’s high quality and high demand content • 2.0: Videos = Short, Narrative, Creative, Emotional, Real People, Sharable • 3.0: Solicit appropriate user generated content
    36. 36. @jaybernhardt Other New Media Platforms • LinkedIn: Join and create groups, recruit talent • Google+: Social layer integrated with gmail, etc. • Pinterest: Pin photos, videos, infographics • Instagram: Share visual stories, photovoice • Vine: Very sharable but must be fun • Google/Bing: Not new media, but SEO matters
    37. 37. @jaybernhardt Systematic Lit Review of Social Media • Reviewed 98 studies using social media and identified 6 main benefits for social media 1. Increased interactions with audience members 2. More available, shared, and tailored information 3. Increased accessibility to health information 4. Increased peer, social, and emotional support 5. Contributing to public health surveillance 6. Influencing public health policy • Limitations: Reliability, Confidentiality, Privacy Moorhead, S.A., et al. (2013). A New Dimension of Health Care: Systematic Review of the Uses, Benefits, and Limitations of Social Media for Health Communication, JMIR, 15(4): e85.
    38. 38. @jaybernhardt mHealth = Multi-Media Platform Voice (live, recorded, IVR) SMS or MMS Email or Instant Message Audio file (MP3, etc.) Games Video file (M4V, etc.) Mobile Web Self- Monitoring Custom applications (“apps”) GPS/Location
    39. 39. @jaybernhardt “We have never lived in a time with the opportunity to put a computer in the pocket of 5 billion people.” - Marc Andreessen
    40. 40. @jaybernhardt Meta-analysis of SMS-based health promotion • Overall weighted mean effect size was d = .329 (p < .001): “small to medium magnitude“ • Smoking cessation and physical activity worked best • Tailoring and personalization improved outcomes • Personalized or decreasing message frequency worked better than using a fixed message frequency • HHS Text4Health Task Force strongly supports SMS Head, K.J., et al. (2013). Efficacy of text messaging-based interventions for health promotion: A meta-analysis, Social Science and Medicine, 97, 41-48.
    41. 41. @jaybernhardt Mobile Web (mWeb) • Almost two-thirds of mobile phone owners go online • More time spent accessing web from mobile than desktops/laptops • Few health depts have mobile optimized website or content • Some health organizations created limited mobile sites
    42. 42. @jaybernhardt mHealth Department Apps • About 1.5B apps available • About 70B downloads • About 40K health apps and 50M downloads • Limited efficacy evidence • High production costs
    43. 43. @jaybernhardt mHealth Department Best Practices • 0.0: Using and promoting existing mobile tools • 1.0: Create apps for local needs and resources • 2.0: Create interactive SMS health programs • 3.0: Develop mWeb with “responsive design”
    44. 44. @jaybernhardt New Media Extras Improving Evaluation Overcoming Barriers Time Check?
    45. 45. @jaybernhardt Evaluating New Media Programs • Develop your new media program strategy – Audience, Objectives, Outcomes, Media, Messages • Select and benchmark your metrics and analytics – Exposure, Engagement, Impacts, Outcomes – Consider evaluation designs with comparison groups • Implement and monitor your program • Gather, code, organize, integrate, analyze data • Report findings, adjust practices and programs
    46. 46. @jaybernhardt Evaluating New Media Programs • Six levels of evaluation data and measurement – Social Media Data and Public Information Cloud – Audience Research and Formative Evaluation – Program Exposure and Reach – Engagement and Interactions – Program Impacts – Health Outcomes CDC Framework for Program Evaluation
    47. 47. @jaybernhardt Evaluation Best Practices • 0.0: Program has target audience and objectives • 1.0: Use analytics to capture exposure and reach • 2.0: Integrate survey and surveillance data • 3.0: Use longitudinal panel design with controls
    48. 48. @jaybernhardt Barriers to using New Media • Limited expertise in the workforce – Recruit, Train, Partner, Outsource • Limited personnel and time – Cross-train workforce, Interns, Partner, Repurpose other org’s channels/content • Difficult to prioritize new media programs – Short term: Move from 0.0 to 2.0 or 3.0 in social – Long term: Start planning your mobile strategy
    49. 49. @jaybernhardt Barriers to using New Media • Limited access to technologies and sites – Highlight new media at peer organizations – Build relationships with IT personnel • Limited data or evidence of efficacy – Research and evaluation evidence is growing – Focus on “systematic literature reviews” • Uninformed or unsupportive bosses – “Know your audience” and address their needs
    50. 50. @jaybernhardt Digital Health Departments Final Thoughts on New Media
    51. 51. @jaybernhardt Jay’s Conclusions & Recommendations • Social media and mobile are nearly ubiquitous • HD’s are using new media with limited uptake • New media requires strategy and evaluation • Best practices can move you from 0.0 to 3.0 • Develop your mobile strategies now Some Closing Thoughts…
    52. 52. @jaybernhardt “Any sufficiently advanced technology is indistinguishable from magic.” - Arthur C. Clarke (1917-2008) Past Present Future
    53. 53. @jaybernhardt Digital Health will be Revolutionary “The best way to predict the future, is to invent it.” - Alan Kay
    54. 54. @jaybernhardt Source:
    55. 55. @jaybernhardt Thank you @jaybernhardt DONALD A. BERRETH LECTURE SEPTEMBER 22, 2014 CHICAGO, ILLINOIS
    56. 56. @jaybernhardt Recommended Resources • CDC HealthCommWorks – • CDC Social Media Tools, Guidelines & Best Practices – • Digital Strategy – • Journal of Medial Internet Research (JMIR) – • Pew Internet and American Life Project –