Obstetrics, Gynecology, and Twitter: A Primer on Strategic Social Media to Improve Women's Health

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Brigham & Women's Hospital, Department of Obstetrics and Gynecology Grand Rounds - given 9/29/10

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  • In the next 10 years social media will fundamentally change the way healthcare is delivered in the United States.As a result, next week at the American College of Surgeons 96th Annual Clinical Congress, there will be a panel discussion titled “To Tweet or To Become Extinct: What Every Surgeon Should Know About Social Networking”.I don’t think things are that dire – we’re not in danger of becoming extinct. But right now, other interested parties are actively using social media to influence the choices women make – and as women’s health providers, we are in danger of having our relevance erode unless we engage in this space as well.
  • ROI and best practices not clear yet – but new information emerging to suggest power of social media to influencewomens healthWhoever figures this out first will wield significant influence on our fieldAnd we don’t even have a presence
  • ROI and best practices not clear yet – but new information emerging to suggest power of social media to influencewomens healthWhoever figures this out first will wield significant influence on our fieldAnd we don’t even have a presence
  • By the time I finish training, 1 out of every 5 dollars spent in the U.S. will be spent on healthcareThere is an increased demand to make sure that the dollar is well spentThe information age has brought technologies that enable a type of transparency and accountability that was not previously possible
  • Online health information appears to have impact
  • Even among patients who are closely plugged into their doctors, who are highly motivated to find reliable information, the Internet serves as the first source of information
  • Nearly half (47%) of internet users, or 35% of adults, have turned to the internet for information about doctors or other health professionals – a similar number has used internet to look up hospitals/treatment facilities. These graphs show percentage who consulted or posted actual online rankings or reviews
  • Use of internet to get specific health information is growingPercentage of total US adults (overall number lowered by substantial elderly population that does not use internet) – numbers much higher when you look at internet users only, and numbers significantly higher when you look at women (unable to graph because they did not report demographics by gender for each year)
  • Americans are not just going online and reading static webpages. They are using social media.FB has 46 million more women visits than men per monthI’m sure this is not a surprise to you, what is surprising…
  • Americans are not just going online and reading static web pages. They are using social media.FB has 46 million more women visits than men per month
  • Americans are not just going online and reading static web pages. They are using social media.FB has 46 million more women visits than men per month
  • Americans are not just going online and reading static web pages. They are using social media.FB has 46 million more women visits than men per month
  • HHS Office of Women’s Health: 1,213 peopleMacArthur Ob/Gyn: 713 peopleKevin Pho 20,000American College of Physicians 5,000American College of Nurse-Midwives 2,000
  • Twitter makes a terrible first impression. You hear about this new service that lets you send 140-character updates to your "followers," and you think, “why does the world need this?”Twitter raised about $100M in venture capital, turned down $500M from Facebook, nearly $1B from Google despite never making a profit
  • The way most New York Times articles are now read – how BarackObama tracks his speechesReal time search - sporting events (FIFA world cup 7000 tweets/minute), Iran electionsEvery company from local business to huge corporations, all politicians
  • Benchmarks:MGH: 600BWH: 1,500NEJM: 10,000CNN: 1.2 millionLady Gaga: 6 millionObama: 5 million
  • 1979People with lowest levels of social contact had mortality rates two to four and a half times stronger than those with strong social networks
  • 1979People with lowest levels of social contact had mortality rates two to four and a half times stronger than those with strong social networks
  • Social Network Index with four tiers, based on number of contacts and weighting system that takes into account importance of these contacts. Graph shows increased mortality with increased isolation, stratified by age group. Demonstrates that social networks exert a strong independent effect on health.
  • Although overall mortality is higher in these age groups for men, relative risk is MUCH higher for women. Age-adjusted risk is 2.3 vs.2.8
  • Do Neighborhood Socioeconomic Deprivation and Low Social Cohesion Predict Coronary Calcification? The CARDIA Study
  • J ObstetGynecol Neonatal Nurs. 2007 Jan-Feb;36(1):9-20.Barriers and facilitators for breastfeeding among working women in the United States.Johnston ML, Esposito N.United States Air Force (USAF), Nurse Corps, Women's Health Care Clinic, Cannon AFB, NM 88101, USA. marina43402@earthlink.netWomen Health. 2005;41(3):63-82.Social network normative influence and sexual risk-taking among women seeking a new partner.Dedobbeleer N, Morissette P, Rojas-Viger C.
  • What came first?
  • Externalities are relatively simple. If recently put my house on the market in Boston. I spent a lot of time and money improving the exterior so that its value would increase. As a consequence, my neighbors homes became marginally more valuable.One could also argue that my neighbors became somewhat more inclined to improved their homes, based on my behavior, but this is harder to prove.
  • Ego – person whose behavior is being analyzed
  • ties
  • Alters – person connected to the ego who may influence their behavior
  • Transfer of attributesDifference between “induction” (true transfer of attributes) vs. homophily (people with like attributes cluster)
  • Each circle (node) represents one person in the data set. There are 2200 persons in this subcomponent of the social network. Circles with red borders denote women and circles with blue borders denote men. The interior color of the circles indicates the person’s obesity status: yellow denotes an obese person (body-mass index, >30) and green de- notes a nonobese person. The size of each circle is proportional to the person’s body-mass index. The colors of the ties between the nodes indicate the relationship between them: purple denotes a friendship or marital tie and orange denotes a familial tie.
  • Evolution of obesity (obese = yellow, nonobese = green)
  • Evolution of obesity (obese = yellow, nonobese = green)
  • Evolution of obesity (obese = yellow, nonobese = green)
  • Evolution of obesity (obese = yellow, nonobese = green)
  • This graph shows a subcomponent drawn from a network of 1,700 undergraduate students whose social ties were ascertained using Facebook. Each node represents one person and ties between them indicate a close friendship. Square nodes are men and circular nodes are women. The interior color of the nodes indicates the person's obesity status: red denotes an obese person, orange an overweight person, yellow an underweight person, and white a normal-sized person. Clusters of obese and non-obese individuals are visible in this online network.
  • Evolution of obesity (obese = yellow, nonobese = green)
  • Online networks can be optimized for induction
  • PatientsLikeMe is a social networking health site that enables its members to share treatment and symptom information in order to track and to learn from real-world outcomes.Physicians and researchers can access the site, enabling them to find out what treatments its patients have tried and how successful the outcome of the treatments were.Search for ALS patients on a variety of parameters including known disease-causing genetic mutations (e.g. SOD1, ALS2, VAPB). Over time we will show patients with the inherited familial form of ALS (FALS) more information about their likely progression rates and publish our findings to the scientific field.See how ALS patients taking an experimental treatment, lithium, are doing in real-timeView FRS scores before and after starting lithium, easily compare individual dosages and blood levels, and filter results by a rich set of patient characteristics.Read more: http://ebennett.org/hsnl/#ixzz0ymQZhXnI
  • Sermo makes money by selling access to physicians’ anonymized comments and polling data to financial institutions, health care organizations, and governmental bodiesValue -> adverse drug reportingMembership larger than AMA -> political battlesRead more: http://ebennett.org/hsnl/#ixzz0ymQZhXnI
  • 825 Hospitals total * 391 YouTube Channels * 631 Facebook pages * 634 Twitter Accounts * 87 BlogsRead more: http://ebennett.org/hsnl/#ixzz0ymQZhXnI
  • Mayo Clinic believes individuals have the right and responsibility to advocate for their own health, and that it is our responsibility to help them use social media tools to get the best information, connect with providers and with each other, and inspire healthy choices. We intend to lead the health care community in applying these revolutionary tools to spread knowledge and encourage collaboration among providers, improving health care quality everywhere.”Read more: http://ebennett.org/hsnl/#ixzz0ymQZhXnI
  • Boston Globe August 2010:Social Media is a conversation. Millions of people use these sites to connect, create trusted circles and talk to each other. Sometimes they talk about us – our hospital, our staff and their experiences here. We have to be in the room – the social media site, if we want to be invited into the conversation.Read more: http://ebennett.org/social-media-talking-points/#ixzz0yn3V3p4A
  • Boston Globe August 2010:Social Media is a conversation. Millions of people use these sites to connect, create trusted circles and talk to each other. Sometimes they talk about us – our hospital, our staff and their experiences here. We have to be in the room – the social media site, if we want to be invited into the conversation.Read more: http://ebennett.org/social-media-talking-points/#ixzz0yn3V3p4A
  • 20,000 followers – small radio station
  • Jeff Livingston uses the technology to make interactions more personal – share baby pictures (bulletin board), post practice news, answer anonymous questions
  • About one in ten online health inquiries have a major impact on someone’s health care or the way they care for someone else.42% of adults say they or someone they know has been helped by online health advice.
  • Obstetrics, Gynecology, and Twitter: A Primer on Strategic Social Media to Improve Women's Health

    1. 1. Obstetrics, Gynecology & Twitter<br />A Primer on Strategic Social Media to Improve Women’s Health<br />Neel T. Shah, M.D., M.P.P.<br />September 29, 2010Brigham & Women’s Hospital<br />
    2. 2. Web 2.0<br />Disclosure<br />I have no financial relationship with a commercial entity producing health care related products or services<br />
    3. 3. Web 2.0<br />What does Facebook have to do with gynecology?<br />
    4. 4. Web 2.0<br />the Internet<br />health care<br />What does Facebook have to do with gynecology?<br />Source: Congressional Budget Office, W3 Consortium<br />
    5. 5. Web 2.0<br />Roadmap<br /><ul><li>How do Americans get healthcare information?
    6. 6. What is web 2.0?
    7. 7. How do social networks influence health outcomes?
    8. 8. How is social media being used to influence health choices?
    9. 9. How can Ob/Gyn’s best engage with social media?</li></li></ul><li>Web 2.0<br />How do Americans get healthcare information?<br />Sources used to find or access health information in the past 12 months<br />Source: iCrossing. How America Searches: Health and Wellness. January 2008<br />
    10. 10. Web 2.0<br />How do Americans get healthcare information?<br />62% of American adults who use the Internet have looked up health information in the last month<br />88% of online American adults have looked up health information at some point<br />Source: Harris Poll August 2010<br />
    11. 11. Web 2.0<br />How do Americans get healthcare information?<br />Information source used first among cancer survivors (2-5 years from diagnosis)<br />Source: National Cancer Institute Health Information National Trends Survey. 2005.<br />
    12. 12. Web 2.0<br />How do Americans get healthcare information?<br />Percentage of internet users who have looked online for information about…<br />Source: Pew Internet and American Life Project<br />
    13. 13. Web 2.0<br />How do Americans get healthcare information?<br />Percentage who consulted or posted online rankings of doctors<br />Source: Pew Internet and American Life Project<br />
    14. 14. Web 2.0<br />How do Americans get healthcare information?<br />Trends in use of internet for health information<br />Source: Pew Internet and American Life Project<br />
    15. 15. Web 2.0<br />How do Americans get healthcare information?<br />37% of U.S. adults are getting health information from social media<br />Women are significantly more engaged then men<br />FB is 57% women – they have 8% more friends and participate in 62% of the sharing compared to men<br />Source: Pew Internet and American Life Project, Google Analytics<br />
    16. 16. Web 2.0<br />What is web 2.0?<br />
    17. 17. Web 2.0<br />What is web 2.0?<br />Web 1.0 – you go to websites to read information<br />Web 2.0 – information from web brought to you through feeds<br />(social media is the platform used to read these feeds)<br />
    18. 18. Web 2.0<br />What is web 2.0?<br />World LIVE Web<br /><ul><li>Author-generated
    19. 19. User-generated
    20. 20. Group wisdom
    21. 21. Controlled message
    22. 22. Read-only
    23. 23. Read/write/collaborate
    24. 24. Static web
    25. 25. Participatory web</li></ul>World WIDE Web<br />
    26. 26. Web 2.0<br />What is web 2.0?<br />Social media are media for social interaction, using highly accessible and scalable publishing techniques via social networks<br />Social media are distinct from industrial or traditional media, such as newspapers, television, and film.<br />Source: Wikipedia 2010<br />
    27. 27. Web 2.0<br />What is web 2.0?<br />500 million active users (150 million mobile)<br />If country, would be third largest behind China and India<br />Fastest growing demographic > 35<br />30 billion pieces of content shared per month<br />Gardasil: 106,000 people<br />HHS Office of Women’s Health: 1,213 people<br />ACOG: 0 people (no page)<br />Source: Facebook<br />
    28. 28. Web 2.0<br />What is web 2.0?<br />Rapid growth<br />Source: Twitter, Reuters, Google News<br />
    29. 29. Web 2.0<br />What is web 2.0?<br />Changing the world?<br /><ul><li>News and opinion
    30. 30. Searching
    31. 31. Marketing, advertising, and campaigning</li></ul>Source: Twitter, Reuters, Google News<br />
    32. 32. Web 2.0<br />What is web 2.0?<br />145 million active users (95 million mobile)<br />Fastest growing demographic 35-45<br />65 million tweets/day (750 per second)<br />Twitter replacing Google search (real time results)<br />MacArthur ObGyn: 1,200 followers<br />ACOG: 800 followers<br />Source: Twitter, Reuters, Google News<br />
    33. 33. Web 2.0<br />What is web 2.0?<br />Social media are media for social interaction, using highly accessible and scalable publishing techniques via social networks<br />Source: Wikipedia 2010<br />
    34. 34. Web 2.0<br />Social Networks and Health Outcomes<br />Source: Berkman LF and Syme SL. “Social Networks, Host Resistance, and Mortality: A Nine Year Follow up Study of Alameda Country Residents.” Amer J Epid. 1979.<br />
    35. 35. Web 2.0<br />Social Networks and Health Outcomes<br />Source: Berkman LF and Syme SL. “Social Networks, Host Resistance, and Mortality: A Nine Year Follow up Study of Alameda Country Residents.” Amer J Epid. 1979.<br />
    36. 36. Web 2.0<br />Social Networks and Health Outcomes<br />All Cause Mortality Rates by Social Network Index for Men and Women Age 60-69<br />Source: Berkman LF and Syme SL. “Social Networks, Host Resistance, and Mortality: A Nine Year Follow up Study of Alameda Country Residents.” Amer J Epid. 1979.<br />
    37. 37. Web 2.0<br />Social Networks and Health Outcomes<br />All Cause Mortality Rates by Social Network Index for Men and Women Age 60-69<br />RR = 1.8<br />RR = 3.0<br />Source: Berkman LF and Syme SL. “Social Networks, Host Resistance, and Mortality: A Nine Year Follow up Study of Alameda Country Residents.” Amer J Epid. 1979.<br />
    38. 38. Social Networks and Health Outcomes<br />Source: Kim D, Diez Roux AV et al. “Do Neighborhood Socioeconomic Deprivation and Low Social Cohesion Predict Coronary Calcification? The CARDIA Study. Amer J Epi. 2010<br />.” Amer J Epid. 1979.<br />
    39. 39. Social Networks and Health Outcomes<br />Social network independently related to postpartum depression<br />Source: Surkan PJ, Peterson KE et al. “The role of social networks and support in postpartum women's depression: a multiethnic urban sample”. Matern Child Health J. 2006<br />Social network independently related to decision to breastfeed<br />Source: Johnston ML, Esposito N. “Barriers and facilitators for breastfeeding among women in the United States”. J Obstet Gynecol. 2007.<br />Social networks normatively influence sexual risk-taking behavior<br />Source: Dedobbeleer N, Morissette P, Rojas-Viger C. “Social network normative influence and sexual risk-taking among women seeking a new partner”. Women Health. 2005.<br />Social networks influence advance care planning decisions of women with ovarian cancer<br />Source: Dizon DS, Schutzer ME et al. “Advance care planning decisions of women with cancer: provider recognition and stability of choices”. J PsychosocOncol. 2009.<br />
    40. 40. Social Networks and Health Outcomes<br />
    41. 41. Web 2.0<br />Network Theory<br /><ul><li>Traditional View
    42. 42. Impact = Reach x Efficacy
    43. 43. Network View
    44. 44. Impact = Reach x Efficacy + Externalities</li></ul>Source: Nathan Cobb M.D., Schroeder Institute for Tobacco Research and Policy Studies, Health 2.0 Conference 2009<br />
    45. 45. Web 2.0<br />Network Theory<br />
    46. 46. Web 2.0<br />Network Theory<br />
    47. 47. Web 2.0<br />Network Theory<br />
    48. 48. Web 2.0<br />Network Theory<br />
    49. 49. Web 2.0<br />Network Theory<br />Largest connected subcomponent of the social network in the Framingham Heart Study in the year 2000<br />Source: N.A. Christakis and J.H. Fowler, "The Spread of Obesity in a Large Social Network Over 32 Years," New England Journal of Medicine 2007; 35: 370-379<br />
    50. 50. Web 2.0<br />Network Theory<br />A selected subcomponent of the social network in the Framingham Heart Study in the years<br />1980<br />1975<br />Source: N.A. Christakis and J.H. Fowler, "The Spread of Obesity in a Large Social Network Over 32 Years," New England Journal of Medicine 2007; 35: 370-379<br />
    51. 51. Web 2.0<br />Network Theory<br />A selected subcomponent of the social network in the Framingham Heart Study in the years<br />1990<br />1985<br />Source: N.A. Christakis and J.H. Fowler, "The Spread of Obesity in a Large Social Network Over 32 Years," New England Journal of Medicine 2007; 35: 370-379<br />
    52. 52. Web 2.0<br />Network Theory<br />A selected subcomponent of the social network in the Framingham Heart Study in the years<br />2000<br />1995<br />Source: N.A. Christakis and J.H. Fowler, "The Spread of Obesity in a Large Social Network Over 32 Years," New England Journal of Medicine 2007; 35: 370-379<br />
    53. 53. Web 2.0<br />Network Theory<br />Is the “spread” of obesity in the Framingham Heart Study network induction orhomophily?<br />Source: N.A. Christakis and J.H. Fowler, "The Spread of Obesity in a Large Social Network Over 32 Years," New England Journal of Medicine 2007; 35: 370-379<br />
    54. 54. Web 2.0<br />Network Theory<br />Obesity in a Facebook Network<br />Source: K. Lewis, J. Kaufman, et al., "Tastes, Ties, and Time: A New (Cultural, Multiplex, and Longitudinal) Social Network Dataset Using Facebook.com," Social Networks 2008<br />
    55. 55. Web 2.0<br />Network Theory<br />The shape of online social networks can be designed to maximize spread of health behaviors<br />Source: Centola D, "The Spread of Behavior in an Online Social Network Experiment," Science, Sep 2010<br />
    56. 56. Web 2.0<br />How is social media being used to influence health choices?<br />Social networks independently effect health outcomes<br />Health choices propagate through social networks via induction, independent of geography<br />Social media enables highly accessible and scalable publication of influential messaging (and it is how many Americans get health information)<br />Social media is being used to influence health choices<br />
    57. 57. Web 2.0<br />How is social media being used to influence health choices?<br />
    58. 58. Web 2.0<br />How is social media being used to influence health choices?<br />
    59. 59. Web 2.0<br />How is social media being used to influence health choices?<br />872 hospitals are using social media<br />Source: Hospital Social Network List ebennett.com August 2010<br />
    60. 60. Web 2.0<br />How is social media being used to influence health choices?<br />“… it is our responsibility to help them use social media tools to get the best information, connect with providers and with each other, and inspire healthy choices …”<br />
    61. 61. Web 2.0<br />How can Ob/Gyn’s best engage with social media?<br />
    62. 62. Web 2.0<br />How can Ob/Gyn’s best engage with social media?<br />#1 Find out what people are saying about you<br />
    63. 63. Web 2.0<br />How can Ob/Gyn’s best engage with social media?<br />#2 Become a credible filter of information<br />
    64. 64. Web 2.0<br />How can Ob/Gyn’s best engage with social media?<br />#3 Integrate social media into your practice<br />
    65. 65. Web 2.0<br />Final Thoughts<br /><ul><li>How do Americans get healthcare information?
    66. 66. What is web 2.0?
    67. 67. How do social networks influence health outcomes?
    68. 68. How is social media being used to influence health choices?
    69. 69. How can Ob/Gyn’s best engage with social media?</li></li></ul><li>

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