Health Promotion Practice                          of Social Media in Health Promotion...
433467                                                     HPPXXX10.1177/1524839911433467Neigeret al. / Measuring the Impa...
Process evaluation, or the measurement of factors                        misunderstandings of antibiotic use (Scanfeld, Sc...
Evaluation and Practice    Analysis of CDC’s Twitter presence across five pro-                    established the Dove Sel...
These four KPIs are defined in this article as follows.                     evaluation measures variables such as fidelity...
Evaluation and Practice                                                   Table 1             Key Performance Indicators a...
References                                                                                            Madden, M., & Zickuh...
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Healthcare Digital-Social Media Activites and KPIs


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KPIs and metrics that are used to evaluate the performance of the healthcare social media and digital marketing activities.

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Healthcare Digital-Social Media Activites and KPIs

  1. 1. Health Promotion Practice of Social Media in Health Promotion : Purposes, Key Performance Indicators, and Evaluation Metrics Brad L. Neiger, Rosemary Thackeray, Sarah A. Van Wagenen, Carl L. Hanson, Joshua H. West, Michael D. Barnes and Michael C. Fagen Health Promot Pract 2012 13: 159 DOI: 10.1177/1524839911433467 The online version of this article can be found at: Published by: On behalf of: Society for Public Health Education Additional services and information for Health Promotion Practice can be found at: Email Alerts: Subscriptions: Reprints: Permissions: >> Version of Record - Mar 1, 2012 What is This? Downloaded from by guest on December 21, 2012
  2. 2. 433467 HPPXXX10.1177/1524839911433467Neigeret al. / Measuring the Impact of Social MediaHealth Promotion Practice / Month XXXX Evaluation and Practice Use of Social Media in Health Promotion: Purposes, Key Performance Indicators, and Evaluation Metrics Brad L. Neiger, PhD, MCHES1 Rosemary Thackeray, PhD, MPH1 Sarah A. Van Wagenen, BS1 Carl L. Hanson, PhD, MCHES1 Joshua H. West, PhD, MPH1 Michael D. Barnes, PhD, MCHES1 Michael C. Fagen, PhD, MPH2 Despite the expanding use of social media, little has Zickuhr, 2011). Public health is also expanding its use of been published about its appropriate role in health social media as evidenced by the finding that 60% of promotion, and even less has been written about evalu- state health departments now use at least one application ation. The purpose of this article is threefold: (a) (Thackeray, VanWagenen, Koch Smith, Neiger, & Prier, outline purposes for social media in health promotion, 2011). In addition, one third of adults use social media to (b) identify potential key performance indicators asso- access health information, and nearly 80% of physicians ciated with these purposes, and (c) propose evaluation who consult with patients online use social media chan- metrics for social media related to the key performance nels to create or share medical content (Hughes, 2010). indicators. Process evaluation is presented in this article As use of social media develops within health pro- as an overarching evaluation strategy for social media. motion settings, it will become increasingly important to track key performance indicators (KPIs) and metrics, Keywords: Internet/electronic interventions; social both common measures in web analytics research. A marketing/health communication; technology metric is any single variable that gets measured (e.g., number of posts, tweets, fans, etc.), whereas a KPI is a unique form of a metric identified by an organization T he term social media refers to activities among as central to its assessment of social media and related people gathered online who share information benefits (Sterne, 2010). Although KPIs are often using conversational media that make it easy to expressed as specific measurements such as ratios or create and share content in the form of words, pictures, averages (e.g., the average number of comments to a videos, and audios (Safko & Brake, 2009). Categories of post) they can also represent broader or more general social media defined by Sterne (2010) include the fol- constructs (e.g., influence or engagement). lowing: forums and message boards, review and opin- ion sites, social networks, blogging and microblogging, 1 Brigham Young University, Provo, UT, USA bookmarking, and media sharing. 2 University of Illinois at Chicago, Chicago, IL, USA The use of social media is expanding rapidly. Sixty- five percent of adult Internet users now report using a social networking site such as MySpace, Facebook, or Associate Editors, Evaluation and Practice Department LinkedIn compared with 29% in 2008 (Madden & Michael Fagen, PhD, MPH, is a Clinical Assistant Professor, Community Health Sciences, in the School of Public Health at the University of Illinois, Chicago. Health Promotion Practice Brad L. Neiger, PhD, MCHES, is a Professor and Associate March 2012 Vol. 13, No. 2 159­ 164 – Dean in the College of Life Sciences at Brigham Young DOI: 10.1177/1524839911433467 University, Utah. © 2012 Society for Public Health Education 159 Downloaded from by guest on December 21, 2012
  3. 3. Process evaluation, or the measurement of factors misunderstandings of antibiotic use (Scanfeld, Scanfeld,that contribute to the success or failure of a program, & Larson, 2010). This information was used to developincluding tracking the number of products, services, or strategies to promote positive behavior change and shareparticipants (McKenzie, Neiger, & Thackeray, 2009), as accurate information about antibiotics. Similar content-well as KPIs and metrics, is recommended here as an related blogs that focused on specific audience segmentsoverarching evaluation strategy for social media. Since (e.g., breast cancer survivors) could be particularlysocial media is a communication or promotions tool insightful.and not a causal factor in behavior change or improvedhealth status, summative evaluation (i.e., impact or out-come evaluation) is not viewed as relevant. Conversely, >> Establish and Promote a Brand With Consumersattention to process evaluation will provide decisionmakers and other stakeholders with a data collection strat- Health promotion programs embedded withinegy to assess the implementation of social media with larger organizations often struggle to create a mean-various types of interventions or as a stand-alone tool. ingful brand (i.e., a distinguishing feature) for a pro- Despite the expanding use of social media, little has gram, product, or service and are adversely affectedbeen published about its appropriate use in health pro- by a lack of brand awareness or the degree to whichmotion. Even less has been written about evaluation. consumers are aware of the brand and have an under-Accordingly, the purpose of this article is threefold: (a) standing of what it represents (Farris, Bendle, Pfeifer,outline purposes for social media in health promotion, & Reibstein, 2010).(b) identify potential KPIs associated with these pur- Kelly (2011) suggests that use of social media toposes, and (c) propose evaluation metrics for social enhance brand awareness progresses through four stages:media related to the KPIs. exposure, influence, engagement, and action. An example Five broad purposes for use of social media in public of these stages to enhance brand awareness is drawn fromhealth/health promotion have been proposed: (a) com- “the 84” campaign from the Massachusetts Department ofmunicate with consumers for market insights (Centers Health. According to Silverman (2011), to promote thefor Disease Control and Prevention [CDC], 2010, Kruse, social norm that most adolescents do not smoke (84%)2010); (b) establish and promote a brand with consumers and to promote positive alternative behaviors, the cam-(Kruse, 2010); (c) disseminate critical information (CDC, paign has featured a website that reflects a youth-oriented2010); (d) expand reach to include broader, more diverse voice and user-generated applications such as forums,audiences (CDC, 2010); and (e) foster public engagement user profiles, and a special interest blog to promote “theand partnerships with consumers (CDC, 2010). 84” brand. Since 2007, more than 700,000 adolescents in Massachusetts have become involved through both online and off-line activities, including social networking via>> Communicate With MySpace and YouTube, and the movement has grown Consumers for Market Insights every year since its inception (Silverman, 2011). Social media can be used to gather both primary andsecondary data during the formative research processto ensure that programs, products, and services are >> Disseminate Critical Informationconsumer oriented. A primary data collection strategy With the ubiquity of digital devices and social mediamight involve a product/services review website, an applications, health promotion practitioners are recog-ongoing blog or a social networking group to elicit nizing social media’s capacity to reach large audiences,input or feedback from consumers. For example, a almost instantaneously, using cost-efficient methods.question could be posted on an organization’s Facebook Many health-related organizations maintain a Facebookwall requesting a response. A Facebook “group” could profile for the sole purpose of disseminating healthalso be created to acquire information from a segment information to friends and fans. For example, Bender,of the population that has experience with a particular Jimenez-Marroquin, and Jadad (2011) report that of thetopic. Discussions on these Facebook walls could also 620 identified breast cancer Facebook groups (totalingprovide insight. 1,090,397 individual members), 236 or 38% of the An example of secondary data could be a content groups existed for the purpose of raising awarenessanalysis of posts and comments on social media sites about breast cancer. The CDC (2011a) has used Twitterthat are not initiated by the organization. For instance, to share flu-related updates and information withresearchers analyzed Twitter posts to identify people’s 160,528 current followers.160 HEALTH PROMOTION PRACTICE / March 2012 Downloaded from by guest on December 21, 2012
  4. 4. Evaluation and Practice Analysis of CDC’s Twitter presence across five pro- established the Dove Self-Esteem Fund to develop pro-files (i.e., CDC eHealth, CDC Emergency, CDC Flu, grams that raise self-esteem among girls and youngCDCgov, and CDC Espanol) since 2008 revealed more women. To promote the fund, several YouTube videosthan 1,617 updates, 1,411,359 followers, and 48,125 were created, including Evolution, which has receivedclickthroughs (CDC, 2011b). After launching a Facebook more than 13.5 million views and nearly 7,000 com-profile in January 2009, the CDC site grew to 68,014 ments. Using YouTube as a promotional platform led tofriends by December 2010 (CDC, 2011b). In addition, high exposure and generated strong engagement fromCDC has maintained over 100 videos on YouTube viewers (Dove, 2004).resulting in almost 3.6 million views (CDC, 2011b). Duringthe 2008-2009 outbreak of salmonella-contaminatedpeanut butter and peanut products, the FDA developed a >> Public Engagement and Foster Partnerships With Consumersdatabase that allowed consumers to enter a productname or barcode to determine if the product had been Engagement in this context is defined as establishingrecalled. CDC then developed a widget that could be a connection with others to contribute to a commonposted on a website or blog that also gave access to the good. Social media can be used to build online partner-database, thus significantly increasing access to the tool ships and engage communities in support of causesand to vital information (Currie, 2009). and to respond to crises. Social media research indi- cates that engagement may be prompted when anchored in blogs and social networking sites and this is espe->> Reach to Include Expand cially true if participants are at least somewhat active Broader, More Diverse Audiences in off-line community participation (Smith, Schlozman, Although social media cannot eliminate health dis- Verba, & Brady, 2009). Merchant, Elmer, and Lurieparities, it can help provide a voice for disproportion- (2011) summarized how social media has engaged andately affected audiences and provide better access to even mobilized populations in emergency prepared-those in need of programs and services. Seventy-three ness/response efforts. They cite speak to tweet (voicepercent of online American teenagers now use social messages sent out as tweets) communication aboutnetworking websites compared with 55% in 2006 safety and health within days of the 2011 Egyptian(Lenhart, Purcell, Smith, & Zickuhr, 2010). In addition, uprising and use of crowd sourcing to link health careuse of digital communication is increasingly detached providers to those with supplies after the 2010 earth-from desktop computers, which is especially true for quake in Haiti.people of color (Smith, 2010). In fact, among Internet Social media can also be used to bring health profes-users, Blacks and English speaking Latinos use social sionals together to establish a foundation for publicmedia applications more often than Whites and minor- engagement. For example, the Substance Abuse andity Americans are also more likely to use social media Mental Health Services Administration (SAMHSA) hasto keep abreast of activity in their neighborhoods created Social Health Hub with the premise that peer(Smith, 2010). learning and sharing is fundamental to the long-term Ultimately, health promotion efforts to engage diverse success of public engagement (SAMHSA, 2011).audiences such as minority populations and adoles- SAMHSA maintains a depository of social media tools,cents may be most successful if they involve social including a directory of the principal hashtags used bymedia applications that interface easily with mobile its Twitter account as well as blog posts related to itsdevices. Individuals from these demographics are less public awareness and support strategic initiativeinclined to use applications such as blogging that (SAMHSA, 2011).involve sometimes-lengthy posts and responses. Rather,adolescents in particular are increasingly involved withmicroblogging through applications such as Facebook >> Performance Key Indicators and Metricsor Twitter. Moreover, the shift to microblogging andother processor-lite applications will likely increase The five purposes of social media in health promo-exposure to African Americans and Hispanics because tion highlighted in this article (market insights, estab-both groups are rapidly adopting the Internet, using lish a brand and create brand awareness, disseminatehandheld devices (Hughes, 2010). critical information, expand reach to more diverse In addition to microblogging, video sharing via audiences, and foster public engagement and partner-YouTube holds potential to reach adolescents. In 2004, ships) are all associated with one or more of the follow-Dove launched the Campaign for Real Beauty and ing KPIs: insights, exposure, reach, and engagement. Neiger et al. / Measuring the Impact of Social Media 161 Downloaded from by guest on December 21, 2012
  5. 5. These four KPIs are defined in this article as follows. evaluation measures variables such as fidelity, doseInsights pertain to consumer feedback from social delivered, recruitment, reach, and context. For exam-media applications that can be derived from practices ple, an organization could begin a process evaluation bysuch as sentiment analysis or data mining that use algo- first determining why it wants to use social media (i.e.,rithms to extract consumer attitudes and other perspec- purposes). This relates to fidelity, which tracks thetives on a particular topic from social media sites. implementation of social media to ensure both contentExposure measures the impressions or number of times and applications are designed and delivered appropri-the content on a social media application is viewed, ately and that they match the intended purposes.and reach is the number of people who have contact Next, KPIs would be selected. For example, if anwith the social media application. organization wanted to use social media to establish a Engagement is a measurement that links social brand and create awareness for cervical cancer screen-media to action and can range from low to medium to ing, it might decide that low, medium, and high engage-high. Low engagement assesses the degree to which ment would serve as KPIs. Low involvement wouldpeople are merely acknowledging an agreement or pref- relate to the extent to which women were acknowledg-erence for content. Medium engagement means people ing and agreeing with content, medium engagementare involved in creating and sharing content with the would relate to women actually creating and sharingcapacity to influence others. For example, content and trying to influence other women, and high(2011) scores use data from social networks to measure engagement would relate to the number of womenhow many people are influenced, how much users using social media applications who actually visit ainfluence others, and the influence of a personal net- health care provider for High engagement relates to actual participation As a final step, the organization would identify met-in off-line interventions either as a consumer or as a rics to measure KPIs (see Table 1). This would involveprogram partner, volunteer, or sponsor and results from elements of process evaluation, such as dose delivered,some exposure to a social media application. recruitment, and reach. These variables, respectively, With respect to social media, evaluation metrics are would relate to the extent to which social media appli-often application specific and give an initial indication cations are actually delivered, the manner in whichof social media’s ability to communicate with and women are invited to participate with the social mediaengage consumers (see Table 1). For example, to assess applications (and the extent to which all women in thethe activity level of blogs, metrics will likely relate to priority population have an opportunity to participate),the frequency of posts and comments. Likewise, met- and the percentage of women in the population whorics associated with a microblogging application such actually participate. Finally, context would be assessedas Twitter will generally relate to the frequency of by examining factors that both promote and inhibit usetweets and retweets, and so forth. Some social media of the social media applications.applications have associated analytic tools available atno charge, whereas other third-party programs areavailable at varying costs, depending on the sophistica- >> Conclusiontion of analysis required. For websites or blogs, web Health promotion organizations and practitionersanalytic software such as Google Analytics or Omniture must be able to match their program needs with reason-are used to collect data related to traffic sources includ- able expectations for what social media can deliver. Foring visitors, views, time on page, and so forth. This example, social media should not be viewed as a solu-software can be free or require a subscription. Social tion to the complexities of behavior change andnetworking sites have similar analytic software availa- improved health outcomes though there are certainlyble to all page users (e.g., Facebook Insights), which applications that can support the change process.provides data on number of fans, unsubscribed fans, Rather, use of social media in health promotion shouldfan interactions, and fan demographics. Twitter’s cor- be valued for its potential to engage with audiences forresponding analytic is called Twitter Analyzer. enhanced communication and improved capacity to As organizations track KPIs through various metrics, promote programs, products, and services. These out-process evaluation represents an approach that can comes are more likely to occur when a comprehensivebring added value to the assessment of social media’s process evaluation strategically tracks variables relatedusefulness in communication and promotional efforts. As to KPIs and metrics and then informs improvements indescribed by Saunders, Evans, and Joshi (2005), process the use of social media.162 HEALTH PROMOTION PRACTICE / March 2012 Downloaded from by guest on December 21, 2012
  6. 6. Evaluation and Practice Table 1 Key Performance Indicators and Metrics Related to Social Media Use in Health PromotionKey PerformanceIndicator Definition MetricInsights Consumer feedback from social Number and types of suggestions or recommendations media applicationsExposure The number of times content Visits  on a social media application Clickthroughs  is viewed Number of comments  Number of ratings Number of reviews on rating site Facebook impressions Views on a video Viewed blog posts (page views) Asset popularity (which content is viewed most often) Proportion of posts and videos viewedReach The number of people who Fans/page likes  have contact with the social Number of people participating in discussions  media application and the Unsubscribed fans  related content Number of followers or subscribers  Demographics of subscribers/fans/followers  Virality (growth rate of fans, followers, and friends)Engagement The number of people who Ratings (low)    acknowledge agreement or Likes on Facebook posts  preference for content Like rates Frequency of favorites Likes or dislikes on videosEngagement The number of people who par- Posts or tweets by users (medium) ticipate in creating, sharing, User-generated content (e.g., videos)  and using content and the Comments on posts  degree to which they influ- Comment rate  ence others Number of threads on discussion topics  Frequency of new discussions, new topics  Downloads  Uploads  Klout scores (see  Number of retweets Retweet rate Mentions The number of times a post, video, or link was sharedEngagement The number of people who Number of people who register for services/make an (high) engage in offline events appointment  (which may be in addition to Number of people who participate in off-line advocacy continued online activity) as a events as volunteers or sponsors  consumer or as a program Number of people who attend off-line events as parti- partner, volunteer, or sponsor cipants  Number of people assisted  Number of participants satisfied Neiger et al. / Measuring the Impact of Social Media 163 Downloaded from by guest on December 21, 2012
  7. 7. References Madden, M., & Zickuhr, K. (2011). Social networking sites report. Retrieved from http://pewinternet/org/Reports/2011/Social-Bender, J. L., Jimenez-Marroquin, M., & Jadad, A. R. (2011). Networking-Sites.aspxSeeking support on Facebook: A content analysis of breast cancergroups. Journal of Medical Internet Research, 13(1), e16. McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning,Centers for Disease Control and Prevention. (2010). The health implementing and evaluating health promotion programs: Acommunicator’s social media toolkit. Retrieved from http://www. primer (5th ed.). San Francisco, CA: Pearson Benjamin Cummings.c d c . g o v / h e a l t h c o m m u n i c a t i o n / To o l s Te m p l a t e s / S o c i a l Merchant, R. M., Elmer, S., & Lurie, N. (2011). Integrating socialMediaToolkit_BM.pdf media into emergency preparedness efforts. New England JournalCenters for Disease Control and Prevention. (2011a). CDC flu. of Medicine, 365, 289-291.Retrieved from!/CDCFlu Safko, L., & Brake, D. K. (2009). The social media bible: Tactics,Centers for Disease Control and Prevention. (2011b). CDC eHealth tools and strategies for business success. Hoboken, NJ: Johnmetrics dashboard. Retrieved from Wiley.Currie, D. (2009, October 13). Public health leaders using social Saunders, R. P., Evans, M. H., & Joshi, P. (2005). Developing amedia to convey emergencies: New tools a boon. The Nation’s process evaluation plan for assessing health promotion programHealth. Retrieved from http://thenationshealth.aphapublications. implementation: A how-to guide. Health Promotion Practice, 6,org/content/39/6/1.2.full 134-147.Dove. (2004). Campaign for real beauty. Retrieved from http:// Scanfeld, D., Scanfeld, V., & Larson, E. L. (2010). Dissemination health information through social networks: Twitter and antibiotics. American Journal of Infection Control, 38, 182-188.Farris, P. F., Bendle, N. T., Pfeifer, P. E., & Reibstein, D. J. (2010).Marketing metrics: The definitive guide to measuring marketing Silverman, J. (2011). Case study: Building an online youth tobaccoperformance (2nd ed.). Upper Saddle River, NJ: Pearson Education. control movement. Retrieved from, A. (2010). Using social media platforms to amplify pub- health-communications/cs-the-84.htmllic health messages: An examination of tenets and best practices Smith, A. (2010). Technology trends among people of color.for communicating with key audiences. Retrieved from http:// Retrieved from September/Technology-Trends-Among-People-of-Color.aspxSM_WhitePaper.pdf Smith, A., Schlozman, K., Verba, S., & Brady, H. (2009). TheKelly, N. (2011). Measuring social media for brand awareness. Internet and civic engagement. Retrieved from http://www.Retrieved from (2011). The Klout score. Retrieved from http://klout. Sterne, J. (2010). Social media metrics: How to measure and opti-com/corp/kscore mize your marketing investment. Hoboken, NJ: John Wiley.Kruse, K. (2010). Social media metrics and ROI: The definitive Substance Abuse and Mental Health Services for life science companies, hospitals and public health (2011). SAMHSA’s social health hub. Retrieved from http://www.organizations. Retrieved from Thackeray, R., VanWagenen, S., Koch Smith, A., Neiger, B., &Lenhart, A., Purcell, K., Smith, A., & Zickuhr, K. (2010). Social Prier, K. (2011, August). Adoption and use of social media amongmedia and mobile internet use among teens and young adults. state health departments. Paper presented at the NationalRetrieved from Conference on Health Communication, Marketing, and Media.Media-and-Young-Adults.aspx Atlanta, GA.164 HEALTH PROMOTION PRACTICE / March 2012 Downloaded from by guest on December 21, 2012