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Online Conversations: From Understanding to Action and Success


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Article by Dana M Lewis illustrating the MDigitalLife Integrated Healthcare Approach developed exclusively for clients of the W2O Group. Article originally appeared in Healthcare Strategy Alert! Issue 1 2016, published by the Forum for Healthcare Strategists.

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Online Conversations: From Understanding to Action and Success

  1. 1. One of the biggest changes as a result of an Internet-enabled world is that healthcare professionals are no longer the sole sources of health information. Research from Pew suggests that 83 percent of people online who have chronic conditions will use the Internet to search for health information—and there is a lot out there. Keep in mind, though, that there is a “1-9-90” rule: 1 percent of people are creating content, 9 percent share and repackage content, and 90 percent primarily listen and learn. So how do you get your content into the hands of the 10 percent who will spread it to the other 90 percent? (See figure 1.) Health Information vs. Health Engagement Resources First, realize this: patients aren’t often merely seeking basic health education information. They’re usually looking to “level up” on their knowledge of self-management, especially for chronic conditions where they’re constantly Online ConversationsFrom Understanding (Through Analysis) to Action and Success Where do patients turn for information when they’re not in front of their healthcare providers? Online, of course. Knowing where and how people access and share information can be of tremendous benefit for healthcare marketing and communication executives looking to reach and engage audiences with legitimate and valuable content. experimenting with what works for them and their lifestyles. These ideas and this information—and any resulting action—may come from two very different places. The first area is how we traditionally think about online health information—often static information that is pushed out to a patient in a one-way format. It is often presented by a credentialed organization (or healthcare provider) and not frequently updated. As a result, it is often fairly generic. The other category is what we would consider online health engagement resources: those that promote the sharing of information and two-way conversations. These resources may be shared on a disease-specific site or forum, but they are also likely to be shared and discussed in more “mainstream” platforms, such as Twitter and Facebook. These resources aren’t always vetted for accuracy, so they must be taken with a grain of salt, but often patients after their initial diagnosis and adjustment will become savvy at finding the right place to seek information or discussion in a more interactive forum. The Reality of Connected Patients As a result, patients are increasingly connecting with each other online. As Susannah Fox, Chief Technology Officer for the U.S. Department of Health & Human Services, recently said, “Patients and caregivers know things—about themselves, about each other, about treatments—and they want to share what they know to help other people. Technology helps to surface and organize that knowledge to make it useful for as many people as possible.” Sometimes this is done through online patient communities—social networks or forums specific to a certain disease type. But these conversations also happen in the midst of other mainstream social media channels. So patients, like the rest of us, use hashtags to flag tweets and to connect with others directly during specific times for chats. Analyzing hashtags can help identify the 1 percent who create the most content in addition to the (Continued on page 6) BY Dana M. Lewis Director, MDigitalLife for W2O Group She can be reached at and @danamlewis. © This article originally appeared in Healthcare Strategy Alert!, Issue 1 2016, published by the Forum for Healthcare Strategists. All rights reserved.
  2. 2. 9 percent who are likely to share and repackage content to distribute to the rest of their communities. Deeper Data Diving Is Possible For marketing or communication professionals (or even clinical professionals), it’s important to understand the hashtags being used by these audiences. The first reason is the same reason we’d share with our colleagues when explaining how to engage in social media: you don’t walk into a crowded party and shout about yourself. Yet that seems to happen more often than not in the healthcare space: hashtags are added to tweets without a lot of consideration, or a campaign is marked as a success because of the “potential reach” of using the hashtag. The second reason is simple: how to know that a particular hashtag is the right one, let alone the most effective one, to use. It’s no longer necessary to rely solely on “potential reach” or other one-dimensional metrics (number of followers, number of tweets) to understand hashtags. Now there is a plethora of metrics to better understand hashtags and the dynamic engagement of online patient communities, and as a result, if and how to best engage and with whom. To illustrate this, a basic analysis was performed over a three-month period (June 1–Aug. 31, 2015) to compare engagement levels by stakeholder audience (patients, healthcare providers, and media) from the MDigitalLife Health Ecosystem database across a variety of diabetes-specific hashtags. The hashtags ranged from generic hashtags (#diabetes, #t1d, #type2diabetes) to hashtags that flag posts (#dblog, #WeAreNotWaiting, #doc), in addition to scheduled community hashtag chats (#DSMA, #DCDE, #ourD) and conference hashtags (#2015ADA, #ADA2015, #AADE15). During that period, there were 46,321 tweets using those hashtags from 3,387 individuals in the database. All Hashtags Are Not Created Equal Before reading this analysis, one might assume that it’s a good idea to add “#diabetes” to a diabetes-related tweet. It catches the eye, right? But depending on the intended audience, that may not be very effective for search purposes. There’s a high volume of usage around #diabetes, so the tweet won’t necessarily stand out. (And just because a tweet is tagged with a hashtag doesn’t ensure that it’ll be seen more than an untagged tweet.) More realistically, if patients are the intended audience, the numbers suggest joining a more targeted conversation where they are conversing in a lower-volume (but still effective) space. As figure 2 shows, members of the health ecosystem (patients and other individuals in the healthcare space who are not medical providers, accounting for 93 percent of the tweets analyzed) are congregating around hashtags like #doc (“diabetes online community”) and #dblog (for “diabetes blog”). Additionally, patients are frequently posting to #DSMA, the weekly (Wednesday) diabetes and social media chat, and even post with the hashtag when the chat is not live to share information with the community. Understanding Is No Longer Out of Reach Comparing the links and correlated web domains that patients, healthcare ◆ ◆ Reflects what people read, search, and discover online every day. What do they learn? Where are they? How can you connect? ◆ ◆ Important to listen, educate, share, and provide unique experiences The 1-9-90 Rule ◆ ◆ Top opinion leaders­—1% or fewer—who drive the ideas that fuel conversation share ◆ ◆ Important to focus content and relationships here 1% of People Create Content INFLUENCERS ◆ ◆ The people who carry the message and where top influencers source ideas ◆ ◆ Important to surround-sound with paid and earned media 9% Share and Repackage ADVOCATES 90% Listen and Learn ENTHUSIASTS (Continued from page 5) Patients, like the rest of us, use hashtags to flag tweets and to connect with others directly during specific times for chats. FIGURE 1 © This article originally appeared in Healthcare Strategy Alert!, Issue 1 2016, published by the Forum for Healthcare Strategists. All rights reserved.
  3. 3. Hashtag Usage Differs: Patients Are Having Different Conversations Than Media and Healthcare Providers providers, and members of the media are sharing reinforces the fact that these groups each use Twitter differently. Those who fall into the media category (journalists as well as healthcare professionals and patients who also write for healthcare publications) are more likely to share science and research-related information through domains such as,, and others. Contrast this with patients, who are instead more often sharing from Instagram and YouTube as well as diabetes-specific sites. While there are fewer healthcare professionals in this analysis overall, they are even more likely than patients to post links and choose to blend posts between diabetes-specific news and general resource information being shared by healthcare brands. Knowing this, the content strategy for reaching healthcare providers, members of the media, and patients should be different—one size will not fit all. In fact, trying to reach everyone with the same message will often miss the mark for all groups. Finding Your 10 Percent The analysis into link sharing (and hashtag usage) provides additional metrics for going beyond “potential reach.” In many cases, a hashtag looks like it has a high volume or a link or domain appears to have been shared many times. Yet a deeper dive shows that often a single individual handle is doing most of the posting, which looks more like spam than meaningful engagement. This helps paint a clearer picture about whether that piece of content is really so popular and whether that hashtag is really reaching the right audience. Similarly, these types of analyses can help assess who might be worthwhile partners for an organization to reach out to, whether through sharing relevant content or a more formal partnership. By analyzing individuals’ hashtag usage, it is clear who uses hashtags the most frequently, and it can be determined whether someone is a frequent poster to a single hashtag or multiple hashtags to further assess what their influence may be in those areas. The same approach can be used to track @mentions of other people and organizations, to better gauge conversationality and influence on varying topics, and to help determine if someone is in the 10 percent (the combination of content creators, sharers, and repackagers). Such analyses may reveal that influence is not purely determined by number of followers; identifying the impact a community participant has on his or her network (regardless of size) may be even more meaningful. By studying the content being shared across conversations and by different segments of the healthcare ecosystem, the channels (and hashtags) being used to distribute and flag content, and the deeper dynamics of conversationality among community members, healthcare marketing and communication executives will find that they are able to develop more effective strategies for reaching and engaging online audiences. 10% FIGURE 2 Note: This data set from the “health ecosystem” includes patients (93% of the group’s tweets) in addition to other individuals who work in healthcare and healthcare organizations, whether these are advocacy groups, medical and professional societies, or health systems. NumberofConversations #diabetes #2015ADA #AADE15 #DSMA #DCDE #WeAreNotWaiting #dblog #doc 25,000 20,000 15,000 10,000 5,000 0 Hashtags Used Healthcare Providers Health Ecosystem Media © This article originally appeared in Healthcare Strategy Alert!, Issue 1 2016, published by the Forum for Healthcare Strategists. All rights reserved.