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THE IMPACT OF SOCIAL MEDIA 
  ON PUBLIC HEALTH RESEARCH 
         AND PRACTICE 
 a conversa*on with Gonzalo Bacigalupe  

Technology developments are moving us towards the predominance of cloud 
compu7ng,  collabora7ve  exchange,  and  social  networking  over  the  use  of 
technology  as  just  storage,  mul7tasking,  and  faster  ways  of  carrying  on 
business as usual. These developments s7mulate new ways of collec7ng data, 
developing messages, and sharing informa7on. No7ons of exper7se, control, 
hierarchy,  acquisi7on  of  knowledge,  locality,  iden7ty,  privacy,  etc.  are  all  in 
flux as social media is adopted by popula7ons worldwide. We explore some 
of these technologies and how they may reshape public health prac7ce. 


                               gonzalo.bacigalupe@umb.edu 
Personal Health Technology: Future? 




hIp://video.msn.com/video.aspx?vid=083e1117‐9f61‐40e1‐aea4‐b31e7baa8f13  
What is public health? 
•    
The effect of Web 2.0 on medical pracGce and educaGon: 

 Web 2.0 is a term describing new collabora7ve Internet 
 applica7ons. The primary difference from the original 
 World Wide Web is greater user par7cipa7on in 
 developing and managing content, which changes the 
 nature and value of the informa7on.  
 Key elements of Web 2.0 include: Really Simple 
 Syndica7on (RSS) to rapidly disseminate awareness of new 
 informa7on; blogs to describe new trends; wikis to share 
 knowledge; and podcasts to make informa7on available 
 quot;on the movequot;.  
 Increasing role in providing health informa7on quot;any 7me, 
 any placequot;. 
 McLean, R., Richards, B. H., & Wardman, J. I. (2007). The effect of Web 2.0 on the future 
 of medical prac7ce and educa7on: Darwikinian evolu7on or folksonomic revolu7on? 
 Medical Journal of Australia, 187(3), 174‐177. 
Web 2.0 Social soKware in health and health care educaGon 
Web 2.0 sociable technologies and social soeware: enablers in health and health 
care, for organiza7ons, clinicians, pa7ents and laypersons.  
They include social networking services, collabora7ve filtering, social 
bookmarking, folksonomies, social search engines, file sharing and tagging, 
mashups, instant messaging, and online mul7‐player games.  
The more popular Web 2.0 applica7ons in educa7on, namely wikis, blogs and 
podcasts, are but the 7p of the social soeware iceberg.  

Web 2.0 technologies represent a quite revolu7onary way of managing and 
repurposing/remixing online informa7on and knowledge repositories, including 
clinical and research informa7on, in comparison with the tradi7onal Web 1.0 
model. (…) tools presented in this review look very promising and poten7ally fit 
for purpose in many health care applica7ons and scenarios, careful thinking, 
tes7ng and evalua7on research are s7ll needed in order to establish 'best 
prac7ce models' for leveraging these emerging technologies to boost our 
teaching and learning produc7vity, foster stronger 'communi7es of prac7ce', and 
support con7nuing medical educa7on/professional development and pa7ent 
educa7on. 
 Kamel Boulos, M. N., & Wheeler, S. (2007). The emerging Web 2.0 social soeware: an 
 enabling suite of sociable technologies in health and health care educa7on. Health Info 
 Libr J, 24(1), 2‐23. 
E‐learning way of e‐learning 
A wide range of social soeware has become readily available to young 
people. There is increasing interest in possibili7es of using social 
soeware for undergraduate medical educa7on. 
To iden7fy the nature and extent of the use of social soeware by first 
year medical students. Structured self‐administered ques7onnaire 
survey.  
Over 90 percent used instant messaging and social networking sites 
were highly used (70 percent). No significant difference between males 
and females. Blogs were read by about a fieh of students and a small 
number (8%) wrote their own blogs. A fieh of males stated that they 
were users of media sharing and contributed to wikis. Social 
bookmarking was rarely used by either sex.  
Medical educators need to recognize the poten7al of social soeware in 
undergraduate medical educa7on but it is essen7al that students 
maintain the informality and privacy of these sites. The challenge for all 
medical educators is how to integrate social soeware into current 
curricula and ins7tu7onal Virtual Learning Environments. 
Sandars, J., Homer, M., Pell, G., & Croker, T. (2008). Web 2.0 and social soeware: the 
medical student way of e‐learning. Medical Teacher, 1‐5. 
Scaling the Skills Learning 
 Public Health Research  
Federal Government Social Media 
Federal health agencies relied 
heavily on social media to inform 
the public about the recent 
outbreak of salmonella tainted 
peanut buIer, possibly reducing 
the number of death and injuries 
caused by the illness, according to 
federal health officials.  
quot;The response has been really 
amazing,quot; said Janice Nall, 
director of the division of eHealth 
marke7ng at CDC, on the public's 
reac7on to her agency's social 
media campaign. quot;We look at 
social media as addi7onal 
channels to reach people where 
they are.”  
GAUTHAM NAGESH 02/09/2009  
hIp://www.nextgov.com/nextgov/
ng_20090209_7840.php  
PrevenGon  
Social markeGng / Social Media   

Users control communica7on in second genera7on of Internet‐based 
applica7ons, holding promise to significantly enhance promo7onal efforts 
within social marke7ng campaigns:  
  • directly engaging consumers in the crea7ve process by both producing and 
    distribu7ng informa7on through collabora7ve wri7ng, content sharing, 
    social networking, social bookmarking, and syndica7on.  
  • enhancing the power of viral marke7ng by increasing the speed at which 
    consumers share experiences and opinions with progressively larger 
    audiences.  
Because of the novelty and poten7al effec7veness of Web 2.0, social 
marketers may be en7ced to prematurely incorporate related applica7ons 
into promo7onal plans.  
But as strategic issues such as priority audience preferences, selec7on of 
appropriate applica7ons, tracking and evalua7on, and related costs are 
carefully considered, Web 2.0 will expand to allow health promo7on 
prac77oners more direct access to consumers with less dependency on 
tradi7onal communica7on channels. 
Thackeray, R., Neiger, B. L., Hanson, C. L., & McKenzie, J. F. (2008). Enhancing promo7onal 
strategies within social marke7ng programs: use of Web 2.0 social media. Health Promot 
Pract, 9(4), 338‐343. 
Social Marke7ng 
Knowledge intermedia7on:  
              source credibility not enough 
As a result of the social process of disintermedia7on enabled by digital media, tradi7onal 
intermediaries are replaced by apomediaries: tools and peers standing by to guide 
consumers to trustworthy informa7on, or adding credibility to informa7on.  

For apomedia7on to be an aIrac7ve and successful model for consumers, the recipient has 
to reach a certain degree of maturity and autonomy. Different degrees of autonomy may 
explain differences in informa7on seeking and credibility appraisal behaviors.  
In this environment, tools, influen7al peers and opinion leaders are the primary conveyors 
of trust and credibility. Apomediary credibility may become equally or more important than 
source credibility or even message credibility.  

Network analysis could be useful to study the dynamics of apomediary credibility in a 
networked digital world. There are prac7cal implica7ons of the apomedia7on model for 
developers of consumer health websites which aspire to come across as quot;credible”: 
Consumers need and want to be able to be co‐creators of content, not merely be an 
audience who is broadcasted to. Web2.0 technology enables such sites. Engaging and 
credible Web sites are about building community and communi7es are built upon personal 
and social needs. 
 Eysenbach, G. (2007). From intermedia7on to disintermedia7on and apomedia7on: new 
 models for consumers to access and assess the credibility of health informa7on in the age 
 of Web2.0. Studies in Health Technology and Informa*cs, 129(Pt 1), 162‐166. 
Social networking can shape services 
We report on a thread discussing the controversial 
decision to use hormone replacement therapy (HRT) 
following prophylac7c oophorectomy (PO). Two 
main groups of women posted: (1) Women who 
were BRCA+, had completed PO, and were deba7ng 
or adjus7ng their HRT op7ons in terms of op7mizing 
both quality and quan7ty of life. (2) Women who 
were BRCA+, were contempla7ng PO, but wanted to 
beIer understand the poten7al physical and 
psychological consequences of surgical menopause 
before deciding. Frustrated by physicians' lack of 
knowledge and contradictory media ar7cles about 
the long‐term consequences of HRT in BRCA+ 
women, they sought resources, emo7onal support 
and specific experien7al knowledge from each other 
and generated a unique sense of community and a 
high level of trust. 

Kenen, R. H., Shapiro, P. J., Friedman, S., & Coyne, J. C. (2007). Peer‐support in coping with medical uncertainty: discussion of oophorectomy 
and hormone replacement therapy on a web‐based message board. Psycho‐Oncology, 16(8), 763‐771. 
Web‐based self‐help interven7on: RCTs 
Four weeks Web‐based course: Among all par7cipants, the interven7on was effec7ve in reducing 
symptoms of depression and anxiety as well as in enhancing quality of life. A higher percentage of 
pa7ents in the interven7on group experienced a significant improvement in symptoms. The course was 
less effec7ve for work‐related stress, but par7cipants in the interven7on group recovered more oeen 
from burnout than those in the control group. Sta7s7cal and clinical significant effects on symptoms of 
depression and anxiety. These effects were even more pronounced among par7cipants with more 
severe baseline problems and for par7cipants who fully completed the course. Effects on work‐related 
stress and quality of life were less clear.  

CigareTe smoking is a major risk factor for many chronic and fatal illnesses. Stopping smoking directly 
reduces those risks. The primary outcome measure was prolonged abs7nence from smoking. 
Secondary outcomes were point‐prevalence abs7nence, number of cigareIes smoked, and incidence 
of quit aIempts reported at follow‐up assessments. Effec7ve web‐based programs can poten7ally help 
large numbers of smokers to quit, thus having a major public health impact. 



Kramer, J. J., Willemsen, M. C., Conijn, B., van Emst, A. J., Bruns7ng, S., & Riper, H. (2009). Effec7veness of a web‐
based self‐help smoking cessa7on interven7on: protocol of a randomised controlled trial. BMC Public Health, 9, 32. 

van Straten, A., Cuijpers, P., & Smits, N. (2008). Effec7veness of a web‐based self‐help interven7on for symptoms of 
depression, anxiety, and stress: randomized controlled trial. J Med Internet Res, 10(1), e7. 
Empowering health consumers   
Consumer health informa7cs has 
emerged as a strategy to inform and 
empower pa7ents for self management 
of their health. The emergence of and 
explosion in use of user‐generated online 
media (e.g., blogs) has created new 
opportuni7es to inform and educate 
people about healthy living. Under a 
preven7on research project, we are 
developing a website that u7lizes social 
content collabora7on mediums in 
conjunc7on with open‐source 
technologies to create a community‐
driven resource that provides users with 
tailored health informa7on. 


Khan, S. A., McFarlane, D. J., Li, J., Ancker, J. S., Hutchinson, C., Cohall, A., et al. (2007). 
Healthy Harlem: empowering health consumers through social networking, tailoring and 
web 2.0 technologies. AMIA Annu Symp Proc, 1007. 
Access to clinicians 
Challenges 
 Health Policy BoIom Up Approach  
Google Uses Searches may be able to detect 
regional outbreaks of the flu a week to 10 days 
     before they are reported by the CDC 
 www.google.org/flutrends 
Mashup Technology: not just for play 




hIp://irevolu7on.wordpress.com/2008/09/03/mapme‐applica7ons‐for‐humanitarian‐mapping  
Disaster Management 
If we are to make good on the UNISDR’s call for a 
shi[ towards people‐centered early warning, 
then flood early warning/response systems 
ought to empower local communi*es to get out 
of harm’s way and minimize loss of livelihood. 
This shi[ in discourse and opera*onal mandate 
is an important one in my opinion. Centralized, 
state‐centered, top‐down, external responses to 
crises are apparently increasingly ineffec*ve. 
    hIp://irevolu7on.wordpress.com/2008/09/07/mumbai  
Flood Warning, Mobile Phones and Dynamic 
     Mapping in India (September 7, 2008) 
•  Today, one in four Indians has a mobile phone. […] From the villager 
   siwng atop his half‐drowned hut calling for help in flood‐hit Bihar, 
   to the kabadiwallah who eagerly hands you his number, it’s mobile 
   networking like never before.“ 
•  […] the mobile phone’s ‘greatest impact [will] be on those people 
   with professions that are 7me, loca7on and informa7on sensi7ve. 
   […] fishermen wan7ng a weather update or the loca7on of the best 
   catch; hospitals contac7ng pa7ents without a permanent address; 
   SMSes on the Sensex.” 
•  “It is true that network coverage and mobile penetra7on are s7ll 
   limited to certain areas. But, interes7ngly, as a study by the Center 
   for Knowledge Socie7es (CKS) showed in Maharashtra, Up and 
   Karnataka, many new mobile users belong to poorer areas with 
   scarce infrastructure, high levels of illiteracy and low PC and 
   internet penetra7on.” 
    hIp://irevolu7on.wordpress.com/2008/09/07/mumbai  
Mobile Phones for Change 
Website Collabora7ve Mashups 
Humanitarian Crises: Kenya Example  
A changing work environment  

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