"Leapfrogging: What Social Media Is Doing for Communicative Competence" was presented at the Center for Health Literacy Conference 2011: Plain Talk in Complex Times by Christina Zarcadoolas, PhD, Professor, CUNY School of Public Health at Hunter College. Description: This presenter will discuss how social media and mobile technologies are helping minorities leapfrog the digital divide and what implications this has for communicating health information and advancing public health literacy.

1. Leapfrogging: What Social Media Is Doing for Communicative Competence Plain Talk in Complex Times Christina Zarcadoolas, PhD CUNY SPH at Hunter College Sept. 23 2011

2. Falling Through the Net…the Coming Digital Divide - 1990’s On July 28, 1998, NTIA – report on telephone and computer penetration rates. Finds, there is still a significant "digital divide" based on race, income, and other demographic characteristics in computers in homes. http://www.ntia.doc.gov/ntiahome/net2 National Telecommunications and Information Administration

3. Who had computers at home?

4. Who was online?

5. Divide – dis-equity

6. What a difference a new century makes.

7. Narrowing Digital Divide National Center for Educational Statistics http://nces.ed.gov/

8. Household Broadband Use by Race/Ethnicity Dept of Commerce 2010 Report (Slide courtesy of Vish Viswanath)

9. Technology is ever more powerful It’s growing EXPONENTIALLY – iPhone 1,2,3…. Technology is crowd- sourced It gets cheaper - Hard drive was $3400 - now $100 ( 10 megabyte) It gets more personally “relevant” – we can “quantify ourselves” : Fit Bit ; deCodeMe It’s in the common discourse and media –People Talk About it - IBMs WATSON beats humans on Jeopardy

10. Technology growth Exponential - iPhone 1, 2, 3,4 20,000 different apps for the iPhone today You can pee on an S chip or check blood glucose via mobile device Yes – there’s an app for that. (See - TED talk - David Kraft, June 2011)

11. Web 2.0 Crowd Sourcing

12. Texting 75% of teens have cell phones(up 45%/2004) They send 50 - 100 text messages a day Nearly three quarters (73%) of online teens and an equal number (72%) of young adults use social network sites.

13. Youth Media Diet – 12 hours Source: 2009 Alloy College Explorer

14. Broad Band Use (2010) 69%of African Americans and 58 % of Hispanics now regularly use the Internet, compared with 79%of whites. Rate of broadband adoption in African American homes has risen to 59%from the 46 percent. (Joint Commission for Political and Economic Studies, 2/25/10 National Minority Broadband Adoption: Comparative Trends in Adoption, Acceptance and Use, Joint Center's website at (www.jointcenter.org)

15. African-Americans and Hispanics leading the charge in growth of mobile. 46 % of non-Hispanic blacks and 51% of English-speaking Hispanics use their phones for internet access, compared with 33% of non-Hispanic white Americans. (poll not in Spanish language) “This is my laptop” http://www.pewinternet.org/Reports/2010/Mobile-Access-2010.aspx http://techcrunch.com/2008/07/11/nielsen-iphone-in-fourth-place-among-smartphones-first-in-customer-satisfaction-not-for-long/

16. Minorities have equal or greater usage on most major social media platforms PEW Internet and American Life Project 2010 data

17. The communication technology revolution: rethinking health literacy Web 2.0 Informatics eHealth

18. eHealth An emerging concept known as "eHealth" seeks to capitalize on the promise of new media technologies to facilitate equal access to timely and credible health information.

19. Web 2.0 communication: key measures Internet penetration(~69-75% adults1, 2) Broadband adoption(~66%2) Mobile technologies (~82% 2) Social networking participation (23% of Internet users1) Health information seeking online (80% of Internet users2) Health-related Internet use3 1 Chou, WS et al. 2009. Social Media Use in the US: Implications for health communication, JMIR, 1(4): e48. 2 Pew Internet and American Life Project 3 Chou, WS et al. 2011. Health-related Internet Use among Cancer Survivors: Data from Health Information National Trends Survey, 2003-2008. J Cancer Survivorship.

20. College Grad/Post Grad No High School Degree Some College High School/GED Lower Use with Less Education Requested password N=14,102 College Grad/Post Grad High School/ GED No High School Degree Some College Logged on N=5671

21. Internet for health purposes Internet as 1st source of health information Emailing Providers Online Rx purchase Support group participation Chou, WS et al. 2011. Health-related Internet Use among Cancer Survivors: Data from Health Information National Trends Survey, 2003-2008. J Cancer Survivorship.

23. Facebook as 1st choice (94%) and YouTube second (32%).http://hcmg.nationalresearch.com/public/News.aspx?ID=9

24. Social media use among Internet users in 2008 (69% of US adult population)

25. 250 million > users on facebook worldwide

26. There’s an app for that! Users are driving the need for us to develop more usable ( readable/navigable/efficient/entertaining) health communication tools

27. What app?

28. Exercise, Nutrition, Smoking Cessation

29. Online blogging

30. Find my iPhone

31. Empowering Communities with Direct Access to Health Data: Patient use of Electronic Medical Records Christina Zarcadoolas, PhD, Wendy Vaughon, MPH With Sara J. Czaja, PhD, Maxine L. Rockoff, PhD, Joslyn Levy MPA NIH R21 1 R21 CA133487-01A2

33. Common Themes Across Groups (a) Consumers unanimously very interested in patient accessible EMRs although most didn’t have access to one. Physical access to technology not a primary barrier. Many participants accessed the internet wirelessly using mobile technology. “This is my laptop.” High interest in lab/test results, but reviewing results, posed unusually high reading and numeracy demands “If I could read it and understand it [I would use it] … I can’t understand it.”

34. Common Themes Across Groups (b) Want health education specific to their condition in their records Want ‘just-in-time’ links to sources that use understandable language. “Web MD … that thing is so hard … it doesn’t really break it down where the average person can understand … some of the translation is in doctor terms … the average person that’s looking at it gets lost.” 33

36. “It all boils down to the same thing … a lot of people don’t take charge of their health because they don’t … remember to take care of themselves and a lot of times they don’t even know at what age they should be checking for what things.”34

37. Categories of Barriers User Characteristics: Linguistic/reading Confidence Navigation Active reasoning - cognitive demands Patient Portal: Readability Strategic repetition Design Navigability

38. Portal Example - Symbols 36

39. Patient Portal - Numeracy

40. Categories of Opportunities Target audience likes and uses social media tools – Usable layouts Easy navigation tools Short, sound byte language Mouseovers – the define and explain content Wikis Google searches Voice overs Streaming video Etc.

41. Using social media – what is it teaching people? Immediacy Crowdsourcing Community Empowerment Leapfrogging over cumbersome vocabulary and syntax

42. Approach to Communication Use health literacy principles to develop content. Use human factors engineering and user-centered design. Use communication modalities and tools people are using in their daily lives. Strive for shared decision making & empowerment

43. A Paradigm Shift

44. Past 20 years we’ve focused on identifying what people CAN’T DO It’s time to focus on identifying what people CAN and ARE doing; To Achieve - Virtuous Honest Inclusive Health Literacy