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The Use of Informatics to Promote Community and Population Health

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The Use of Informatics to Promote Community and Population Health

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by: Samantha Lerch, Glenda Lopez, Paul McCarty, Jessica Novisk, Eydelf Pozo, Nella Olinick

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a. Core Public Health Functions
b. Community Health Risk Assessment: Tools for Acquiring Knowledge
c. Processing Knowledge and Information to Support Epidemiology and Monitoring Disease
Outbreaks
d. Applying Knowledge to Health Disaster Planning and Preparation
e. Informatics Tools to Support Communication and Dissemination
f. Using Feedback to Improve Responses and Promote Readiness

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Using health infomatics to connect with the community.

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Using health infomatics to connect with the community.

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Health Informatics is being used to connect us with our community. Health and disease trends are being tracked online and in real time. Heathcare resourses are being streamed on the internet from major health organization (CDC, WHO, CMS). These organizations are providing u with up to date tracking information and trends on diseases, and providing the community with knowledge of disease sign and symptoms, and treatments.

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How GE is using informatics to deliver safe and optimal care.
Infomratics within the community can also incorporate cutting edge technology that makes your life easier.

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Centricity Integrated Care Solution: Population Health

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Core  Public Health Functions. This graphic explains how public health is a researched based science. Public health requires careful coordination between researchers, government entities, healthcare practitioners, and the  general public. This process may require reevaluation or restructuring to ensure public health goals are met or health threats are subdued.The Public Health Nurse's role on this continuum is to function as a researcher, educator, or case manager.

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Core  Public Health Functions. This graphic explains how public health is a researched based science. Public health requires careful coordination between researchers, government entities, healthcare practitioners, and the  general public. This process may require reevaluation or restructuring to ensure public health goals are met or health threats are subdued.The Public Health Nurse's role on this continuum is to function as a researcher, educator, or case manager.

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Centers for Disease Control and Prevention. (2020). Resources Organized by Essential Services | EHS | CDC. Retrieved 31 May 2020, from https://www.cdc.gov/nceh/ehs/10-essential-services/resources.html

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Processing Knowledge and Information to Support Epidemiology and Monitoring Disease Outbreaks. Public Health Informatics facilitates the process of quickly disseminating and monitoring of disease outbreaks in the community. The key components of this informatic tool are evidenced based knowledge and the strategic use of frameworks.

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Processing Knowledge and Information to Support Epidemiology and Monitoring Disease Outbreaks. Public Health Informatics facilitates the process of quickly disseminating and monitoring of disease outbreaks in the community. The key components of this informatic tool are evidenced based knowledge and the strategic use of frameworks.

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Frameworks Institute. (2015). Making Public Health Informatics Visible: Communicating an Emerging Field [PDF] (pp. 3-8). Washington,D.C.: Frame Works Institute. Retrieved from https://www.frameworksinstitute.org/toolkits/informatics/elements/pdfs/informatics_phiistrategicmtgfinalseptember2015.pdf

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Processing Knowledge and Information to Support Epidemiology and Monitoring Disease Outbreaks cont..

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Processing Knowledge and Information to Support Epidemiology and Monitoring Disease Outbreaks cont..

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Center for Disease Control and Prevention. (2016). Introduction to Public Health Surveillance [Video]. Retrieved from https://youtu.be/kATQimRXcs4

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Centers for Disease Control and Prevention (CDC)

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Introduction to Public Health Surveillance

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Community Health Risk Assessments: Tools for Acquiring Knowledge     

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Community Health Risk Assessments: Tools for Acquiring Knowledge     

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https://journals.lww.com/jphmp/Citation/2017/07001/Knowing_Your_Community__Community_Health.3.aspx

Bender, Kaye PhD, RN, FAAN Knowing Your Community, Journal of Public Health Management and Practice: July/August 2017 - Volume 23 - Issue. Retrieved 27 May 2020 from https://journals.lww.com/jphmp/Citation/2017/07001/Knowing_Your_Community__Community_Health.3.aspx

McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundations of knowledge (pg. 345). Burlington, MA: Jones & Bartlett Learning.

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Determining the presence of risk factors within a community is a key part of Community Health Risk Assessments.

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Determining the presence of risk factors within a community is a key part of Community Health Risk Assessments.

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McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundations of knowledge (pg. 345). Burlington, MA: Jones & Bartlett Learning.

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Community Health Risk Assessments are used to evaluate Threat (a harmful act) and Risk (the expectation that a threat may succeed and what potential damage may occur). Once collected, this data can then be shared within informatics systems to evaluate the level of or potential for injury or death within a community. 

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Community Health Risk Assessments are used to evaluate Threat (a harmful act) and Risk (the expectation that a threat may succeed and what potential damage may occur). Once collected, this data can then be shared within informatics systems to evaluate the level of or potential for injury or death within a community. 

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https://www.epa.gov/risk/human-health-risk-assessment

Human Health Risk Assessment. (2016, October 3). Retrived 27 May 2020 from
https://www.epa.gov/risk/human-health-risk-assessment

McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundations of knowledge (pg. 346). Burlington, MA: Jones & Bartlett Learning.

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Suicide Prevention is an example of a Community Health Risk Assessment Tool that most of us are familiar with as Healthcare Workers.Suicide Prevention Community Health Assessment Tools are methods  that address general community health information, prevention networks and demographics of  the target population as well as community assets and risk factors.

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Suicide Prevention is an example of a Community Health Risk Assessment Tool that most of us are familiar with as Healthcare Workers.Suicide Prevention Community Health Assessment Tools are methods  that address general community health information, prevention networks and demographics of  the target population as well as community assets and risk factors.

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https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No1-Jan-2015/Suicide-Assessment-and-Nurses.html

Bolster, C., Holliday, C., Oneal, G., Shaw, M., (January 31, 2015) "Suicide Assessment and Nurses: What Does the Evidence Show?" OJIN: The Online Journal of Issues in Nursing Vol. 20, No. 1, Manuscript 2. Retrived 30 May 2020 from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No1-Jan-2015/Suicide-Assessment-and-Nurses.html

McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundations of knowledge (pg. 345). Burlington, MA: Jones & Bartlett Learning.

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Modern day society requires prompt sharing of public health risks with the world population as well as the healthcare workers tasked with caring for those effected...Community Health Risk Assessments help facilitate the sharing of this information.

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Modern day society requires prompt sharing of public health risks with the world population as well as the healthcare workers tasked with caring for those effected...Community Health Risk Assessments help facilitate the sharing of this information.

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http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-22-2017/No1-Jan-2017/Emerging-Global-Health-Issues.html

Edmonson, C., McCarthy, C., Trent-Adams, S., McCain, C., Marshall, J., (January 31, 2017) "Emerging Global Health Issues: A Nurse’s Role" OJIN: The Online Journal of Issues in Nursing Vol. 22, No. 1, Manuscript 2. Retrieved 31 May 2020 from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-22-2017/No1-Jan-2017/Emerging-Global-Health-Issues.html

McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundations of knowledge (pg. 345). Burlington, MA: Jones & Bartlett Learning.

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The overall goal of Community Health Risk Assessments is risk reduction and improved health.

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The overall goal of Community Health Risk Assessments is risk reduction and improved health.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927449/

Krist, A. H., Glasgow, R. E., Heurtin-Roberts, S., Sabo, R. T., Roby, D. H., Gorin, S. N., Balasubramanian, B. A., Estabrooks, P. A., Ory, M. G., Glenn, B. A., Phillips, S. M., Kessler, R., Johnson, S. B., Rohweder, C. L., Fernandez, M. E., & MOHR Study Group (2016). The impact of behavioral and mental health risk assessments on goal setting in primary care. Translational behavioral medicine, 6(2), 212–219. Retrieved 30 May 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927449/

McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundations of knowledge (pg. 347). Burlington, MA: Jones & Bartlett Learning.

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Applying Knowledge to Health Disaster Planning and Preparation

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Applying Knowledge to Health Disaster Planning and Preparation

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Being ready for an emergency as a nurse is extremely important. No one knows when, where, or what may happen in an emergency, but preparation is key for keeping the chaos organized. Medical emergencies can result from all sorts of scenarios: natural disasters, car accidents, mass-shootings, pandemics, etc. As a civilian, preparing for a health disaster can mean getting supplies, saving emergency hotline information, taking shelter, staying cautious, or simply (and probably the most important) receiving the necessary information about the health disaster.

As a medical professional, preparing for health disaster means that we need to understand the level of knowledge the public has. According to the model above, it shows a basic understanding of having more than enough or too little knowledge and its involvement in preparation.

"The premise stands that if a person has a high level of knowledge and involvement, then their attitude will be favorable and may motivate the person to take action," (Groves, 2013) which is important when attempting to spread a message through the public.

As a medical professional, understanding what the public knows about emergency preparedness will better assist in understanding of "how they will process message content providing  communications practitioners with future strategies addressing the effectiveness of outreach campaigns," (Groves, 2013)

Groves, Season, "Knowledge, Involvement and Emergency Preparedness" (2013).Graduate Theses and Dissertations. https://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=5880&context=etd

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Using feedback to improve response and Promote readiness

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Using feedback to improve response and Promote readiness

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Using feedback to improve response and promote readiness. 

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Using feedback to improve response and promote readiness. 

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On March 6, 2020, the President signed into law the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116-123). This act provides funding to prevent, prepare for, and respond to Coronavirus Disease 2019 (COVID-19).

To support governmental public health emergency response to COVID-19, the Centers for Disease Control and Prevention (CDC) has activated CDC-RFA-TP18-1802 Cooperative Agreement for Emergency Response: Public Health Crisis Response. CDC has awarded nearly $730 million in funding under Components A and B of the cooperative agreement to the 65 eligible jurisdictions that are on the approved but unfunded (ABU) list for CDC-RFA-TP18-1802 to provide resources to prevent, prepare for, and respond to COVID-19. This funding is intended for state, local, territorial, and tribal health departments to carry out surveillance, epidemiology, laboratory capacity, infection control, mitigation, communications, and other preparedness and response activities.

CDC has awarded this funding in two phases:

March 16: $569,822,380 was awarded to 65 jurisdictions. CDC awarded this critical funding in just 10 days, well within the 30-day window required by the supplemental appropriation.

April 6: $160 million was awarded to 34 jurisdictions. This includes 27 jurisdictions with high COVID-19 case counts or evidence of rapidly accelerating case counts and seven U.S. territories and freely associated states with unique COVID-19 response challenges.

In addition, CDC redirected agency funds to initially award $25 million on March 5 to 21 jurisdictions for COVID-19 response activities.

For more information on the COVID-19 supplemental funding and the activities supported by these resources, please see the COVID-19 Crisis Response Cooperative Agreement - Components A and B Supplemental Funding Interim Guidancepdf icon .

View the complete breakdown of all COVID-19 funding provided through Epidemiology and Laboratory Capacity (ELC), including the most recent Paycheck Protection Program and Health Care Enhancement Act (PPPHEA) supplement.pdf icon

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On March 6, 2020, the President signed into law the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (P.L. 116-123). This act provides funding to prevent, prepare for, and respond to Coronavirus Disease 2019 (COVID-19). To support governmental public health emergency response to COVID-19, the Centers for Disease Control and Prevention (CDC) has activated CDC-RFA-TP18-1802 Cooperative Agreement for Emergency Response: Public Health Crisis Response.

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Using feedback to improve response and promote readiness.

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Using feedback to improve response and promote readiness.

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The Centers for Disease Control and Prevention (CDC), with input from partners, has developed a checklist to help hospitals (acute care facilities) assess and improve their preparedness for responding to a community-wide outbreak of COVID-19.

https://www.cdc.gov/coronavirus/2019-ncov/downloads/HCW_Checklist_508.pdf

COVID-19Surge is a spreadsheet-based tool that hospital administrators and public health officials can use to estimate the surge in demand for hospital-based services during the COVID-19 pandemic.

A user of COVID-19Surge can produce estimates of the number of COVID-19 patients that need to be hospitalized, the number requiring ICU care, and the number requiring ventilator support.
The user can then compare those estimates with hospital capacity, using either existing capacity or estimates of expanded capacity

https://www.cdc.gov/coronavirus/2019-ncov/hcp/covidsurge.html

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Centers for Disease Control and Prevention

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Patient Impact and Hospital Capacity Pathway

This dashboard is automatically updated by 9:00 am ET each day and includes data for every facility that reported in NHSN for the most recent three days.

The displays shown in this dashboard present the data entered into the NHSN application by facilities participating in the COVID-19 Module, which constitute a subset, not necessarily representative, of all facilities in the United States. As a result, the displays presented in the dashboard may not necessarily represent the effects of the COVID-19 pandemic in all facilities in the country.

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national healthcare safety network (nhsn)

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COVID-19 Data Dashboard - Patient Impact & Hospital Capacity

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Patient Impact and Hospital Capacity Pathway This dashboard is automatically updated by 9:00 am ET each day and includes data for every facility that reported in NHSN for the most recent three days.

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The Following video was put out by Stanford University as a tool to globally disseminate public health information in regards to COVID 19. (JN)

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Social media networks to communicate with busy patients was recognized as an important public health tool more than a decade ago. The use has become more frequent over the years. By adding words like "benefit", "health" and "effective", blogs, chats and websites are easier for patients to locate. The use of socia media to acquire health information has been linked to healthier lifestyle choices and better coping skills. Health professionals use social media for things like disease surveillance, health education and outbreak management. Most teen and young adult patients use social media for health management and also for knowledge acquisition, managing mental health, and pharmacological information. There are many pro and cons to the use of social media in public health, read the article for more info. (JN)

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Abstract

Introduction

Research examining the effective uses of social media (SM) in public health and medicine, especially in the form of systematic reviews (SRs), has grown considerably in the past decade. To our knowledge, no comprehensive synthesis of this literature has been conducted to date.

Aims and methods

To conduct a systematic review of systematic reviews of the benefits and harms ("effects") of SM tools and platforms (such as Twitter and Facebook) in public health and medicine. To perform a synthesis of this literature and create a 'living systematic review'.

Results

Forty-two (42) high-quality SRs were examined. Overall, evidence of SM's effectiveness in public health and medicine was judged to be minimal. However, qualitative benefits for patients are seen in improved psychosocial support and psychological functioning. Health professionals benefited from better peer-to-peer communication and lifelong learning. Harms on all groups include the impact of SM on mental health, privacy, confidentiality and information reliability.

Introduction

The emergence of social media (SM) and social networking services to communicate in real-time and on-the-go by patients and health professionals was recognized as an important public health development more than a decade ago [ 1- 3].

In 2007, Kamel Boulos described social networking services (SNSs) as collaborative, mediated environments [ 4], where personal computers and mobile devices can be used to foster stronger connections, and new forms of information can be shared. Some examples of SM types are wikis (e.g., Wikipedia), social networking sites (e.g., Facebook, LinkedIn), media-sharing sites (e.g., YouTube, SlideShare), blogs and micro-blogs (e.g., Blogger, Twitter), immersive worlds (e.g., Second Life), and 3-D virtual globes (e.g., Google Earth) [ 4].

According to the Pew Research Centre, the popularity of SNSs is linked to the adoption of healthier lifestyles and coping skills for day-to-day health concerns [ 5]. Pew reports that patients enjoy helping each other and sharing their healthcare experiences [ 5]. Patients say that the Internet is a helpful way to find answers to health problems; in fact, the research shows that frequent use of social networks is associated with increased patient awareness and empowerment [ 6]. Health professionals have increased their social networking via Twitter, Facebook, blogs, vlogs (video blogs, e.g., on YouTube), infotainment, games and infographics [ 7].

Background

In a 2013 systematic review, Moorhead et al. identified seven key ways that SM are being used in healthcare:

1. To provide information on a range of issues;

2. To provide answers to medical questions;

3. To facilitate dialogue between patients and health professionals;

4. To collect data on patient experiences and opinions;

5. To use SM as a health intervention, for health promotion and health education;

6. To reduce illness stigma; and

7. To provide a mechanism for online consultations [ 8].

Social media research has improved considerably in the past decade. In fact, better empirical research is now conducted, and many higher quality studies are being published [ 8- 10]. The aim in this SR is to conduct a qualitative synthesis of systematic reviews of the effective uses of SM in public health and medicine, both for patients and health professional groups.

Methods

This paper is a systematic review and qualitative synthesis of papers published between 2003 to 2017. The authors perform a systematic review of SRs as the volume of primary papers would have made meaningful synthesis of that literature impossible. We selected the SR methodology as it provided a more complete view of the literature and varying interventions, populations and settings. In addition, different types of papers can be compared and contrasted [ 11].

In exploring the relationships between studies, this SR aims to answer two questions.

1. What are the most effective uses, benefits and harms of SM usage in health and medicine?

2. What tools are more effective (e.g., for information-sharing, communication, education, mobile and e-learning) as interventions in health programmes and services? In what ways are they beneficial or effective (or harmful), and for whom?

At the start, we registered our protocol at PROSPERO, the Prospective Register of Systematic Reviews [ 12]. Here, we follow the ENTREQ guidelines to enhance the transparency of our methods and to improve the reporting of the qualitative evidence [ 13].

Information sources: bibliographic databases and search engines

Comprehensive searches were performed in fifteen bibliographic databases and search engines from 1995 to 2017 (Table I ).

Reference harvesting and citation searches were conducted in Google Scholar and in the Web of Science. To locate recent papers, the authors also created current awareness alerts in databases such as MEDLINE, Embase, the Web of Science and Google Scholar. Key journals and prominent e-health journals were identified using the Web of Science and searched iteratively to increase sensitivity and to overcome any indexing deficiencies (Table II ). As the top impact factor journals in e-health were available online, manual searching was conducted by scanning online tables of contents and by using the journals' search engines.

Search terms - effective uses of social media in healthcare

The search strategies for MEDLINE and Embase were developed based on the strategies reported by Moorhead [ 8] and Hamm [ 9], and adapted accordingly. To achieve optimal sensitivity, we created strategies that combined keywords with controlled or index terms (Table III ).

Table III

A. "social media" or "social web" or "social software" or "social network*" or "web2" or "web 2.0" or "health 2.0" or "medicine 2.0" or "nursing 2.0" or "pharmacy 2.0" or "telemedicine 2.0";

B. blog* or Facebook or Flickr or Googl* or "instant messaging" or Instagram or Microblog* or Myspace or "online forum*" or PatientsLikeMe or Pinterest or podcast* or Second Life or SnapChat or Twitter or tweet* or Tumblr or "user generated content" or "video sharing" or "virtual world*" or webcast* or "web log" or WhatsApp or Wiki* or YouTube or Zotero;

C. Patient* or health consumer*;

D. "Health provider*" or "health professional*" or "physician*" or "doctor*" or "hospital*" or med* student* or pharm* student* or nurs* student*.

The following terms were added at various points in combination to refine and filter results:

Best practice*, benefit*, barrier*, risk*, compar*, concern*, cost*, cost-effect*, effectiv*, effectiveness, evaluat*;

Harm*, impact, improve*, limitation*, negativ*, positiv*, private, privacy, problem*, safety, trend*, trolling, use*;

Ehealth, e-health, e*learn*, healthcare, "health care", medicine, public health, telehealth, mhealth

Systematic review* or meta-analy* or systematic.

The full search strategy for Ovid MEDLINE is listed in Appendix A.

Data extraction and analysis

Our searches yielded 8521 papers from 15 bibliographic databases, search engines and manual searches (reference harvesting and citation searching). Our results were imported into RefWorks for title and abstract screening and results were loaded into MS Excel. The CASP (Critical Appraisal Skills Programme) tool for systematic reviews was used to assess the quality of papers [ 14]. We performed a thematic analysis using methods as described by Braun and Clarke [ 15].

Titles and abstracts of retrieved citations were independently coded and assessed by two reviewers (DG, SMA). Papers viewed as eligible were obtained in full-text and assessed further using pre-defined inclusion and exclusion criteria. Any disagreement between reviewers was resolved by a third (MNKB). Reasons for exclusion were recorded using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Our aim was to describe and synthesize papers but we did not attempt to determine effect sizes in the studies.

In Excel, we created columns and rows to describe the papers and their features, and piloted our spreadsheet for data extraction. Variables included the type of systematic searches performed, timeframe of searches, number of studies included, types of studies, SM tools and SNS platforms examined, study and population characteristics, focus on the interventions, outcomes measured and results, author conclusions, and broader themes and categories.

Results

In our searches, we identified a total of 8375 papers: 2051 in MEDLINE, 4075 in EMBASE, 1062 in CINAHL, 562 in PsycINFO, and a total of 625 from the remaining databases. Reference harvesting, search engine and manual searching added 146 papers for a total of 8521 papers ( Table VI).

Deduplication and screening reduced the number of papers to 232 which were assessed for eligibility using full-text. This reduced yield to 102 papers which were then critically appraised using CASP. Two reviewers independently provided scores out of 10 for each paper by indicating "yes" to each of ten items on the CASP checklist. We had strong inter-rater agreement of the 102 papers (an overall agreement of 92%). Discrepancies were adjudicated by a third reviewer. In the analysis, 42 papers scored high (9 out of 10) or a perfect 10 out of 10 score.

Study validity

A summary of the quality assessment of the 42 papers is contained in Appendix B.

Study populations

The study populations in the 42 papers dealt mostly with patients (n=30), health professionals or health students (n=8), or both patients and health professionals (n=4). Ages ranged from young adults averaging 18 years of age up to adults in their senior years. The maximum age in the three studies that examined the effects of SM on older (senior) people was up to 80 years of age.

Publication years of papers

In our inclusion set, 34 papers were published between 2014 and 2016. In 2014, there were 12 papers published, with 13 papers in 2015 and 9 papers in 2016. Six papers were published between 2010 and 2013, and two papers were published in an early period from 2004 to 2009. The authors observed a marked increase in the number of papers published starting in 2010. (Since our searches were conducted to December 2016, we have seen a sharp increase in the numbers of papers published in 2017 and 2018 - a major reason why we have made this a living systematic review but more about that later.)

Description of the included reviews

The summary of the 42 systematic reviews in this paper are listed in Appendix C. The papers were published from 2004 to 2016. All but two (Eysenbach et al., 2004; Griffiths et al., 2009) were published between 2010 and 2016. The papers reveal a range of quantitative, qualitative and mixed method designs. A wide variance in the search strategies show a low of one reported database in one study (Househ et al., 2014) to more than 11 reported in several papers (Eysenbach et al., 2004; Williams et al., 2014; Dyson et al., 2016). The number of included papers ranged from a low of 3 (Shaw et al., 2016) to a high of 170 (Sawesi et al., 2016). The average number of included papers was 36.571 in each of the 42 included SRs.

Breakdown of the # of SRs by country of the corresponding authors (n=42 papers)

The included papers were published in a range of journals in public health and medicine such as informatics, general medicine and medical education. Twenty papers (47%) were published in informatics journals; 12 of those (29%) were published by the Journal of Medical Internet Research. Ten papers (24%) were published in general medicine or medical education journals. The remaining papers appeared in specific biomedical journals where the focus of the systematic review seemed appropriate for the journal in question: infectious diseases (n=3), pharmacy (n=2), public health (n=2), and one paper each in journals specializing in nutrition, paediatrics, rehabilitation and microbiology and immunology.

Thematic analysis and categorization

The 42 papers in this review were analyzed using a method as described by Braun and Clarke [ 14]. The work of Thomas and Harden [ 57] helped to inform our thematic and narrative synthesis. Thematic analysis is a flexible means of identifying, analyzing, and reporting patterns within data [ 14]. Data analysis was completed by note-taking on first impressions of reading the papers. Each paper was then analyzed, and themes or categories were noted in relation to study participants, technologies or health conditions. Following the analysis of papers, a hierarchical content analysis was conducted. Themes from the reviews were coded and placed into categories. These were placed into higher order or smaller sub-themes.

According to Thomas and Harden (2008), thematic synthesis consists of three stages: coding of text 'line-by-line', development of 'descriptive themes' and a generation of 'analytical themes' [ 57]. While the development of descriptive themes is closely linked to the primary studies, the analytical themes represent a stage of interpretation where the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations and hypotheses.

Findings from the thematic analysis

The thematic analysis is presented as a conceptual map in Appendix D. The conceptual map reveals the multi-dimensional nature of SM, its most common uses and tools, potential benefits and challenges. All 42 papers were classified into 9 major themes or categories:

1. Population groups using SM

2. Technology and healthcare

3. Limitations (including harms) of SM

4. Disease types and prevention

While the nine themes provide insight into the 42 papers, and aid in our categorization, we developed 97 subthemes and categories for further classificatory detail.

Positive and negative effects of SM in health populations

Positive effects and benefits

SM have been used across a range of populations with both positive and negative effects. One paper in our inclusion set is Eysenbach et al.'s highly-cited paper from 2004, which examined 45 papers from the early period of SM use from 1995 to 2003 [ 42]. The authors found that the benefits of peer-to-peer (P2P) communities and electronic self-support were difficult to assess with most studies showing 'no effects'. Some authors acknowledged anecdotal evidence of electronic self-help groups but recommended better evaluation to determine the precise impact [ 8, 36, 54].

One large SR in our review synthesized 170 papers; a total of 112 randomized controlled trials, 7 case studies, 19 cohort studies, 15 cross-sectional analyses, and 17 quasi-experimental trials up to 2016 [ 31]. The authors found that 88.8% (151/170) showed some positive impact of SM on patient behaviours and health outcomes, and 82.9% reported major improvements in patient engagement by using SM platforms [ 31]. For example, Facebook provided a forum for reporting personal experiences, asking questions, and receiving direct feedback for people living with diabetes [ 31]. Text messaging enhanced successful engagement and HIV patients used Internet-based interventions to access information and manage health problems [ 31]. Some patients, in using tele-monitoring, video and game-based interventions, found it useful to communicate with healthcare providers via information technologies [ 31].

In two well-performed meta-analyses, published in 2014 and 2015 respectively, the use of SM by patients in different age groups was found to result in some self-reported and measurable changes in behaviour [ 21, 54]. Some social networking services (SNS) showed statistically-measurable effects in promoting healthy behaviours [ 21, 54]. In 2015, Laranjo et al. called for better research to be done in health behaviour change theory pointing out the phenomenon of social 'network alteration' where close ties and 'homophily' encourage health-behaviour-change diffusion in social networks [ 54]. Maher et al. reported that 90% of the papers they examined revealed significant improvements in health behaviour change. However, it was unclear whether SNS-based interventions were equally useful for all health behaviours longer term [ 21].

Facebook and Twitter were, from 2011 to 2016, the most preferred SM tools (n=15 papers), followed by blogs (n=4), YouTube (n=3), virtual worlds (n=3), and electronic bulletin boards (n=3). Facebook and Twitter were often chosen by users in meeting others and exchanging information about health concerns [ 8, 20, 35], and repeatedly used to access information and expertise [ 17, 24, 26, 35, 36]. There was little evidence statistically that they actually promoted health [ 35]. Adults aged 18 to 49 make up the largest group using Facebook and Twitter, and officials applied them to target demographic groups for projects in sexual health, health promotion, and in disease screening [ 21, 29, 30]. The affordances of Facebook and Twitter (i.e., openness or "publicness", high potential for or degree of sociality, ease of use) were well-suited to the social networking needs of most users [ 8].

Older (senior) patients were the main study populations in two papers from 2016 [ 45, 51]. From 2013 to 2016, older adults were mentioned as the study population in several papers [ 8, 30, 44, 45, 55]. To assist older patients in coping with social isolation, SM tools were shown to be effective for some seniors. In most cases, SM should be selected with the population in mind where the best platforms have been studied empirically and deployed accordingly [ 45]. Research on other types of ICTs (e.g., mobile phone-based instant messaging apps) should be conducted to promote understanding of ICT-based social-isolation interventions for older people [ 45].

In reviews from 2011 to 2016, various diseases and health concerns were seen as the focus of interventions for depression, HIV, diabetes, cancer, heart disease, fitness, weight management and sexual health across all age ranges [ 19, 20, 26, 30, 33, 34]. Repeatedly, papers revealed that patients and health consumers were using SM to engage in socially-supportive activity and conversations [ 20, 42]. Selected e-health online social networks, such as PatientsLikeMe and Daily Strength, were mentioned in four papers (8, 48, 52, 54), but their precise benefits and effectiveness were not clearly measured.

In public health, there was growing usage of SM to educate the public about avoiding infectious agents [ 19, 24, 49] and to monitor emerging health threats [ 27]. At least two reviews characterized SM as having benefits in public health and developing policy [ 8, 48].

Overall, the use of SM by health professionals was very positive with good levels of learner satisfaction [ 22, 40]. SM resulted in increases in learner satisfaction and positive experiences for students, especially in problem-based learning [ 46]. One review found positive effects from the adoption of educational technologies, and listed 8 roles that tools such as digital learning objects, interactive whiteboards, plasma screens and learning management systems play in developing skills [ 46]. More training in using educational technologies was also mentioned [ 16, 28, 40, 46].

Problematic or negative effects of SM

Some problematic or harmful effects of SM were seen. As social networks take larger roles in our personal and professional lives, problematic effects are increasingly likely to emerge. Some papers showed that SM has a role in increasing risky behaviours (displayed online which could be taken offline) as well as a diminished sense of well-being [ 8, 35, 45, 50, 52]. Balatasoukas et al. said that negative emotions expressed on SM are contagious, thereby networking the problematic behaviours [ 35]. The idea of contagion was why some health information shared in social networks seems to be of poor quality, a phenomenon that affects the reliability of information as it is shared 'virally'. In some cases, SM were responsible for spreading incorrect medical advice, false claims, misinformation and even fake news [ 8, 9, 30].

The barriers and limitations of SM, especially on Facebook and Twitter, may be related to 'context collapse', where personal and professional boundaries can overlap undesirably [ 59]. When SM were used in medical education, the benefits of private social networks and learning management systems were not fully measured [ 46]. One problem is the failure to identify whether Facebook or Twitter are more or less effective than private platforms (or as supplements in 'blended' models). Broad use of SM is inhibited by the tension between openness on the Web and upholding medical privacy and confidentiality norms. Some adverse events were seen but they occurred infrequently confirming for some that SM can be used safely by medical educators (notwithstanding their benefits are hard to prove) [ 11, 17, 36]. Twelve limitations of using SM in communication was drawn to help health professionals fully appreciate all the challenges [ 8].

A few studies published in 2014 and 2015 raised the concern about professional misconduct for health workers and distractions related to SM use [ 11, 17, 36]. These concerns inhibit the use of SM generally. More robust research is needed in medical education to understand how tools and platforms can be used in mobile learning especially at a distance. The effects of SM on medical education, recruitment, and professionalism should also be studied further [ 28, 37].

SM may lead to better social interactions for some, but recurring concerns were expressed about harms. For example, concerns about cyberbullying and its effects on the well-being of young adults were commonly expressed [ 36]. SM had positive effects on health provider-patient relationships, but some users express discomfort with communicating via social networks [ 52]. In one paper, extreme uses of SM resulted in trolling (deliberate provocation of others) and flaming (mocking or encouraging deliberate self-harm). In the study of detrimental effects of SM by young people, self-harm extended to increased suicidality [ 42]. The authors, however, pointed to a lack of evidence linking SM use and harmful behaviours, and reminded health providers to promote general Internet safety practices to avoid adverse events [ 42].

Limitations

Evidence is inconclusive

In this review, the evidence was revealed to be inconclusive with respect to benefits or harms. Not surprisingly, the quality of the primary research is weak. Further, the tools and platforms revealed only moderate positive and negative effects. From the evidence, little is known about the sustainability or long-term effects of these technologies. The speed at which SM tools, platforms, mobile devices and user practices change, for different populations, present difficulties for e-health researchers. Constant variation and change make it difficult to measure effects, what works and how, and this complicates any effort to compare findings in the research.

There were methodological flaws in the primary research cited in the papers we examined. For example, many papers did not pool their findings by study type or time period. Generally, there was confusion about SM terminologies, categories and definitions. Researchers using terms such as 'information and communication technologies', 'digital tools' and 'online learning platforms' are encouraged to define them and use them with more precision. Some papers did not understand the defining characteristics of SM technologies and platforms and confused them with interactive websites.

In a majority of papers (n=20), conflicting results and conclusions meant that the findings were not generalizable. Findings that examined SM use in resource-rich countries, such as the United States, United Kingdom and Australia, could not be compared to poorer countries; the reverse was also true. For example, some developing countries periodically block their citizens from using Facebook and Twitter making them unreliable platforms to use in public health. Further, SM must be examined in the ecological contexts of health promotion and evidence-based decision-making; some interventions thought to be portable from one socio-economic or cultural setting or context to another were clearly not. In many SRs, SM were used as a subset of other e-health interventions making it difficult to assess specific tools and platforms.

Reflections on the study methodology

There are inherent weaknesses in the methodology we used. For our own results, we had to rely on the critical appraisal of individual studies, as well as on the interpretation of results, in each paper we examined. Further, the SRs we examined differed considerably in their study populations, interventions, comparisons and outcomes, sometimes with contradictory findings and results. Some SRs did not do a good job of specifying inclusion criteria, and literature searches were not routinely performed to high standards. As a whole, the reviews were heterogeneous; thus sensitivity, subgroup, or meta-analyses could not be performed. Due to poor quality, it was difficult to extrapolate overall themes and conclusions from dissimilar studies with any confidence. Pooling older studies (n=2 from 2004 and 2009) with newer ones (n=40 from 2010 to 2016) presented difficulties in longitudinal cross-comparisons as settings and contexts changed.

Future research

Social technologies and the mobile devices used to access them (including device penetration, capabilities, user communities, digital skills of user groups) are rapidly changing. E-health researchers need more responsive approaches to evaluation that address these rapid changes. By the time an evaluation is published, the results may not apply to the current version of the tool under investigation (the latest version can often be different from the one being evaluated).

In 2015, Vandelanotte et al. said that most research examining the value of social networks has been disappointing [ 58]. To demonstrate the effective uses of SM in healthcare, more creative and experimental study designs will be required. Future research will have to account for the speed of change as many studies revealed that some SM tools were no longer available.

Repeatedly, we felt that the primary research was hampered by heterogeneity of interventions, and other methodological limitations. Moreover, there seems to be a need to conduct better studies, with appropriate controls, where the focus is on patients. An important emerging issue is the lack of evidence and understanding of the exponential costs of using SM. While many tools are free to use, their implementation in healthcare is not cost-neutral. Cost-effectiveness and return-on-investment studies are needed to demonstrate value in the long term. Demonstrated economic benefits could guide future practices in the field.

To inform future research, studies should adopt better and more consistent definitions of social media. Definitions should account for more recent tools (e.g., Instagram, SnapChat, WhatsApp, WeChat, etc.), and the emergence of fraudulent research, misinformation and fake news. SNSs such as WhatsApp and Facebook have been implicated in identity theft, spreading spam, and creating trust in false information and fake treatments [ 60, 61].

Our paper is already out of date. Many new SRs have been published recently. However, these papers will now be part of a living systematic review [ 62]. See our wiki http://hlwiki.slais.ubc.ca/index.php/Effective_uses_of_social_media_in_healthcare:_a_living_systematic_review_of_reviews where updates will be posted and papers that satisfy our inclusion criteria will be included with a brief thematic categorization.

Conclusions

SM have been widely-studied in health and medicine from 2003 to 2017 but evidence of their effectiveness is inconclusive. The positive, measurable effect of SM in the delivery of health services and programmes is lacking and the quality of papers is modest. However, our SR provides a starting point for future research and in identifying effective uses of social media. Future investigations of SM effects should focus on best practices, patient-oriented research, and the costs-benefit of using certain tools or platforms in varying healthcare settings.

Our paper suggests that SM research has entered a mobile-intensive period where patients and health professionals seek better ways to conduct their online activities and lifelong learning. Future research should identify not just how patients use SM in their daily lives but seek to understand their positive and negative effects. Researchers must examine the circumstances that lead to adoption of SM in specific ecologies and populations and undertake cost-effectiveness and return-on-investment studies. Better research designs in e-health are strongly needed given the increased prominence and potential value of SM in 21 st c. healthcare.

Appendix A. Sample Search Strategy (MEDLINE)

Database: MEDLINE via Ovid <1946 to Present file>

Search Title: Effective uses of social media in public health and medicine

Search dates: 25 June 2016, updated 5 December 2016

Results: 2051

Internet and social media related MeSH:
1. Blogging/
2. Computer-Assisted Instruction/
3. Computer Communication Networks/
4. Computers/td, ut
5. Electronic Mail/
6. exp Internet/
7. Mass Media/td, ut
8. Medical Informatics/
9. Online Systems/td, ut
10. Search Engine/
11. Social Media/
12. User-Computer Interface/

Internet and social medial related keywords:
13. blog*.mp.
14. Facebook*.mp.
15. (forum* adj3 (internet or web* or chat*)).mp.
16. Googl*.mp.
17. "Health 2.0".mp.or "Medicine 2.0".mp.
18. microblog*.mp.
19. myspace.mp.
20. (online or on-line).mp.
21. PatientsLikeMe.mp.
22. podcast*.mp.
23. Second Life.mp.
24. (social adj3 media*).mp.
25. (Social adj3 network*).mp.
26. (twitter or tweet*).mp.
27. user generated content.mp.
28. (virtual adj3 (world* or communit*)).mp.
29. ("Web 2.0" or "Web 2").mp.
30. web-based.mp.
31. WebMD.mp.
32. (website* or web site* or webpage* or web page*).mp.
33. wiki*.mp.
34. World Wide Web.mp.
35. YouTube.mp.

36. or/1-35 [Internet/social media MeSH and keywords]

Health care, patient care, self-care, information-sharing terms
37. exp Attitude to Health/
38. exp Health Education/
39. exp Health Promotion/
40. exp Health/
41. exp Self Care/
42. exp Self-Help Groups/
43. Communication/
44. "Delivery of Health Care"/
45. health behavior/
46. Health Communication/
47. Information Dissemination/
48. Information Seeking Behavior/
49. Information Services/
50. "Information Storage and Retrieval"/
51. Patient Care/
52. social support/
53. (health adj3 (behavio?r* or care or communicat* or educat* or promot* or service*)).mp.
54. (inform* adj3 (disseminat* or retriev* or seek* or service*)).mp.
55. (self adj3 (care or help or support*)).tw.

56. or/36-54 [MeSH words for health promotion/information seeking]

57. 36 and 55 [combination of social media + health information terms]

Search filters to identify effective uses, best practices and harms

58. Best practice*.mp.
59. benefit*.mp.
60. concern*.mp.
61. confidential*.mp.
62. cost*.mp. or cost-effect* or effective*
63. impact*.mp. or limitation**.mp. or negativ*.mp. or positive*.mp. or problem*.mp.
64. risk*.mp. or harm*.mp. or safety.mp.
65. troll*.mp. or trend*.mp.
66. or/ 58-65

SR Filter (to filter out non-systematic review research)

67. meta analysis.mp,pt.
68. systematic review.mp,pt.
69. search*.tw.
70. or/67-69 [HIRU SR filter to balance sensitivity and specificity]

Limits: publication years 2003-2016

Appendix B. Quality assessment of the 42 papers

Papers included in this review

Quality Assessment Indicators - CASP Tool for Systematic Reviews

I

II

Focused question

Right type of
papers

Relevant studies included

Quality
assessment

Combined results

Overall results

Precision of results

Applicable to local population

Important outcome considered

Benefits worth harm and cost

Balatsoukas et al, 2015

✓

✓

✓

-

✓

✓

✓

✓

✓

✓

9

9

Appendix C. Summary of the 42 systematic reviews

Study

Main aims

Type of study, methods, topic, population

Included papers & main findings

To examine use of SM by the elderly to promote independent living, social integration, to improve health, reduce cognitive decline, and prevent early death.

* Systematic review.
* Use of ambient and SNSs in social integration of the elderly / older adults.
* Elderly populations.

* 53 papers included.
* Controlled trial (24), non-controlled (5), case series, 2), controlled case series (4), other (18).
* There was an increase in participation of older adults in SNSs who can benefit from the use of ambient and social technologies. Different technologies have been suggested to socially integrate the elderly, but they can be expensive.
* SNSs are a way to promote socialization of elderly adults.

Jin et al, 2014 (Hong Kong) 46]

To examine the effects of educational technologies on student learning and staff engagement in problem-based learning.

* Systematic review.
* The use of educational tech in problem-based learning.
* Postsecondary students and tutors in medicine, dentistry, speech and hearing sciences.

* 28 papers included.
* The review demonstrates the generally positive effect of educational technologies in PBL. Positive outcomes for learning include providing rich, authentic problems and/or case contexts for learning; student development of medical expertise; making disciplinary thinking explicit; providing a platform to elicit articulation, collaboration, and reflection; reducing perceived cognitive load.
* Limitations included cumbersome scenarios, infrastructure requirements, and the need for staff and student support in light of the technological demands of new affordances.

The use and taxonomy of SM in cancer-related studies.

* Systematic review.
* The use of SM by cancer patients, and its impact on the digital divide and health literacy; cancer disparities.
* Cancer care communities

* 69 papers included.
* Use of SM in cancer from 1996 to 2007 focuses on discussion forums, message boards and support group websites. By 2008, researchers began to view the benefits of blogging during cancer treatment and survivorship. Intervention studies were not reported until 2010.
* Most research analyses the content of SM forums where users asynchronously post or respond, share resources, reliable cancer information or emotional support.
* Adults aged 18 to 49 make up large group using Facebook and Twitter which might be useful for cancer screening.

Appendix D. A thematic analysis of the 42 papers presented as a conceptual map

References

34. Willis EA, Szabo-Reed AN, Ptomey LT, Steger FL, Honas JJ, Washburn RA, Donnelly JE. Do weight management interventions delivered by online social networks effectively improve body weight, body composition, and chronic disease risk factors? A systematic review. J Telemed Telecare. 2016 Feb 15. pii: 1357633X16630846 [ PMC free article] [ PubMed]

41. Toma T, Athanasiou T, Harling L, Darzi A, Ashrafian H. Online social networking services in the management of patients with diabetes mellitus: systematic review and meta-analysis of randomised controlled [ PubMed]

47. Luo B. The effectiveness of social networking interventions for HIV prevention: a systematic review. HKU Theses Online (HKUTO). 2015 [ Google Scholar]

61. Viviani M, Pasi G. 2017. Credibility in social media: opinions, news, and health information-a survey. Wiley Interdiscip Rev Data Min Knowl Discov. 10.1002/widm.1209 [[ CrossRef] Google Scholar]

Articles from Online Journal of Public Health Informatics are provided here courtesy of JMIR Publications Inc.

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Effective uses of social media in public health and medicine: a systematic review of systematic reviews

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Research examining the effective uses of social media (SM) in public health and medicine, especially in the form of systematic reviews (SRs), has grown considerably in the past decade. To our knowledge, no comprehensive synthesis of this literature has ...

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Social media and healthcare has become a powerful combination. Benefits of the combo include raising awareness, combating misinformation, crisis communication, answering common questions, public health mentoring, citizen engagement and patient support. Dangers exist with the use of social media due to online compliance and regulation of reliable and unreliable sources as well as online security. (JN)

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Modern lives are going digital, and healthcare is no exception. Social networks have become an important health resource, and not just for millenials. Nearly 90 percent of older adults have used social media to seek and share health information.

It can be hard to know how to navigate the healthcare social media rules. Providers, agencies, and brands need to create informative, engaging social content. At the same time, you need to follow industry rules and regulations.

In this post, we look at the many benefits of using social media in healthcare. We also provide some tips on how to keep your social channels compliant and secure.

Bonus: Get the step-by-step social media strategy guide with pro tips on how to grow your social media presence.

Benefits of social media in healthcare

Raise awareness and counter misinformation

"Health care systems must provide trusted information on immunization, flu virus, therapy, ebola, you name it." So says Michael Yoder, the social media consultant for Spectrum Health. Social media is a key way to get that information to the public.

At the same time, in a world of "fake news," there's a lot of health misinformation on social networks.

Dr. Zubin Damania is better known on social as ZDoggMD. His fun social videos counter untrue and irresponsible health claims. He has built a community of more than a million followers on his Facebook page.

On Twitter, Dr. David Juurlink shares important information about the ongoing opioid crisis. He is also dedicated to taking down health non-science.

I have reviewed
the detox
you found on
the Internet

and which
you were probably
planning
for New Year's

Believe me
it is irrational
so unscientific
and so dumb

- David Juurlink (@DavidJuurlink) December 29, 2018

Crisis communication

More people now get their news from social media than from newspapers. That makes social a key place to share breaking information. It's a perfect platform for critical instructions during a health crisis.

Typhoon Mangkhut hit the Philippines in September 2018. As it approached, the World Health Organization turned to its social channels. The organization posted infographics about staying safe during and after the typhoon.

Here are things that you can do before Typhoon #RositaPH (international name: #Yutu) hits. Stay safe! pic.twitter.com/bFq5CwtAHh

- World Health Organization Philippines (@WHOPhilippines) October 29, 2018

The American Health Lawyers Association, the American Society for Healthcare Risk Management, and the Society for Healthcare Strategy and Market Development worked together to create a quick, free guide to crisis communications in healthcare. Here are some of their key points to help you prepare for a crisis in advance.

Identify key stakeholders, a primary contact, and a spokesperson

Know what to do in the first five minutes of a crisis

Build trust with your audience-including your internal audience

Want to make sure you're ready to use social media in a healthcare crisis situation? Check out our post on social media crisis management.

Public health monitoring

People post about everything online, including their health. Hashtags like #flu can reveal when diseases are popping up in new locations. Public health organizations can even get a sense of the severity of symptoms.

"Social media offers advantages over traditional data sources, including real-time data availability, ease of access, and reduced cost. Social media allows us to ask, and answer, questions we never thought possible." So wrote professors Michael Paul and Mark Dredze in their book, Social Monitoring for Public Health.

Official healthcare social media channels can also provide real-time health information.

For example, look at the Centers for Disease Control's tweets during flu season. They share updates on flu activity across the United States to encourage people to get a flu shot.

Latest #FluView report says #flu activity continues to increase nationally. With weeks of #fluseason yet to come, it's not too late to get a flu vaccine: https://t.co/d6sEAK1Aqs pic.twitter.com/zwzdA5uhhb

- CDC Flu (@CDCFlu) January 2, 2019

Citizen engagement

Healthcare issues can be tricky to talk about, even with doctors, especially for subjects seen as private or embarrassing. That can get in the way of effective healthcare.

For example, according to the American Sexual Health Association (ASHA), only 12 percent of young people said they had been tested for sexually transmitted diseases in the last year. But more than half of STDs affect those between the ages of 15 and 24.

ASHA wanted to encourage this age group to view STD testing as a normal part of taking care of their own health. So, they created a healthcare social media campaign. The main component was a social video. In it, comedian Whitney Cummings talking to college students about sexual health.

The video got more than 3.6 million views in 10 weeks. Facebook ads drove 77 percent of the 107,0000 visits to the campaign landing page. Those ads were responsible for 43 percent of clicks on the campaign's clinic locator. That shows viewers planned to take real action.

Patient support

Nearly 40 percent of young people (ages 14 to 22) have used online tools, to try to connect with other people who have similar health challenges. That includes social media groups.

That connection can have real benefits for patients. Researchers published in the journal Surgery created a Facebook group for 350 liver transplant patients, caregivers, and healthcare providers. A full 95 percent of survey respondents said that joining the group had been positive for their care.

Facebook groups are also a great place for healthcare professionals and patients to interact. Those interactions can include patient support and education. One study is evaluating if a Facebook group for coronary heart disease patients can increase participation in cardiac rehabilitation .

Of course, here are privacy concerns when discussing health online. this is a great use of Facebook secret groups, which do not show up in search results. Users have to be invited to join.

Research recruitment

Social networks offer an opportunity to connect with potential study and survey participants. Like brands, researchers need to understand social media demographics. It's also important to know how to use keywords, and how to target social media ads.

Connected & Open Research Ethics is a project of the University of California San Diego. The group help researchers establish guidelines for ethical research using new digital tools. Social networks are among those tools.

Reputation management

A recent survey found that nearly three-quarters of patients use online reviews as the first step when finding a new doctor.

The survey found that most patients tend to leave positive reviews. Sometimes, of course, a doctor or practice does receive a negative review. When that happens, 65 percent of respondents said it was important for the doctor to respond.

Marketing

Nearly two-thirds of U.S. healthcare marketers used social media to reach healthcare professionals in 2017. On the consumer side, 2017 marked the first time more than half of firms (56.8%) used social marketing.

In Germany, Merck Consumer Health used a Facebook ad campaign for its Femibion BabyPlanung product. The goal was to raise product awareness through product sampling. The campaign brought in 10,000 leads.

"Only 50% of women are consulting their gynecologist when making the decision to get pregnant. But they are searching for information on the internet and for experiences within social media." So said Beate Rosenthal, global brand director digital & media, Merck Consumer Health.

Social media tips for healthcare organizations

Educate and share valuable content

People need a reason to follow and engage with you online. Valuable content that educates and informs is a great reason.

For example, the Mayo Clinic creates regular social videos. The "Mayo Clinic Minutes" cover popular health and wellness subjects. Recent examples include skiing safety, allergies, and making healthier pancakes. The videos regularly rack up more than 10,000 views. This one, on the rise of e-cigarettes, has been watched more than 20,000 times.

The information needs to be credible, of course. And true. But you can get creative and entertaining if that makes sense for your brand. For example, here's another ZDoggMD video:

Make sure the tone you use is appropriate for your brand personality. The Mayo Clinic videos and the ZDoggMD videos are both engaging in their own way. But it would be very jarring if they exchanged styles.

Effective use of social media in healthcare requires a strong voice. Think your healthcare product or organization is too boring? Think again. For inspiration, check out our post on ways to promote a "boring" product on social media.

Listen for relevant conversations

You read earlier in this post that people say it's important for a doctor to respond to negative online reviews. That's a good reason to use social listening effectively. Otherwise, you may not know when people leave negative posts about you on social networks. And if you don't know about the negative posts, you can't respond.

Of course, social listening is about much more than addressing negative posts. It also allows you to track conversations relevant to your field.

Those conversations can help you understand how people feel about you. You can also learn how they feel about the competition. You might even identify new ideas that help guide your marketing communication strategy.

Here are some key terms to listen for on social channels:

Your organization or practice name and handles

Your product name(s), including common misspellings

Your competitors' brand names, product names, and handles

Industry buzzwords: The Healthcare Hashtag Project is a great place to start.

Your slogan and those of your competitors

Names of key people in your organization (your CEO, spokesperson, etc.)

Names of key people in your competitors' organizations

Campaign names or keywords

Your branded hashtags and those of your competitors

Here's how to get started:

Remain compliant

Healthcare social media accounts are subject to some pretty strict rules and regulations. HIPAA compliance is a big one, but you also need to make sure you follow FDA rules about advertising.

One of the best-known examples of social media and healthcare clashing in the eye of authorities involves Kim Kardashian. She endorsed the morning sickness drug Diclegis in an Instagram post. Her post contained a link to risk information and limitations of use. But, the FDA determined this information needed to be within the post itself.

After a stern FDA warning, she had to replace he post. Here's the updated version after the FDA warning:

#CorrectiveAd I guess you saw the attention my last #morningsickness post received. The FDA has told Duchesnay, Inc., that my last post about Diclegis (doxylamine succinate and pyridoxine HCl) was incomplete because it did not include any risk information or important limitations of use for Diclegis. A link to this information accompanied the post, but this didn't meet FDA requirements. So, I'm re-posting and sharing this important information about Diclegis. For US Residents Only. Diclegis is a prescription medicine used to treat nausea and vomiting of pregnancy in women who have not improved with change in diet or other non-medicine treatments. Limitation of Use: Diclegis has not been studied in women with hyperemesis gravidarum. Important Safety Information Do not take Diclegis if you are allergic to doxylamine succinate, other ethanolamine derivative antihistamines, pyridoxine hydrochloride or any of the ingredients in Diclegis. You should also not take Diclegis in combination with medicines called monoamine oxidase inhibitors (MAOIs), as these medicines can intensify and prolong the adverse CNS effects of Diclegis. The most common side effect of Diclegis is drowsiness. Do not drive, operate heavy machinery, or other activities that need your full attention unless your healthcare provider says that you may do so. Do not drink alcohol, or take other central nervous system depressants such as cough and cold medicines, certain pain medicines, and medicines that help you sleep while you take Diclegis. Severe drowsiness can happen or become worse causing falls or accidents. Tell your healthcare provider about all of your medical conditions, including if you are breastfeeding or plan to breastfeed. Diclegis can pass into your breast milk and may harm your baby. You should not breastfeed while using Diclegis. Additional safety information can be found at www.DiclegisImportantSafetyinfo.com or www.Diclegis.com. Duchesnay USA encourages you to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

A post shared by Kim Kardashian West (@kimkardashian) on

Of course, you don't want lawyers writing all your social media posts. But you might want lawyers (or other compliance experts) to review posts before they go live. This is especially true for major announcements or posts that are particularly sensitive,

Hootsuite can get more of your team involved without increasing compliance risk. People from across your organization can contribute social media content. Then, only those who understand the compliance rules can make a post live.

Your organization needs a social media strategy, a social media style guide, and social media guidelines. These can help make sure everyone understands the social strategy. They also make it clear how the strategy aligns with the relevant rules and regulations. Include clear, HIPAA-compliant guidelines for handling patient information in social posts.

Don't forget to keep an eye on the comments users leave on your social media posts and profiles, too. These can also create compliance concerns.

It's always good practice to respond to and engage with social comments. After all, no one likes talking into a void. Your followers will be more likely to engage with your content if they get a response from someone on your team.

When compliance is involved, you may need to take extra steps. For example, you should remove comments that raise privacy concerns. Also watch out for inappropriate claims.

Stay secure

It's important to put security guidelines in place for your social media channels. You need to be able to revoke access for anyone who leaves the organization.

With Hootsuite, you can manage permissions from one centralized dashboard. That means you can always control access to social channels.

Integrations can help further secure your healthcare social media channels. For instance, AETracker can help you find and report issues like product complaints and off-label usage. You'll find out as they happen, so you can take action right away.

Social Safeguard can help screen your social posts against your social media policies. This prevents non-compliant posts from going live.

The simple truth is that patients now use social media. They use it to look for information, find support, and make healthcare decisions. Combining social media and healthcare can be challenging, it's true.

But the use of social media in healthcare also presents incredible new opportunities. Social media is a great platform to share important health information. It's also a key place to gather real-time research and insights. Most important, social media is away to support patients.
Effectively communicate with the public, improve patient experience, and ensure compliance with health care industry regulations by managing your social media presence with Hootsuite. From one dashboard, you can create, schedule, and publish to all the major social networks.

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How to Use Social Media in Healthcare: A Guide for Health Professionals

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Modern lives are going digital, and healthcare is no exception. Social networks have become an important health resource, and not just for millenials. Nearly 90 percent of older adults have used social media to seek and share health information. It can be hard to know how to navigate the healthcare social media rules.

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