A Smoking Cessation Campaign on Twitter: Understanding the Use of Twitter and Identifying Major Players in a Health Campaign

The current study examined the use of online social media for a health campaign. Collecting tweets (N = 1,790) about the recent smoking cessation campaign by the Centers for Disease Control and Prevention, the current study investigated the dissemination of health campaign messages on Twitter and answered questions from the process evaluation of health campaigns: who tweeted about the campaign, who played central roles in disseminating health campaign messages, and how various features of Twitter were used for sharing of campaign messages. Results showed that individuals and nonprofit organizations posted frequently about the campaign: Individuals and nonprofit organizations posted about 40% and 30% of campaign-related tweets, respectively. Although the campaign under investigation was steered by a government agency, nonprofit organizations played a vital role as mediators who disseminated campaign messages. The culture of retweeting demonstrated its particular usefulness for the dissemination of campaign messages. Despite the expectation that the use of social media would expand opportunities for engagement, actual two-way interactions were few or minimal. Drawn from the results, practical suggestions on how to strategize the use of Twitter for future health campaigns are discussed.     

Systems approach to population health improvement

Managed care organizations (MCOs) are uniquely well positioned to implement population health initiatives. In an MCO setting, populations may be clearly defined. Health care may be provided via integrated clinical care delivery systems. Centralized services such as information systems, community relations, health promotion and disease prevention support, and marketing campaigns may aid in the achievement of population health improvement objectives. However, in order to sustain population health improvement efforts long-term, continued support and allocation of critical resources are needed. For this to occur, efforts need to be integrated with the personal, social, economic, regulatory, and business objectives of all key stakeholders involved in this process. Furthermore, the process needs to continuously generate deliverables in order to allow for ongoing feedback, evaluation, accountability, relationship building and maintaining, and continuous quality improvement to occur. Hence, specific strategies may be considered from a systems perspective. The present article describes a systems approach in which a population health cycle generates health improvement outcomes that are used to provide the rationale for continued allocation of resources.     

Primary sources of health information: comparisons in the domain of health attitudes, health cognitions, and health behaviors

The recent growth in consumer autonomy in health care accompanied by the surge in the use of new media for health information gathering has led to an increasing scholarly interest in understanding the consumer health information search construct. This article explores consumer health information seeking in the realm of the primary sources of health information used by consumers. Based on an analysis of the 1999 HealthStyles data, the paper demonstrates that active communication channels such as interpersonal communication, print readership, and Internet communication serve as primary health information sources for health-conscious, health-information oriented individuals with strong health beliefs, and commitment to healthy activities. On the other hand, passive consumption channels such as television and radio serve as primary health information resources for individuals who are not health-oriented. Media planning implications are drawn from the results, suggesting that broadcast outlets with an entertainment orientation are better suited for prevention campaigns. Such channels provide suitable sites for entertainment-education. On the other hand, print media, interpersonal networks, and the Internet are better suited for communicating about health issues to the health-active consumer segment.     

Selling health lifestyles: using social marketing to promote change and prevent disease

As part of its continuing mission to serve trustees and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) brought together grantmakers, researchers, and public health professionals on May 20, 2004 to discuss the application of social marketing principles to health promotion and chronic disease prevention. As a behavior change technique, social marketing has proven effective in motivating people to make the complex and difficult behavior changes that can improve health and reduce the risk of chronic diseases such as cardiovascular disease, cancer, and diabetes. The Issue Dialogue used the lens of tobacco prevention and cessation, physical activity, and healthy eating to examine how health grantmakers can use social marketing principles and techniques to encourage and support the adoption of healthier behaviors across the lifespan. This Issue Brief incorporates the information and ideas shared at the meeting with a background paper on social marketing that was prepared for participants who attended the Issue Dialogue. It starts with an introduction of social marketing concepts and provides a framework for assessing whether social marketing is an appropriate approach to use in addressing a particular issue. Subsequent sections: (1) describe both the social marketing communications process and techniques, using examples from campaigns developed by health grantmakers and others; (2) describe how social marketing can be used to promote policy change; (3) provide information on communication strategies that can complement social marketing; and (4) present opportunities for grantmakers.     

Advancing community health through community health partnerships

Improving a community's health is a key goal of health services organizations. Effectively pursuing that goal requires health services organizations to create partnerships with other organizations to help identify community health needs and to create and carry out programs that bring together community members and needed health services. Drawing on community systems concepts and a recent study of community health partnership efforts in three cities, this article provides a framework for such partnerships. Types of partnerships described include: Community action partnerships, in which the partnership forms to address a specific problem or pursue a specific opportunity. Community organization partnerships, in which a set of organizations in a similar service sector agree to collaborate for mutually agreed upon goals; and Community development partnerships, in which a partnership attempts to increase participation by people and organizations in collaborative activities that advance the community on multiple fronts or that contribute to community assets and services in multiple areas. The article also describes how the pressures to create large integrated delivery systems can affect creation of partnerships to improve community health. Increasingly, healthcare leaders are being held accountable for the health of communities they serve. When creating partnerships for community health and carrying out health-improvement activities, leaders should be aware of and respond to four key dimensions of accountability: political accountability, commercial accountability, clinical/patient accountability, and community accountability.     

Qualitative Methodologies and Community Participation in Examining Reproductive Experiences: The Harlem Birth Right Project

Objectives: Racial disparities in health present a challenge to public health because of the complexity of interacting social forces. The Harlem Birth Right Project sought to improve understanding of these forces by using qualitative and community participatory methods. In this paper we 1) describe the process of qualitative inquiry and community involvement, 2) evaluate the impact of community participation, and 3) present a brief summary of the findings on social context as it relates to pregnancy outcomes of women in Harlem. Methods: We operationalized the qualitative method by combining participant observation, longitudinal case studies, and focus groups. An ethnographic survey was used to verify and triangulate findings across methods of data collection. We involved the community in the design, implementation, and analysis by collaborating with community-based organizations, setting up a community advisory board, and the use of dialogue groups and community meetings. Results: The use of qualitative methods and community partnership uncovered important aspects of the social context of women's lives that may not have emerged through traditional epidemiologic research. We found that pregnancy may serve as a catalyst to increase perception of the magnitude of preexisting social stressors. Several stressors and chronic strains associated with structural forces were identified. For example, the high percentage of households headed by women is seen as one consequence of larger structural forces. While social support networks serve as an important coping mechanism to buffer against the stress caused by these structural forces, the types of support women seek differs by social strata, and some strategies were identified as being substantially more effective than others. Conclusions: Qualitative and community participatory research can be successfully conducted to support public health goals and can derive important new information on the social context of women's lives.     

A community-based approach to disseminate health information on the hazards of prenatal mercury exposure in Brooklyn, NY

Exposure to mercury (Hg) in utero can have neurotoxic effects on the developing fetus. Mercury exposure in women of childbearing age has been associated with frequent fish consumption, coastal proximity, foreign birth, and exposure during ritualistic practices. The aim of this study was to identify culturally-appropriate strategies to disseminate messages on the hazards of in utero Hg exposure in fertile and pregnant women in a predominantly urban immigrant community in Flatbush, Brooklyn, following findings from a recent study on mercury exposure in this community. Nineteen key informant interviews were conducted in Flatbush, Brooklyn with community members, medical professionals, fishmongers, and a religious practitioner to solicit feedback on culturally sensitive methods to educate the community on Hg hazards. The main themes identified include clinical integration, where providers integrate the message in routine care; community integration, whereby influential organizations and community members foster message delivery; media usage; and message reinforcement via continuous exposure. It is vital for healthcare providers and public health practitioners to be culturally sensitive in educating their patients on fish selection during pregnancy and safety of handling Hg. Instead of a single approach, a combination of media and educational strategies would help to reinforce the message. These findings form a basis for public health campaigns to apprise other urban immigrant communities of the hazards of in utero Hg exposure.     

Well-being revisited: improving the health of a population

Changes in society and the healthcare system are challenging healthcare executives to do more than provide medical services. Leaders now take broader responsibility for the health and well-being of the people and communities they serve. Health--the "state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (World Health Organization 1944)--is determined by four forces: environment, heredity, lifestyle, and medical care services. Health-care managers who want to improve the health of their served populations must improve these forces. Strategic and operational lessons can be learned from the pioneering work done by several hospitals, health plans, and healthcare systems to improve their local environment, heredity, lifestyles, and medical care services. Managers who wish to improve health in their communities should strongly embrace and commit to "health" rather than mere "medical services" in their mission, vision, and values. They should collaborate with many other organizations and people--such as schools, churches, police, and businesses--to build partnerships that extend beyond the healthcare sector into the total community. Healthcare organizations should provide some resources and funds to improve the health of their served populations, and they should view this commitment as an investment (especially if there are capitated lives) rather than as an expense. They should also obtain public and private grant funds and leverage the resources of their collaborative partners to improve their local environment, heredity, lifestyles, and medical care services. Finally, leaders can advocate and support public policy that would improve the four forces that shape health.     

The social nature of chronic noncommunicable diseases and how to tackle them through communication technology, training, and outreach

As world leaders prepare for the United Nations High Level Meeting on Noncommunicable Diseases, to take place in September 2011, international organizations, nongovernmental organizations, and economic and business fora have created new alliances and initiatives to accelerate research, advocacy, and political commitment. This article argues that the time is propitious to reflect on the social nature of the most common behavioral noncommunicable disease determinants, including tobacco and alcohol use, physical inactivity, and unhealthy diet. Evidence is presented related to the fact that these diseases are profoundly rooted in social and community ties and points to the need for a modern communication strategy to serve as a linchpin of any successful action to address these public health threats. Several proposals, aimed at promoting health literacy, strengthening health workforce skills, capturing the power of new media and technologies, and targeting vulnerable groups, are discussed.     

Interpersonal communication as an indirect pathway for the effect of antismoking media content on smoking cessation

In the context of health campaigns, interpersonal communication can serve at least 2 functions: (a) to stimulate change through social interaction and (b) in a secondary diffusion process, to further disseminate message content. In a 3-wave prospective study of 1,079 smokers, the authors demonstrate that mass media messages (antismoking campaigns and news coverage relevant to smoking cessation) have an indirect effect on smoking cessation intention and behavior via interpersonal communication. Exposure to campaigns and news coverage prompts discussion about the campaigns, and, in turn, about smoking cessation. Interpersonal communication regarding smoking cessation then influences intention to quit smoking and attempts to quit smoking. The study finds evidence not only for the social interaction function of interpersonal communication, but also for the secondary diffusion function. A substantial number of smokers who are not directly exposed to the antismoking campaigns are nevertheless indirectly exposed via communication with people who have seen these campaigns. These results imply that encouragement of interpersonal communication can be an important campaign objective.     

Are people more health conscious? A longitudinal study of one community.

Secular changes in cardiovascular health awareness, knowledge and behavior were observed in four biennial cross-sectional surveys and a cohort survey in a New England community. These changes are not related to more health promotion activities in the social milieu of respondents, but are more likely due to national mass media health campaigns, the effects of which may influence outcomes of community-based cardiovascular disease prevention studies.     

The impact of mass communication campaigns in the health field

This article analyzes a series of health education projects that used the mass media to change behavior. First, the article describes how persuasion theories are used to maximize impact in mass communication campaigns. Second, this paper discusses theories of social psychology used in such campaigns. One such theory, cognitive dissonance, explains changes at the level of attitudes, beliefs and opinion. Another theory, social learning, defines strategies of behavior changes. A third theory, concerning diffusion of innovations, helps understand the network of interpersonal relationships essential for the adoption of any innovation. McGuire's inoculation theory suggests strategies to aid resistance to harmful environmental influences (e.g. smoking, excessive drinking, etc.). Third, this work reviews public health campaigns that have used one or more of these theories of social psychology. The first project, dealing with smoking behavior cessation and prevention, mainly used strategies of interpersonal communication for inoculating and modeling useful behavior in order to resist social pressures favorable to smoking. The second project, designed to prevent alcoholism, used the mass media primarily. The objective of this campaign was to obtain changes in knowledge, attitude and behavior in the public through modeling desirable behaviors over public service announcements. The third campaign, a heart disease prevention program, used a combination of mass media and interpersonal communication to achieve changes in lifestyle of the population. Finally, this article describes limitations in using mass media in behavior change health programs.     

Strengthening the Merci Mon Héros Campaign Through Adaptive Management: Application of Social Listening Methodology

BackgroundBetween 2014 and 2018, the penetration of smartphones in sub-Saharan Africa increased from 10% to 30%, enabling increased access to the internet, Facebook, Twitter, Pinterest, and YouTube. These platforms engage users in multidirectional communication and provide public health programs with the tools to inform and engage diverse audiences on a range of public health issues, as well as monitor opinions and behaviors on health topics.ObjectiveThis paper details the process used by the U.S. Agency for International Development–funded Breakthrough RESEARCH to apply social media monitoring and social listening techniques in Burkina Faso, Côte d’Ivoire, Niger, and Togo for the adaptive management of the Merci Mon Héros campaign. We documented how these approaches were applied and how the lessons learned can be used to support future public health communication campaigns.MethodsThe process involved 6 steps: (1) ensure there is a sufficient volume of topic-specific web-based conversation in the target countries; (2) develop measures to monitor the campaign’s social media strategy; (3) identify search terms to assess campaign and related conversations; (4) quantitatively assess campaign audience demographics, campaign reach, and engagement through social media monitoring; (5) qualitatively assess audience attitudes, opinions, and behaviors and understand conversation context through social media listening; and (6) adapt campaign content and approach based on the analysis of social media data.ResultsWe analyzed posts across social media platforms from November 2019 to October 2020 based on identified key search terms related to family planning, reproductive health, menstruation, sexual activity, and gender. Based on the quantitative and qualitative assessments in steps 4 and 5, there were several adaptive shifts in the campaign’s content and approach, of which the following 3 shifts are highlighted. (1) Social media monitoring identified that the Facebook campaign fans were primarily male, which prompted the campaign to target calls to action to the male audience already following the campaign and shift marketing approaches to increase the proportion of female followers. (2) Shorter videos had a higher chance of being viewed in their entirety. In response to this, the campaign shortened video lengths and created screenshot teasers to promote videos. (3) The most negative sentiment related to the campaign videos was associated with beliefs against premarital sex. In response to this finding, the campaign included videos and Facebook Live sessions with religious leaders who promoted talking openly with young people to support intergenerational discussion about reproductive health.ConclusionsPrior to launching health campaigns, programs should test the most relevant social media platforms and their limitations. Inherent biases to internet and social media access are important challenges, and ethical considerations around data privacy must continue to guide the advances in this technology’s use for research. However, social listening and social media monitoring can be powerful monitoring and evaluation tools that can be used to aid the adaptive management of health campaigns that engage populations who have a digital presence.     

Low breastfeeding rates and public health in the United States

The medical community has orchestrated breastfeeding campaigns in response to low breastfeeding rates twice in US history. The first campaigns occurred in the early 20th century after reformers linked diarrhea, which caused the majority of infant deaths, to the use of cows' milk as an infant food. Today, given studies showing that numerous diseases and conditions can be prevented or limited in severity by prolonged breastfeeding, a practice shunned by most American mothers, the medical community is again inaugurating efforts to endorse breastfeeding as a preventive health measure. This article describes infant feeding practices and resulting public health campaigns in the early 20th and 21st centuries and finds lessons in the original campaigns for the promoters of breastfeeding today.     

Social marketing and communication in health promotion

Communication is a central aspect of health promotion and theopportunity for mass communication makes the ‘media’a popular option amongst health promoters. The media in thiscontext includes any non-personal channels of communication,from leaflets to television commercials to teaching packs. Thesechannels can be employed directly using deliberately designedmedia materials. Alternatively, they may be used indirectlyby stimulating editorial interest and comment on a particularissue. This paper will make some suggestions for improving theuse of the media in health promotion. In seeking guidance about how to make best use of the media,health promoters can turn to a number of disciplines, includingeducation, medicine, social psychology and communication theory.Another obvious source of insights is commercial marketing,where purposeful media communication, most apparent in the formof advertising, is in continuous use. it is this source of advicethat we want to examine here. In recent years much has been written about the applicationof commercial marketing approaches to social issues-so calledsocial marketing. This paper will begin by examining the originsof ‘social marketing’. it will then discuss itskey concepts and consider how these might help health promoterscommunicate more effectively. However, to interest active health promoters, the discussionneeds to progress beyond ideas and concepts, beyond theory anddemonstrate practical benefits that social marketing can providein real life situations. The paper will therefore continue byexamining the case histories of a number of media based healthpromotion campaigns and illustrate how the most basic of socialmarketing insights, consumer orientation, has contributed tothem.     

Women Connect! Strengthening communications to meet sexual and reproductive health challenges

Women's nongovernmental organizations (NGOs) have significant comparative advantage for addressing sexual and reproductive health challenges facing women and families. This article describes an initiative to assist women's NGOs in developing greater skills using media and information communication technology for communicating women's health messages. Participating women's groups in Africa undertook innovative media projects--radio broadcasts on human immunodeficiency virus (HIV) and family planning, an antiviolence campaign, media campaigns on avoiding teen pregnancy--and designed websites, established Internet cafés, and downloaded health information from the Internet. Lessons learned offer guidance for collaboration with women's NGOs everywhere to strengthen communication for addressing critical sexual and reproductive health issues.     

Acceptance of health information technology in health professionals: an application of the revised technology acceptance model

The response of health professionals to the use of health information technology (HIT) is an important research topic that can partly explain the success or failure of any HIT application. The present study applied a modified version of the revised technology acceptance model (TAM) to assess the relevant beliefs and acceptance of HIT systems in a sample of health professionals (n = 133). Structured anonymous questionnaires were used and a cross-sectional design was employed. The main outcome measure was the intention to use HIT systems. ANOVA was employed to examine differences in TAM-related variables between nurses and medical doctors, and no significant differences were found. Multiple linear regression analysis was used to assess the predictors of HIT usage intentions. The findings showed that perceived ease of use, but not usefulness, relevance and subjective norms directly predicted HIT usage intentions. The present findings suggest that a modification of the original TAM approach is needed to better understand health professionals' support and endorsement of HIT. Perceived ease of use, relevance of HIT to the medical and nursing professions, as well as social influences, should be tapped by information campaigns aiming to enhance support for HIT in healthcare settings.     

Relations between Internet use, socio-economic status (SES), social support and subjective health

This study aimed to explore relations between Internet use, socio-economic status (SES), social support and subjective health. Participants were from representative samples between 15 and 80 years of age from seven different European countries. Two different survey datasets were used: (i) eHealth trends (eHT; N = 7934) and (ii) the European social survey (ESS2; N = 11248). Internet users who had used the Internet for health purposes were compared with Internet users who had not used it for health purposes. Structural equation modelling was used to assess the relationships between SES, Internet use, social support and subjective health. Use of other media was compared to Internet use in relation to social support and subjective health. Internet use was found to be more closely related to social support and subjective health than use of other media. Internet use was also found to be a plausible mediator between SES and subjective health, especially through interacting with social support.     

Networks as a type of social entrepreneurship to advance population health

A detailed case study from the field of social entrepreneurship is used to illustrate the network approach, which does not require more resources but rather makes better use of existing resources. Leaders in public health can use networks to overcome some of the barriers that inhibit the widespread adoption of a population health approach to community health. Public health leaders who embrace social entrepreneurship may be better able to accomplish their missions by building their networks rather than just their organizations.