This article was downloaded by: [University of Illinois Chicago] On: 17 October 2014, At: 14:15 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Health Communication Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hhth20
Health Care and Social Media Platforms in Hospitals a
a
b
b
Michele L. McCarroll , Shannon D. Armbruster , Jae Eun Chung , Junghyun Kim , Alissa c
McKenzie & Vivian E. von Gruenigen
d
a
Department of Obstetrics and Gynecology, Summa Center for Women’s Health Research, Akron, Ohio b
School of Communications, Kent State University
c
Department of Marketing and Communications, Summa Health System, Akron, Ohio
d
Department of Obstetrics and Gynecology, Summa Health System, Akron, Ohio Published online: 02 Dec 2013.
To cite this article: Michele L. McCarroll, Shannon D. Armbruster, Jae Eun Chung, Junghyun Kim, Alissa McKenzie & Vivian E. von Gruenigen (2014) Health Care and Social Media Platforms in Hospitals, Health Communication, 29:9, 947-952, DOI: 10.1080/10410236.2013.813831 To link to this article: http://dx.doi.org/10.1080/10410236.2013.813831
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Health Communication, 29: 947–952, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1041-0236 print / 1532-7027 online DOI: 10.1080/10410236.2013.813831
RESEARCH IN BRIEF
Health Care and Social Media Platforms in Hospitals Michele L. McCarroll and Shannon D. Armbruster Downloaded by [University of Illinois Chicago] at 14:15 17 October 2014
Department of Obstetrics and Gynecology Summa Center for Women’s Health Research, Akron, Ohio
Jae Eun Chung and Junghyun Kim School of Communications Kent State University
Alissa McKenzie Department of Marketing and Communications Summa Health System, Akron, Ohio
Vivian E. von Gruenigen Department of Obstetrics and Gynecology Summa Health System, Akron, Ohio
The objective of this article is to illustrate user characteristics of a hospital’s social media structure using analytics and user surveys. A 1-year retrospective analysis was conducted along with an Internet survey of users of the hospital’s Facebook, Twitter, and blog. Of the survey respondents (n = 163), 95.7% are female and 4.3% are male; most are ages 50–59 years (31.5%) and 40–49 years (27.8%); and 93.2% are Caucasian. However, the hospital system database revealed 55% female and 37% minority population, respectively. Of the survey respondents, 61.4% reported having a bachelor’s degree or higher, whereas only 11.7% reported having a high school degree/equivalent or lower. However, within the hospital patient databases, 93% of patients have a high school degree/equivalent or lower and only 3% have a bachelor’s degree or higher in our women’s services population. Social media were used to seek personal health information 68.7% (n = 112), to learn about hospital programming 27.6% (n = 45), and to seek family health information 25.2% (n = 41). Respondents younger than 49 years of age were more likely to seek personal health information using social media compared to those 50 years of age and older (p = .02). Respondents with a bachelor’s degree or higher education were statistically less likely to search for physician information compared to those less educated individuals (p = .04). We conclude that social media may play an important role in personal health information, especially for young female respondents; however, the survey provides strong evidence that further research is needed to ensure that social network sites provided by hospitals are reaching the full spectrum of health system patients.
Correspondence should be addressed to Dr. Michele L. McCarroll, Summa Center for Women’s Health Research, Summa Health System, 525 East Market Street, Akron, OH 44304. E-mail: [email protected]
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Internet usage continues to expand, becoming an integral part of American society, with 85% of U.S. adults reporting usage in 2012 (Pew Research Center, 2013). Nearly half of all U.S. Internet users (ages 12 years and older) have a profile on one or more online social network sites (SNS) (e.g., Facebook, YouTub, Twitter, and blogs), and among these, 3 in 10 Internet users access SNS several times a day (Edison Research and Arbitron, 2011). In 2010, this translated to U.S. Internet users spending about a quarter of their Internet time on SNS (Nielsen, Inc., 2010). As the amount of time online increases, so does the information exchange with the public. The Health Information National Trends Survey (HINTS) survey from 2011/2012 revealed that 77.6% of American adults searched online for healthcare information for themselves and 55.9% looked for health or medical information for someone else (Redmond, Baer, Clark, Lipsitz, & Hicks, 2010). In 2011, 15% of SNS users, 7% of American adults, accessed health care information from their SNS (Fox, 2011). SNS are particularly suitable channels to reach and engage health consumers because of their “social” characteristics (Ellison, Steinfield, & Lampe, 2007; Subrahmanyam, Reich, Waechter, & Espinoza, 2008). They provide an easily accessible connection within and between patients and physicians (Thielst, 2011). These social interactions lead to quick and wide dissemination of information. Interpersonal interaction can also foster exchanges of social support, which can stimulate changes in health behaviors and attitudes. SNS (Chou, Prestin, Lyons, & Wen, 2013), are also expected to improve health care access, reduce health disparities, and lower cultural and linguistic barriers (Hawn, 2009; Krowchuk, Lane, & Twaddell, 2010). It has been shown that respondents who used health care providers as an information source had higher odds of meeting recommendations for health benefits (Redmond et al., 2010). Therefore, SNS can provide a gateway to connect patients with other patients as well as to providers, creating an information supplying support system that can ultimately improve patient health. During the last few years, SNS have been embraced by hospitals and health care organizations as a way to reach, engage, and educate patients (Weaver, 2011). In the United States alone, as of October 2011, approximately 1,229 hospitals use at least one online social media outlet (1068 Facebook pages, 814 Twitter accounts, 575 YouTube channels, 149 blogs, and 946 FourSquare and 556 LinkedIn accounts) (Bennett, 2011). Yet despite the popularity of SNS and integration of health care information by hospitals into these networks, a minority of patients access hospital SNS as an outlet for local health information, especially within an underserved population (Fox, 2011; Summa Health System, Akron Children’s Hospital, & Akron General Health System, 2010). Specifically, within the Summa Health System, SNS, including Summa Flourish, a women’s health blog, Twitter, and Facebook, were created to provide easy access to health information, provide support, and unite the health
community. In order to obtain these goals, it is imperative that our SNS are accessible to and utilized by all demographics the health system serves. The goal of this descriptive analysis is to assess, using the current Internet infrastructure, the characteristics of individuals utilizing the three SNS, follow the growth of the hospital-based SNS platforms, and examine the reasons individuals accessed hospital-based SNS platforms, in order to continue expansion to reach the hospital’s entire population.
MATERIALS AND METHODS This study, with a phased approach, was a retrospective analysis to assess SNS user patterns from January 1, 2011, to December 31, 2011, which was the first year the hospital engaged three types of SNS: Facebook, Twitter, and Summa Flourish (a women’s health blog). The Facebook page provides information about health promotions, allows communication between patients, and encourages healthy lifestyle choices through newsfeed postings and links. Twitter provides information about hospital programming and health issues, and provides encouragement to make health-conscious decisions. The third SNS, Summa Flourish, a women’s blog, posts approximately 10 blogs per month, providing information on a variety of women’s health topics including but not limited to preventative care, pregnancy, oncology, menopause, gynecologic issues, and women’s empowerment. The retrospective analysis of the three SNS was completed using the platforms of Twitter (HootSuite), Women’s Health blog (Sitemeter and Google Feedburner), and Facebook (Facebook® analytics), offered by the inner-city hospital system serving five counties with seven hospitals. An online survey was distributed to all Facebook likes (n = 2,923), Twitter followers (n = 1,324), and blog subscribers (n = 1,050), from September 1, 2011, to October 15, 2011, to obtain basic user information. All of these participants (n = 5,297) were invited to participate in the online survey (SurveyMonkey, Palo Alto, CA). SNS members were requested to complete the survey once, even if they received multiple survey requests (one from each SNS site). The survey took about 10 minutes to complete and was open from September 1, 2011, to October 15, 2011. Users were reminded every 2 weeks over the 6-week period to complete the survey. The health system demographics were captured using the Explorys (Cleveland, OH) database, which provides populations, providers, treatments, and outcomes in real time from participating hospitals. Institutional review board approval was obtained to conduct this study. Survey data were analyzed using the SPSS 17.0. Means with standard deviation (SD) or standard error (SE) are reported for all measures. For all statistical analyses, a p value less than .05 was considered statistically significant. Data from individuals who withdrew prior to survey
HOSPITALS AND SOCIAL MEDIA
completion or missing data were not included in the final analysis.
4000 3000 2000 1000 0
ok Fa Ja ce n' bo 11 ok D ec Tw '1 1 itt er Ja Tw n' 11 itt er D ec '1 B 1 lo g Ja n' 11 B lo g D ec '1 1
Likes, Followers, and Visitors
Our retrospective findings showed the inner-city hospital’s SNS grew steadily over the year (Figure 1), with Facebook having the largest number of users (n = 2,923 likes), then Twitter (n = 1,324 followers), followed by the blog (n = 1,050 visitors/month). Among the three platforms, Facebook received the most rapid growth and activity, with an increase of 675 to 2,923 likes in 1 year. For Twitter, the number of followers increased from 774 to 1,324. About two people join as new followers of the hospital’s Twitter handle every day. Over the year, the hospital posted 2,216 tweets and about 14% of them were retweeted by followers. The third most active SNS was the women’s health blog (Table 1). During the 12-month period, approximately
Fa ce bo
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RESULTS
SNS Platforms FIGURE 1 Hospital-based SNS growth. TABLE 1 Women’s Health Blog Analytics Over a 1-Year Period
Total visits Unique visitors‡ Page views Pages per visit Average visit duration Bounce rate† New visits
January 1, 2011
December 31, 2011
Percent Change
514 356 1,302 2.53 00:02:14 59.7% 60.1%
1,367 1,050 2,652 1.94 00:01:34 68.9% 67.0%
166% 195% 103% −23% −30% −9.2% 6.9%
‡ Unique visitors are measured by the computer IP address, a computer’s fingerprint, and are counted only once no matter how many times they visit the site. † Bounce rates are visitors who enter the blog and then leave rather than continuing to view other blog postings.
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10 blogs were posted every month, with visitors averaging at least one comment for each posting. Since the inception of the women’s health blog, the number of page views has doubled from 1,302 to 2,652, while monthly visitors have almost tripled from 356 to 1,050. The number of monthly visitors (n = 1,050) was much greater than that of people subscribing to e-mail notices on new postings (n = 467), indicating that the majority of visits resulted from sources other than e-mail subscription to the blog, such as through the hospital’s other social media outlets such as Facebook, Twitter, and search engines (e.g., Google, Bing, Yahoo, etc.). Unique visitors, defined by the user’s IP address, increased by 195% over 1 year to the women’s health blog. Bounce rates, defined as the percentage of visitors who enter the site and then left, rather than continuing viewing other pages of the blog, decreased (–9.2%) over the year, providing evidence of growing interest in the content provided by the blog. In total, n = 163 participants using the hospital’s SNS completed the online survey (Table 2), while n = 3 were removed for incomplete surveys. Our online survey results (Figure 2) showed the majority of respondents reported that they use the hospital’s SNS outlets to seek personal health information 68.7% (n = 112), followed by a desire to learn about the hospital’s programming 27.6% (n = 45), and lastly to seek family health information 25.2% (n = 41). Respondents who reported their age to be less than 49 years were statistically (p = .02) more likely to seek personal health information from the hospital’s SNS compared to those in age groups 50 years and older. Those participants who reported having a bachelor’s degree or higher were statistically (p = .04) less likely to search for physician information using the hospital’s SNS compared to those who reported to have less education. Using the Explorys database, we examined demographic differences between the patients that utilize the health system to respondents of the SNS survey (Table 3). These observations showed differences in gender, race, and reported educational levels. The SNS survey respondents compared to the inner-city hospital’s service demographics were 93.2% versus 73% Caucasian, 5% versus 8.4% African-American, 0.6% versus 5% Asian, and 1.2% versus 13.6% other, respectively. Additionally, most of the respondents were female (93%), which is compared to the health system population of 55%. A disproportionally high percentage of SNS users had a bachelor’s degree or higher (61.4%) compared to the hospital database, where 93% of patients have a high school degree/equivalent or lower and only 3% have a bachelor’s degree or higher.
COMMENTS This analysis sought to evaluate the SNS trends of an innercity hospital that uses Facebook, Twitter, and a women’s
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MCCARROLL ET AL. TABLE 2 Hospital SNS Survey Results
Questions
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1. Are you male or female?
Response Rates
Male: Female: 2. Which category below includes your age? 60: 3. What is the highest level of school you have completed or the highest High school or lower: degree you have received? Some college: Associate’s degree: Bachelor’s degree: Graduate degree: 4. What is your race? Caucasian: African-American: Asian: Other: 5. Are you a person of Hispanic, Latino, or Spanish origin? Non-Hispanic/Latino: Hispanic/Latino: 6. Are you . . . (click all that apply): A fan of Summa Health System on Facebook: Following Summa Health System on Twitter: Subscribed to the women’s health blog, Flourish: Other: To seek personal health information: 7. Why do you access the Health System’s social media outlets (e.g., Summa’s Facebook page, Twitter account, women’s health blog)? To seek family member health information: (click all that apply) To search for physician information: To look for hospital program information: To meet and communicate with different people: To have fun and stimulating conversation with others: To have a nice break from routine: To meet people who can understand me and listen to me: Other: 8. Where do you currently receive your health care? Within the health system: Outside the health system:
health blog to reach its constituents. The retrospective results showed growth over time of all three SNS platforms. These findings show the success of the hospital’s efforts to enhance the reach of the SNS in the health system community. Promotion of the SNS has been accomplished through physician, patient, and hospital system word of mouth and information about all SNS sites on each SNS platform. Of the survey respondents, 94% were female, which is considerably higher than the proportion of women represented within the general hospital population. This is a positive finding, considering that the primary focus of one third of our social media effort is directed toward improving women’s health through our blog, Summa Flourish. Our analysis also highlighted usage characteristics, identifying that the majority of respondents were interested in seeking personal health information, especially if the individual was younger than 49 years of age. Additionally, those less educated respondents were more likely to seek physician information through SNS. This information can be used to improve and expand the current SNS to include the
4.3% (n = 7) 95.7% (n = 156) 0.06% (n = 1) 6.8% (n = 11) 17.3% (n = 28) 27.8% (n = 45) 31.5% (n = 51) 16% (n = 26) 11.7% (n = 19) 16.3% (n = 25) 11.7% (n = 19) 31.3% (n = 51) 30.1% (n = 49) 73% (n = 152) 8.4% (n = 8) 0.60% (n = 1) 0.02% (n = 2) 99.4% (n = 162) 0.60% (n = 1) 33% (n = 54) 4.8% (n = 8) 77% (n = 122) 1.2% (n = 2) 73.2% (n = 115) 26.8% (n = 42) 11.5% (n = 18) 29.9% (n = 47) 1.9% (n = 3) 12.1% (n = 19) 24.8% (n = 39) 7% (n = 11) 9.6% (n = 21) 79.6% (n = 129) 21.4% (n = 34)
information the public is trying to obtain. We can enhance the disease-specific information available through SNS to target individuals of less than 49 years of age. Specifically, the health system can attempt to reach these individuals with age-specific information and health-related campaigns or conversations relative to their everyday survival (Southwell & Yzer, 2009). The targeted campaigns and conversations are underscored in Chou et al. (Chou, Hunt, Beckjord, Moser, & Hess, 2009), emphasizing the extent to which age determines who uses social media especially for health information. The overall response to the survey was 3.5%, compared to the average response rate of online surveys of 33% (Chou et al., 2009). It is important to note that an individual could have received the survey up to three times, if the person were a member of all three SNS sites. Despite the instructions to complete the survey only once, we were not able to account for duplication in the data set if the same person completed a survey more than once. Of those who did complete the
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FIGURE 2 Reasons for using hospital-based SNS platforms (% of respondents) (color figure available online). TABLE 3 Demographic Differences of Health System Patients Versus SNS Survey Responders
Race Caucasian African-American Asian Other Ethnicity Non-Hispanic/Latino Hispanic/Latino Gender Female Male Education High school or lower Some college but no degree Associate’s degree Bachelor’s degree Graduate degree Total
Patients Who Use Health System in 2011 (n = 680,770)
Hospital SNS Survey Respondents in 2011 (n = 163)
n
%
n
%
496,962 57,185 34,039 92,585
73.0 8.4 5.0 13.6
152 8 1 2
93.2 5.0 0.6 1.2
677,600 3,170
99.0 0.05
162 1
99.4 0.6
376,310 304,460
55.3 44.7
156 7
95.7 4.3
660,347 — — 20,423 —
93.0 — — 3.0 — 680,770
19 25 19 51 49
11.7 16.3 11.7 31.3 30.1 163
survey, their demographics and characteristics did not match those of our hospital system. Specifically, there were notable differences in race and education levels when comparing to the hospital population, thus identifying that the hospital needs to improve outreach to a more diverse population. Limitation of this descriptive analysis may contribute to the differences in the data between respondents and the health system, including race and education. The individuals
who chose to respond to the survey may have had different characteristics than those who did not, including educational level and socioeconomic class. Without being able to capture a larger number of the social media population, it is difficult to completely determine who is utilizing the SNS. It is also possible that the SNS are not reaching certain groups within the hospital population. The mostly (most) likely explanation is a combination of the two previous theories,
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failure of already captured individuals to respond to the survey and inability to reach all demographics of the hospital population. Another limitation of this analysis is the inability to obtain and confirm demographic and individual user information on present platforms without violating user privacy. Strengths of this study includes its originality to begin to fill a void in the literature regarding hospital-based SNS; a sample size large enough to detect within-groups differences between age and education preferences for SNS usage; and providing evidence that an inner-city hospital’s SNS continues to gain popularity in likes, followers, and subscribers within the primary demographic area it serves. Social media are utilized throughout the United States regardless of an individual’s gender, age, education, race, ethnicity, or health care access (U.S. Department of Labor, n.d.). A recent study published in the Journal of Medical Internet Research shows that social media can reach a population regardless of education, race/ethnicity, or health care access. Considering implications of health communication efforts, the results of this study suggest that in the future, social media can be useful in reaching the target population regardless of their socioeconomic and health-related characteristics. If we can enable broader and more equitable mobile access, thus reducing the digital divide, the potential for improving health and health behavior of in our healthcare population through social media is tremendous. Further research is needed to explore the relationship between social networking, changes in health behaviors, and health disparities. Our research reveals a possible disconnection between the respondents currently accessing the platforms and the population served by the health system. As our health system’s SNS continues to expand, we do know the importance of engaging with online, mobile, and connected patients about positive and educational health messages. Future studies should include hospital based SNS analysis to assess influences on patient health using SNS, more disparity in populations using SNS with available technology for chronic disease information, and longitudinal studies with SNS from hospitals on patient health outcomes over time.
CONFLICTS OF INTEREST None to report.
REFERENCES Bennett, E. (2011, April 5). Hospital social network list. Retrieved from http://ebennett.org/hsnl Chou, W. S., Hunt, Y. M., Beckjord, E. B., Moser, R. P., & Hess, B. W. (2009). Social media use in the United States: Implications for health communication. Journal of Medical Internet Research, 11, e48. Chou, W. Y. S., Prestin, A., Lyons, C., & Wen, K. Y. (2013). Web 2.0 for health promotion: Reviewing the current evidence. American Journal of Public Health, 103, e9–e18. Edison Research and Arbitron. (2011, April 5). The infinite dial 2011: Navigating digital platforms. Retrieved from http://www.edisonresearch. com/home/archives/2011/04/the_infinite_dial_2011.php Ellison, N. B., Steinfield, C., & Lampe, C. (2007). The benefits of Facebook “friends”: Social capital and college students’ use of online social network sites. Journal of Computer-Mediated Communication, 12, 1143–1168. Fox, S. (2013, April 23). The social life of health information, 2011. Retrieved from http://www.pewinternet.org/Commentary/2011/ November/Pew-Internet-Health.aspx Hawn, C. (2009). Take two aspirin and tweet me in the morning: How Twitter, Facebook, and other social media are reshaping health care. Health Affairs, 28, 361–368. Krowchuk, H. V., Lane, S. H., & Twaddell, J. W. (2010). Should social media be used to communicate with patients?. MCN: The American Journal of Maternal/Child Nursing, 35, 6–7. Nielsen, Inc. (2010, August 2). What Americans do online: Social media and games dominate activity. Retrieved from http://www.nielsen.com/us/ en/newswire/2010/what-americans-do-online-social-media-and-gamesdominate-activity.html Pew Research Center. (2013). Trend data (Adults) (2013, April17-May 19). Demographics of Internet users. Retrieved from http://www.pewinternet. org/Static-Pages/Trend-Data-%28Adults%29/Whos-Online.aspx Redmond, N., Baer, H. J., Clark, C. R., Lipsitz, S., & Hicks, L. S. (2010). Sources of health information related to preventive health behaviors in a national study. American Journal of Preventive Medicine, 38, 620–627. Southwell, B. G., & Yzer, M. C. (2009). When (and why) interpersonal talk matters for campaigns. Communication Theory, 19, 1–8. Subrahmanyam, K., Reich, S. M., Waechter, N., & Espinoza, G. (2008). Online and offline social networks: Use of social networking sites by emerging adults. Journal of Applied Developmental Psychology, 29, 420–433. Summa Health System, Akron Children’s Hospital, & Akron General Health System. (2010). Community health needs assessment results. Retrieved from http://www.thesummafoundation.org/media/55/17824. pdf Thielst, C. B. (2011). Using social media to engage patients: Many tools exist to connect, communicate and build loyalty. Healthcare Executive, 26, 66–68. U.S. Department of Labor. (n.d.). Fact sheet—General facts on women and job based health. Retrieved from http://www.dol.gov/ebsa/newsroom/ fshlth5.html Weaver, B. (2011). Ubicare white paper: Healthcare & Facebook® in 2011—Are your fans customers and your customers fans? Jamaica Plain, MA: UbiCare/TPR Media LLC.
Health Communication Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/hhth20
Health Care and Social Media Platforms in Hospitals a
a
b
b
Michele L. McCarroll , Shannon D. Armbruster , Jae Eun Chung , Junghyun Kim , Alissa c
McKenzie & Vivian E. von Gruenigen
d
a
Department of Obstetrics and Gynecology, Summa Center for Women’s Health Research, Akron, Ohio b
School of Communications, Kent State University
c
Department of Marketing and Communications, Summa Health System, Akron, Ohio
d
Department of Obstetrics and Gynecology, Summa Health System, Akron, Ohio Published online: 02 Dec 2013.
To cite this article: Michele L. McCarroll, Shannon D. Armbruster, Jae Eun Chung, Junghyun Kim, Alissa McKenzie & Vivian E. von Gruenigen (2014) Health Care and Social Media Platforms in Hospitals, Health Communication, 29:9, 947-952, DOI: 10.1080/10410236.2013.813831 To link to this article: http://dx.doi.org/10.1080/10410236.2013.813831
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Health Communication, 29: 947–952, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1041-0236 print / 1532-7027 online DOI: 10.1080/10410236.2013.813831
RESEARCH IN BRIEF
Health Care and Social Media Platforms in Hospitals Michele L. McCarroll and Shannon D. Armbruster Downloaded by [University of Illinois Chicago] at 14:15 17 October 2014
Department of Obstetrics and Gynecology Summa Center for Women’s Health Research, Akron, Ohio
Jae Eun Chung and Junghyun Kim School of Communications Kent State University
Alissa McKenzie Department of Marketing and Communications Summa Health System, Akron, Ohio
Vivian E. von Gruenigen Department of Obstetrics and Gynecology Summa Health System, Akron, Ohio
The objective of this article is to illustrate user characteristics of a hospital’s social media structure using analytics and user surveys. A 1-year retrospective analysis was conducted along with an Internet survey of users of the hospital’s Facebook, Twitter, and blog. Of the survey respondents (n = 163), 95.7% are female and 4.3% are male; most are ages 50–59 years (31.5%) and 40–49 years (27.8%); and 93.2% are Caucasian. However, the hospital system database revealed 55% female and 37% minority population, respectively. Of the survey respondents, 61.4% reported having a bachelor’s degree or higher, whereas only 11.7% reported having a high school degree/equivalent or lower. However, within the hospital patient databases, 93% of patients have a high school degree/equivalent or lower and only 3% have a bachelor’s degree or higher in our women’s services population. Social media were used to seek personal health information 68.7% (n = 112), to learn about hospital programming 27.6% (n = 45), and to seek family health information 25.2% (n = 41). Respondents younger than 49 years of age were more likely to seek personal health information using social media compared to those 50 years of age and older (p = .02). Respondents with a bachelor’s degree or higher education were statistically less likely to search for physician information compared to those less educated individuals (p = .04). We conclude that social media may play an important role in personal health information, especially for young female respondents; however, the survey provides strong evidence that further research is needed to ensure that social network sites provided by hospitals are reaching the full spectrum of health system patients.
Correspondence should be addressed to Dr. Michele L. McCarroll, Summa Center for Women’s Health Research, Summa Health System, 525 East Market Street, Akron, OH 44304. E-mail: [email protected]
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Internet usage continues to expand, becoming an integral part of American society, with 85% of U.S. adults reporting usage in 2012 (Pew Research Center, 2013). Nearly half of all U.S. Internet users (ages 12 years and older) have a profile on one or more online social network sites (SNS) (e.g., Facebook, YouTub, Twitter, and blogs), and among these, 3 in 10 Internet users access SNS several times a day (Edison Research and Arbitron, 2011). In 2010, this translated to U.S. Internet users spending about a quarter of their Internet time on SNS (Nielsen, Inc., 2010). As the amount of time online increases, so does the information exchange with the public. The Health Information National Trends Survey (HINTS) survey from 2011/2012 revealed that 77.6% of American adults searched online for healthcare information for themselves and 55.9% looked for health or medical information for someone else (Redmond, Baer, Clark, Lipsitz, & Hicks, 2010). In 2011, 15% of SNS users, 7% of American adults, accessed health care information from their SNS (Fox, 2011). SNS are particularly suitable channels to reach and engage health consumers because of their “social” characteristics (Ellison, Steinfield, & Lampe, 2007; Subrahmanyam, Reich, Waechter, & Espinoza, 2008). They provide an easily accessible connection within and between patients and physicians (Thielst, 2011). These social interactions lead to quick and wide dissemination of information. Interpersonal interaction can also foster exchanges of social support, which can stimulate changes in health behaviors and attitudes. SNS (Chou, Prestin, Lyons, & Wen, 2013), are also expected to improve health care access, reduce health disparities, and lower cultural and linguistic barriers (Hawn, 2009; Krowchuk, Lane, & Twaddell, 2010). It has been shown that respondents who used health care providers as an information source had higher odds of meeting recommendations for health benefits (Redmond et al., 2010). Therefore, SNS can provide a gateway to connect patients with other patients as well as to providers, creating an information supplying support system that can ultimately improve patient health. During the last few years, SNS have been embraced by hospitals and health care organizations as a way to reach, engage, and educate patients (Weaver, 2011). In the United States alone, as of October 2011, approximately 1,229 hospitals use at least one online social media outlet (1068 Facebook pages, 814 Twitter accounts, 575 YouTube channels, 149 blogs, and 946 FourSquare and 556 LinkedIn accounts) (Bennett, 2011). Yet despite the popularity of SNS and integration of health care information by hospitals into these networks, a minority of patients access hospital SNS as an outlet for local health information, especially within an underserved population (Fox, 2011; Summa Health System, Akron Children’s Hospital, & Akron General Health System, 2010). Specifically, within the Summa Health System, SNS, including Summa Flourish, a women’s health blog, Twitter, and Facebook, were created to provide easy access to health information, provide support, and unite the health
community. In order to obtain these goals, it is imperative that our SNS are accessible to and utilized by all demographics the health system serves. The goal of this descriptive analysis is to assess, using the current Internet infrastructure, the characteristics of individuals utilizing the three SNS, follow the growth of the hospital-based SNS platforms, and examine the reasons individuals accessed hospital-based SNS platforms, in order to continue expansion to reach the hospital’s entire population.
MATERIALS AND METHODS This study, with a phased approach, was a retrospective analysis to assess SNS user patterns from January 1, 2011, to December 31, 2011, which was the first year the hospital engaged three types of SNS: Facebook, Twitter, and Summa Flourish (a women’s health blog). The Facebook page provides information about health promotions, allows communication between patients, and encourages healthy lifestyle choices through newsfeed postings and links. Twitter provides information about hospital programming and health issues, and provides encouragement to make health-conscious decisions. The third SNS, Summa Flourish, a women’s blog, posts approximately 10 blogs per month, providing information on a variety of women’s health topics including but not limited to preventative care, pregnancy, oncology, menopause, gynecologic issues, and women’s empowerment. The retrospective analysis of the three SNS was completed using the platforms of Twitter (HootSuite), Women’s Health blog (Sitemeter and Google Feedburner), and Facebook (Facebook® analytics), offered by the inner-city hospital system serving five counties with seven hospitals. An online survey was distributed to all Facebook likes (n = 2,923), Twitter followers (n = 1,324), and blog subscribers (n = 1,050), from September 1, 2011, to October 15, 2011, to obtain basic user information. All of these participants (n = 5,297) were invited to participate in the online survey (SurveyMonkey, Palo Alto, CA). SNS members were requested to complete the survey once, even if they received multiple survey requests (one from each SNS site). The survey took about 10 minutes to complete and was open from September 1, 2011, to October 15, 2011. Users were reminded every 2 weeks over the 6-week period to complete the survey. The health system demographics were captured using the Explorys (Cleveland, OH) database, which provides populations, providers, treatments, and outcomes in real time from participating hospitals. Institutional review board approval was obtained to conduct this study. Survey data were analyzed using the SPSS 17.0. Means with standard deviation (SD) or standard error (SE) are reported for all measures. For all statistical analyses, a p value less than .05 was considered statistically significant. Data from individuals who withdrew prior to survey
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completion or missing data were not included in the final analysis.
4000 3000 2000 1000 0
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Likes, Followers, and Visitors
Our retrospective findings showed the inner-city hospital’s SNS grew steadily over the year (Figure 1), with Facebook having the largest number of users (n = 2,923 likes), then Twitter (n = 1,324 followers), followed by the blog (n = 1,050 visitors/month). Among the three platforms, Facebook received the most rapid growth and activity, with an increase of 675 to 2,923 likes in 1 year. For Twitter, the number of followers increased from 774 to 1,324. About two people join as new followers of the hospital’s Twitter handle every day. Over the year, the hospital posted 2,216 tweets and about 14% of them were retweeted by followers. The third most active SNS was the women’s health blog (Table 1). During the 12-month period, approximately
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RESULTS
SNS Platforms FIGURE 1 Hospital-based SNS growth. TABLE 1 Women’s Health Blog Analytics Over a 1-Year Period
Total visits Unique visitors‡ Page views Pages per visit Average visit duration Bounce rate† New visits
January 1, 2011
December 31, 2011
Percent Change
514 356 1,302 2.53 00:02:14 59.7% 60.1%
1,367 1,050 2,652 1.94 00:01:34 68.9% 67.0%
166% 195% 103% −23% −30% −9.2% 6.9%
‡ Unique visitors are measured by the computer IP address, a computer’s fingerprint, and are counted only once no matter how many times they visit the site. † Bounce rates are visitors who enter the blog and then leave rather than continuing to view other blog postings.
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10 blogs were posted every month, with visitors averaging at least one comment for each posting. Since the inception of the women’s health blog, the number of page views has doubled from 1,302 to 2,652, while monthly visitors have almost tripled from 356 to 1,050. The number of monthly visitors (n = 1,050) was much greater than that of people subscribing to e-mail notices on new postings (n = 467), indicating that the majority of visits resulted from sources other than e-mail subscription to the blog, such as through the hospital’s other social media outlets such as Facebook, Twitter, and search engines (e.g., Google, Bing, Yahoo, etc.). Unique visitors, defined by the user’s IP address, increased by 195% over 1 year to the women’s health blog. Bounce rates, defined as the percentage of visitors who enter the site and then left, rather than continuing viewing other pages of the blog, decreased (–9.2%) over the year, providing evidence of growing interest in the content provided by the blog. In total, n = 163 participants using the hospital’s SNS completed the online survey (Table 2), while n = 3 were removed for incomplete surveys. Our online survey results (Figure 2) showed the majority of respondents reported that they use the hospital’s SNS outlets to seek personal health information 68.7% (n = 112), followed by a desire to learn about the hospital’s programming 27.6% (n = 45), and lastly to seek family health information 25.2% (n = 41). Respondents who reported their age to be less than 49 years were statistically (p = .02) more likely to seek personal health information from the hospital’s SNS compared to those in age groups 50 years and older. Those participants who reported having a bachelor’s degree or higher were statistically (p = .04) less likely to search for physician information using the hospital’s SNS compared to those who reported to have less education. Using the Explorys database, we examined demographic differences between the patients that utilize the health system to respondents of the SNS survey (Table 3). These observations showed differences in gender, race, and reported educational levels. The SNS survey respondents compared to the inner-city hospital’s service demographics were 93.2% versus 73% Caucasian, 5% versus 8.4% African-American, 0.6% versus 5% Asian, and 1.2% versus 13.6% other, respectively. Additionally, most of the respondents were female (93%), which is compared to the health system population of 55%. A disproportionally high percentage of SNS users had a bachelor’s degree or higher (61.4%) compared to the hospital database, where 93% of patients have a high school degree/equivalent or lower and only 3% have a bachelor’s degree or higher.
COMMENTS This analysis sought to evaluate the SNS trends of an innercity hospital that uses Facebook, Twitter, and a women’s
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MCCARROLL ET AL. TABLE 2 Hospital SNS Survey Results
Questions
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1. Are you male or female?
Response Rates
Male: Female: 2. Which category below includes your age? 60: 3. What is the highest level of school you have completed or the highest High school or lower: degree you have received? Some college: Associate’s degree: Bachelor’s degree: Graduate degree: 4. What is your race? Caucasian: African-American: Asian: Other: 5. Are you a person of Hispanic, Latino, or Spanish origin? Non-Hispanic/Latino: Hispanic/Latino: 6. Are you . . . (click all that apply): A fan of Summa Health System on Facebook: Following Summa Health System on Twitter: Subscribed to the women’s health blog, Flourish: Other: To seek personal health information: 7. Why do you access the Health System’s social media outlets (e.g., Summa’s Facebook page, Twitter account, women’s health blog)? To seek family member health information: (click all that apply) To search for physician information: To look for hospital program information: To meet and communicate with different people: To have fun and stimulating conversation with others: To have a nice break from routine: To meet people who can understand me and listen to me: Other: 8. Where do you currently receive your health care? Within the health system: Outside the health system:
health blog to reach its constituents. The retrospective results showed growth over time of all three SNS platforms. These findings show the success of the hospital’s efforts to enhance the reach of the SNS in the health system community. Promotion of the SNS has been accomplished through physician, patient, and hospital system word of mouth and information about all SNS sites on each SNS platform. Of the survey respondents, 94% were female, which is considerably higher than the proportion of women represented within the general hospital population. This is a positive finding, considering that the primary focus of one third of our social media effort is directed toward improving women’s health through our blog, Summa Flourish. Our analysis also highlighted usage characteristics, identifying that the majority of respondents were interested in seeking personal health information, especially if the individual was younger than 49 years of age. Additionally, those less educated respondents were more likely to seek physician information through SNS. This information can be used to improve and expand the current SNS to include the
4.3% (n = 7) 95.7% (n = 156) 0.06% (n = 1) 6.8% (n = 11) 17.3% (n = 28) 27.8% (n = 45) 31.5% (n = 51) 16% (n = 26) 11.7% (n = 19) 16.3% (n = 25) 11.7% (n = 19) 31.3% (n = 51) 30.1% (n = 49) 73% (n = 152) 8.4% (n = 8) 0.60% (n = 1) 0.02% (n = 2) 99.4% (n = 162) 0.60% (n = 1) 33% (n = 54) 4.8% (n = 8) 77% (n = 122) 1.2% (n = 2) 73.2% (n = 115) 26.8% (n = 42) 11.5% (n = 18) 29.9% (n = 47) 1.9% (n = 3) 12.1% (n = 19) 24.8% (n = 39) 7% (n = 11) 9.6% (n = 21) 79.6% (n = 129) 21.4% (n = 34)
information the public is trying to obtain. We can enhance the disease-specific information available through SNS to target individuals of less than 49 years of age. Specifically, the health system can attempt to reach these individuals with age-specific information and health-related campaigns or conversations relative to their everyday survival (Southwell & Yzer, 2009). The targeted campaigns and conversations are underscored in Chou et al. (Chou, Hunt, Beckjord, Moser, & Hess, 2009), emphasizing the extent to which age determines who uses social media especially for health information. The overall response to the survey was 3.5%, compared to the average response rate of online surveys of 33% (Chou et al., 2009). It is important to note that an individual could have received the survey up to three times, if the person were a member of all three SNS sites. Despite the instructions to complete the survey only once, we were not able to account for duplication in the data set if the same person completed a survey more than once. Of those who did complete the
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FIGURE 2 Reasons for using hospital-based SNS platforms (% of respondents) (color figure available online). TABLE 3 Demographic Differences of Health System Patients Versus SNS Survey Responders
Race Caucasian African-American Asian Other Ethnicity Non-Hispanic/Latino Hispanic/Latino Gender Female Male Education High school or lower Some college but no degree Associate’s degree Bachelor’s degree Graduate degree Total
Patients Who Use Health System in 2011 (n = 680,770)
Hospital SNS Survey Respondents in 2011 (n = 163)
n
%
n
%
496,962 57,185 34,039 92,585
73.0 8.4 5.0 13.6
152 8 1 2
93.2 5.0 0.6 1.2
677,600 3,170
99.0 0.05
162 1
99.4 0.6
376,310 304,460
55.3 44.7
156 7
95.7 4.3
660,347 — — 20,423 —
93.0 — — 3.0 — 680,770
19 25 19 51 49
11.7 16.3 11.7 31.3 30.1 163
survey, their demographics and characteristics did not match those of our hospital system. Specifically, there were notable differences in race and education levels when comparing to the hospital population, thus identifying that the hospital needs to improve outreach to a more diverse population. Limitation of this descriptive analysis may contribute to the differences in the data between respondents and the health system, including race and education. The individuals
who chose to respond to the survey may have had different characteristics than those who did not, including educational level and socioeconomic class. Without being able to capture a larger number of the social media population, it is difficult to completely determine who is utilizing the SNS. It is also possible that the SNS are not reaching certain groups within the hospital population. The mostly (most) likely explanation is a combination of the two previous theories,
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failure of already captured individuals to respond to the survey and inability to reach all demographics of the hospital population. Another limitation of this analysis is the inability to obtain and confirm demographic and individual user information on present platforms without violating user privacy. Strengths of this study includes its originality to begin to fill a void in the literature regarding hospital-based SNS; a sample size large enough to detect within-groups differences between age and education preferences for SNS usage; and providing evidence that an inner-city hospital’s SNS continues to gain popularity in likes, followers, and subscribers within the primary demographic area it serves. Social media are utilized throughout the United States regardless of an individual’s gender, age, education, race, ethnicity, or health care access (U.S. Department of Labor, n.d.). A recent study published in the Journal of Medical Internet Research shows that social media can reach a population regardless of education, race/ethnicity, or health care access. Considering implications of health communication efforts, the results of this study suggest that in the future, social media can be useful in reaching the target population regardless of their socioeconomic and health-related characteristics. If we can enable broader and more equitable mobile access, thus reducing the digital divide, the potential for improving health and health behavior of in our healthcare population through social media is tremendous. Further research is needed to explore the relationship between social networking, changes in health behaviors, and health disparities. Our research reveals a possible disconnection between the respondents currently accessing the platforms and the population served by the health system. As our health system’s SNS continues to expand, we do know the importance of engaging with online, mobile, and connected patients about positive and educational health messages. Future studies should include hospital based SNS analysis to assess influences on patient health using SNS, more disparity in populations using SNS with available technology for chronic disease information, and longitudinal studies with SNS from hospitals on patient health outcomes over time.
CONFLICTS OF INTEREST None to report.
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