Category: eHealth

Information & communication technologies for health

eHealthinnovationpublic healthsocial innovationsocial media

Seeing the lights in research with our heads in the clouds

Lights in the clouds

Lights in the clouds

Some fields stagnate because they fail to take the bold steps into the unknown by taking chances and proposing new ideas because the research isn’t there to guide it while social innovation has a different twist on the problem: it has plenty of ideas, but little research to support those ideas. Unless the ideas and research match up it is unlikely that either area will develop.

 

Social innovation is a space that doesn’t lack for dreamers and big ideas. That is a refreshing change of pace from the world of public policy and public health that are well-populated by those who feel chained down to what’s been done as the entry to doing something new (which is oxymoronic when you think about it).

Fields like public health and medicine are well-served by looking to the evidence for guidance on many issues, but an over-reliance on using past-practice and known facts as the means to guide present action seriously limits the capacity to innovate in spaces where evidence doesn’t exist and may not be forthcoming.

The example of eHealth, social media and healthcare

A good example of this is in the area of eHealth. While social media has been part of the online communication landscape for nearly a decade (or longer, depending on your definition of the term), there has been sparse use of these tools and approaches within the health domain by professionals until recently. Even today, the presence of professional voices on health matters is small within the larger discourse on health and wellbeing online.

One big reason for this — and there are many — is that health systems are not prepared for the complexity that social media introduces.  Julia Belluz’s series on social media and healthcare at Macleans provides among the best examples of the gaps that social media exposes and widens within the overlapping domains of health, medicine, media and the public good. Yet, such problems with social media do not change the fact that it is here, used by billions worldwide, and increasingly becoming a vehicle for discussing health matters from heart disease to weight management to smoking cessation.

Social innovation and research

Social innovation has the opposite problem. Vision, ideas, excitement and energy for new ideas abound within this world, yet the evidence generation to support it, improve upon it and foster further design innovations is notably absent (or invisible). Evaluation is not a word that is used much within this sphere nor is the term research applied — at least with the rigour we see in the health field.

In late May I participated in a one-day event in Vancouver on social innovation research in Vancouver organized by the folks at Simon Fraser University’s Public Square program and Nesta as part of the Social Innovation Week Canada events.Part of the rationale for the event can be explained by Nesta on its website promoting an earlier Social Frontiers event in the UK:

Despite thriving practitioner networks and a real commitment from policymakers and foundations to support social innovation, empirical and theoretical knowledge of social innovation remains uneven.

Not only is this research base uneven, it’s largely invisible. I choose to use the word invisible because it’s unclear how much research there is as it simply isn’t made visible. Part of the problem, clearly evident at the Vancouver event, is that social innovation appears to be still at a place where it’s busy showing people it exists. This is certainly an important first step, but as this was an event devoted to social innovation research it struck me that most attendees ought to have already been convinced of that.

Missing was language around t-scores, inter-relater reliability, theoretical saturation, cost-benefit analysis, systematic reviews and confidence intervals – the kind of terms you’d expect to hear at a research conference. Instead, words like “impact” and “scale” were thrown out with little data to back them up.

Bring us down to earth to better appreciate the stars

It seems that social innovation is a field that is still in the clouds with possibility and hasn’t turned the lights on bright enough to bring it back down to earth. That’s the unfortunate part of research: it can be a real buzz-kill. Research and evaluation can confirm what it means for something to ‘work’ and forces us to be clear on terms like ‘scale’ and ‘impact’ and this very often will mean that many of the high-profile, well-intentioned initiatives will prove to be less impactful than we hope for.

Yet, this attention to detail and increase in the quality and scope of research will also raise the overall profile of the field and the quality and scope of the social innovations themselves. That is real impact.

By bringing us down to earth with better quality and more sophisticated research presented and discussed in public and with each other we offer the best opportunity for social innovation to truly innovate and, in doing so, reach beyond the clouds and into the stars.

Photo credit: Lightbulb Clouds by MyCatkins used under Creative Commons License. Thanks Mike for sharing!

eHealthevaluationsocial mediasystems thinking

Evaluating Health Promotion Social Media Strategies for Public Health Impact

How is social media stacking up?

How is social media stacking up?

I recently spoke at an interactive workshop presentation at the 2013 Ontario Public Health Convention (TOPHC) looking at social media use in public health and the strategies available for evaluating those strategies in practice. The talk was focused on the tools, methods and approaches and the inherent challenges in dealing with a dynamic social communication environment.

Here are the slides from that presentation.

Evaluating Health Promotion Social Media Strategies for Public Health Impact

Image: Shutterstock (used under licence)

behaviour changeeHealthhealth promotioninnovationpublic health

Social Media and Health: Leaders(hip) and Followers(hip)

Social media is finally catching on with healthcare, public health, and  health promotion. With a few recent articles published in the academic literature to rest on, academic health sciences has finally (and I might argue, begrudgingly) conceded that 900+ million users and $100B valuations (Facebook), and thousands of messages exchanged every milisecond (microblogs like Twitter and Sina Wiebo) might have some value for the public beyond entertainment.

If you note how long it took the health sector to start using the telephone as a serious means of engaging their patients or the public, this is lightning-quick adoption. Still, the barriers to adoption are high and the approach to using the technology is scattered. Indeed, just like the start of Internet-delivered telehealth (or cybermedicine (PDF), which has now evolved into eHealth), there is a mad rush to get liked, followed or some other metrics that most health professionals barely understand.

And that is part of the problem.

Meaningful Social Media Metrics

What is a meaningful metric for social media and health? A recently published article in Health Promotion Practice suggested four metrics that are taken from social marketing and applied to social media. These Key Performance Indicators (KPI’s) are:

  • Insights (consumer feedback)
  • Exposure (media impressions, visits, views, etc..)
  • Reach (# people who connect to the social media application)
  • Engagement (level of interaction with the content)

These are reasonable, but to to the uninitiated I would suggest a few words of caution and commentary to this list.

Firstly, the insights suggested by Neiger and colleagues “can be derived from practices such as sentiment analysis or data mining that uses algorithms to extract consumer attitudes and other perspectives on a particular topic” (p.162). While not incorrect, this makes the job sound relatively simple and it is not. Qualitative analysis + quantitative metrics such as those derived from data mining are key. Context counts immeasurably in social media use. It’s only in situations where social media is used as a broadcasting tool that gross measures of likes and sentiment analysis work with little qualification.

Even that is problematic. Counts of ‘likes’, ‘visits’, ‘follows’ and such are highly problematic and can be easily gamed. I am ‘followed’ on Twitter by people who have tens of thousands of followers, yet virtually no presence online. Most often they are from marketing fields where the standard practice is to always follow back those who follow you. Do this enough and pretty quickly you, too can have 23,000 followers and follow 20,000 more. This is meaningless from the perspective of developing relationships.

Engagement is the most meaningful of these metrics and the hardest to fully apply. This category gets us to consider the difference between “OMG! AWESOME!” and “That last post made me think of this situation [described here] and I suggest you read [reference] here for more” as comments. Without understanding the context in which these are made within the post, between posts (temporally and sequentially), and in relation to a larger social and informational context, simple text analysis won’t do.

Social Media Evidence: Problems and More Problems

One of the objections to the use of social media by some is that it is not evidence-based. To that extent I would largely agree that this is the case, but then we’ve been jumping out of airplanes with parachutes despite any randomized controlled trial to prove their worth.

Another article in Health Promotion Practice in 2011 highlights potential applications for social media and behaviour change without drawing on specific examples from the literature, but rather on theoretical and rhetorical arguments. An article published in the latest issue of Perspectives on Psychological Science highlights the current state of research on Facebook, which is timely given that its IPO is set for today. That review by Wilson and colleagues illustrates the largely descriptive nature of the field and offers some insight on to the motivation of Facebook users and their online activities, but rather little in what Facebook does to promote active change in individuals and communities when they leave the platform.

The answer to whether social media like platforms such as Facebook ‘work’ as methods of promoting change is simply: we don’t know.

Does social media provide support to people? Yes. Does it inform them? Yes to that too. Does that information produce something other than passive activity on the topic? We don’t know.

In order to answer these questions, health sciences professionals, evaluators, and tech developers need to consider not just followership, but leadership. In this respect, it means creating changes to the way we gather evidence, the tools and methods we use to analyse data, and the organizational structures necessary to support the kind of real-time, rapid cycle evaluation and developmental design work necessary to make programs and evidence relevant to a changing context.

As Facebook launches into its new role as a public company it is almost assured to be introducing new innovations at a rapid pace to ensure that investor expectations (which are enormous) are met. This means that today’s Facebook will not be next month’s. Having funding mechanisms, review and approval mechanisms, a staff trained and oriented to rapid response research, and an overall organizational support system for innovation is the key.

Right now, we are a long way from that. Hospitals are very large, risk averse organizations; public health units are not much different. They both operate in a command-and-control environment suited for complicated, not complex informational and social environments. Social media is largely within the latter.

Systems thinking, design thinking, developmental evaluation, creativity, networks and innovation: these are the keywords for health in the coming years. They are as author Eric Topol calls the dawning of the creative destruction of medicine.

The public is already using social media for health and now the time has come for health (care, promotion and protection) systems to get on board and make the changes necessary to join them.

complexitydesign thinkingeHealthhealth promotionpublic health

Complexity, Interaction Design and Social Media

Social Media Targeting for Head & Heart

Social media, like all human activities, involves designed interactions in a complex environment. How we design for this space is as much about the social — and the complexity that results from it — as it is the media.

Yesterday I participated in a webinar on social media strategy hosted by the Program Training and Consultation Centre’s Media Network. The focus was on how public health professionals can use social media to engage their populations of interest to advance health promotion. Examples of how social media is being used were presented from ParticipACTION, the U.S. Centers for Disease Control and my own research group’s Youth4Health initiative to show how these tools could enhance health communications.

What might have caught some of attendees by surprise was the introduction of complexity science concepts and design thinking into the discussion. These terms are not often used in public health, but as I’ve argued many times in this space, they ought to play a much larger role.

The other potential surprise for some might have been the emphasis on relationships, connection and the kind of things that Brian Solis showcases (see infographic above). Solis describes social media as:

Social media is a deeply personal ecosystem that I lovingly refer to as the EGOsystem. As such, there is a “me” in social media for a reason. It is quite literally a world in which we are at the center of our online experiences, a place where everything and everyone revolves around us. – Brian Solis

When a person is at the centre of an experience that is human formed and technology mediated, design is very important. How one engages with others and the opportunities afforded within that environment or EGOsystem is largely a product of design. For example, Facebook provides a great deal of opportunity to bring in your close “friends” into a conversation, but is relatively poor at bringing in strangers. In contrast, Twitter is about bringing anyone into the conversation, particularly strangers. As I like to put it:

Twitter enables you to learn answers to questions you never thought to ask, have conversations you could have never planned, and meet people you never knew existed

In both of these contexts, the manner in which one designs for interactions has a profound influence on what kind of conversations take place. To use Solis’ model above, attention to interaction design qualities of the technological and social space helps amplify the white arrows, dampen the effect of the blue arrows, with an aim of enhancing the power of the red arrow (belevolence).

This attention to these kind of patterns is at the heart (no pun intended) of complexity oriented planning and why social media, design and complexity require mutual consideration in developing strategy. When in complex spaces, the tempo, rhythm, and pattern of information exchange shifts constantly, just like in a regular conversation. So approaching the program from the perspective of a traditional, more linear-focused mindset will inevitably lead to a misalignment between program activities and the outcomes produced.

If you’re expecting to get a firm outcome from a social media strategy, you might be disappointed. If you are looking for surprises, consider more flexible outcomes, then social media may deliver the goods — but only if you design your strategy to suit the complexity of the context. A complex setting is one where there are multiple agents interacting and producing emergent new properties through such interaction. It it therefore fitting that the concept of interaction design be considered in examining how we engage in these environments.

Much of the discourse on social media from marketing and communication leaders hints at these concepts, but doesn’t name them. By explicitly making complexity, design and the social part of social media a focus we can more intentionally create better experiences that will engage our audiences, and in the case of public health, promote health.

behaviour changecomplexityeHealthinnovationknowledge translation

The Face-to-Face Complexity of eHealth & Knowledge Exchange

The Public Health Agency of Canada‘s 2010 Knowledge Forum on Chronic Disease was held last night today in Ottawa with the focus on social media. The invitation-only affair was designed to bring together a diverse array of researchers, practitioners, policy developers, consultants and administrators who work with social media in some capacity. There were experts and non-experts alike gathered to learn about what the state of the art of social media is and how it can support public health. By state of the art, I refer not to the technological side of things, but rather the true art of public health, much like that discussed earlier this year at the University of Toronto.

Last night began with a presentation from Leanne Labelle that got us all thinking about how social media is radically different in the speed of its adoption and breadth of its social impact drawing inspiration from this video from Eric Qualman’s Socialnomics website.

Today we got down to business and started working through some of the issues that we face as a field when adopting social media. I would probably consider myself among the most experienced users in the audience, yet still gained so much from the day. Although I learned some things about how to use social media in new ways, what I learned most was how others use it and what struggles they have. This is always a useful reminder.

What stuck out was a presentation and related discussion from Christopher Wilson from the University of Ottawa’s Centre on Governance and a consultant on governance issues. In speaking about the challenges of doing collaboration, Christopher pointed to the problems of a ‘one-size fits all’ strategy using a diagram illustrating the fundamental differences between engagement at a small scale (under 25 people) and what is the mass collaboration that folks like Clay Shirky, Don Tapscott, and others write about. His diagram looks like this:

Technology Spectrum of Social Collaboration by Christopher Wilson

What Wilson stressed to the audience was the role that complexity plays in all of this. Specifically, he stated:

The more complex and interdependent things become, the more people need to be aware of the changing context and the changes in shared understanding.

As part of this, groups are required to engage in ways that enable them to deal with this complexity. In his experience, this can’t be done exclusively online. He further stated:

As complexity increases, the need for offline engagement increases.

I couldn’t agree more. In my work with community organizing and eHealth promotion, I’ve found the most effective means of fostering collaboration is to blend the two forms of knowledge generation and exchange together. The model that my research team and I developed is called the CoNEKTR (Complexity, Networks, EHealth, and Knowledge Translation Research Model).

This model combines both face-to-face methods of organizing and ideation, with a social media strategy that connects people together between events. The CoNEKTR model has been applied in many forms, but in each case the need to have ways to use the power of social media and rich media together with in-person dialogue has been front and centre. Using complexity science principles to guide the process and powered by social media and face-to-face engagement, the power to take what we know, contextualize it, and transform it into something we can act on seems to me the best way forward in dealing with problems of chronic disease that are so knotted and pervasive, yet demand rapid responses from public health.

behaviour changeeHealthpublic healthsocial media

Social Marketing, Marketers and Responsibility

Set Godin

Seth Godin, a business and marketing thought-leader and someone I’ve written on before, posed the question on his blog: Are marketer’s responsible for what they promote?

« The power of buttons and being normal

Are you responsible for what you market?

Let’s assert that marketing works.

If it works, then, are you responsible for what happens after that?

If you market cigarettes aggressively, are you responsible for people dying of lung cancer?

I think there are two ways to go here:

1. You’re not responsible. The marketer is like a lawyer representing the obviously guilty client. Everyone is entitled to a lawyer, and it’s up to the jury to decide. The lawyer’s job is to do the best she can, not to decide on the outcome. Market the best you can and let buyers take responsibility.

2. You are responsible. Your insight and effort cause people to change, and without you, that change would never happen.

My take: if you’re not proud of it, don’t sell it.

As I mentioned in a previous post, social marketing in the health sector (not including the ‘miracle cure’ hawkers) tends towards promoting “healthful” things. Yet, even these supposedly healthful activities such as donating to a particular cause, paying attention to certain lines of evidence, or attending certain educational events have unintended consequences. Donations to one charity means that money isn’t going to others. Adhering to certain protocols and procedures means disregarding or not paying attention to others. While choosing to attend certain events takes you away from other activities you could pursue (like your email back at the office, meetings with colleagues, time with family, or attending other events).

While the above example of cigarettes might lead us to an obvious answer to Seth’s question, what about what happens in our knowledge translation activities on the side of health? Do we stop to consider the unintended consequences of our actions, even if they are well intentioned? Systems thinking is one of the tools to help us through this, particularly systems dynamic modeling. On an individual level, contemplative inquiry is another strategy.

In both cases, we need time, care, attention and the capacity to bring this knowledge to light.

One example is with the Transtheoretical Model and Stages of Change theory. When I started getting into the health field Stages of Change was just gaining popularity. A search of PubMed finds nearly 1000 published articles using variants on the Stage of Change concept. In a nutshell, this theory suggests we work our way up to change by planning over time towards a change. Local, provincial/state, and national programs throughout the world have taken this approach to organizing their activities. For a while it seemed that the only way to get funded was to have some accounting of stage.

The problem was, Stage of Change does a lousy job of predicting change in certain behaviours. Robert West and others looked at the evidence and found that in many cases, Stages of Change did a terrible job of predicting whether people would change their behaviour or not, particularly in the realm of addictions. Smokers or problem drinkers might stop “cold turkey” without any advance planning, which isn’t well accounted for by the model.

Yet, the model, so ingrained in the psyche of many health promotion planners and educators, continues to be used widely, blinding us to other options. The unintended consequences of this is that we are often unable (unwilling?) to consider that other models might work. Or, that the models we have don’t work as well as we’d hoped and that maybe we need new ones. By not only putting these ideas out there, but actively promoting them, we are marketing not only products, but ways of thinking about problems and it is here that we get into trouble.

Pride in what you do might avoid the problem’s that Seth Godin in talking about, but when it obscures our vision from considering other options, it might be time to do less social marketing and more social systems thinking.

education & learningeHealthsocial media

Social Marketing/ Social Media Blowback And eHealth Communication Etiquette

 

Those of us working at that interface between the professional and public worlds of health have to wear many hats. We need to be good at communicating in ways that gain respect within our professional worlds. This position means writing scholarly manuscripts, using technical language (but not always), and synthesizing the work of our peers on one hand, while being able to work within the world of most marketers, which includes reaching the public. That means working within the realm of (social) marketing.

Social marketing is described as:

Social Marketing is a planned process for influencing change. Social Marketing is a modified term of conventional Product and Service Marketing. With its components of marketing and consumer research, advertising and promotion (including positioning, segmentation, creative strategy, message design and testing, media strategy and planning, and effective tracking), Social Marketing can play a central role in topics like health, environment, and other important issues.

In its most general sense, Social Marketing is a new way of thinking about some very old human endeavours. As long as there have been social systems, there have been attempts to inform, persuade, influence, motivate, to gain acceptance for new adherents to certain sets of ideas, to promote causes and to win over particular groups, to reinforce behaviour or to change it — whether by favour, argument or force. Social Marketing has deep roots in religion, in politics, in education, and even, to a degree, in military strategy. It also has intellectual roots in disciplines such as psychology, sociology, political science, communication theory and anthropology. Its practical roots stem from disciplines such as advertising, public relations and market research, as well as to the work and experience of social activists, advocacy groups and community organizers.

Social marketing is about getting ideas out there and in use and within the realm of public health and social welfare programming, we often presume that what we’re “selling” is good in its quality, intent, potential use, and social benefit.

The problem is that most of what passes for social marketing in the health sector is not done by marketers, or even those skilled in health communications, but rather everyday researchers, clinicians and administrators. Certainly there are many large organizations where such skilled professionals do reside, but in the decentralized web of social media, those are drops in the bucket of content.

The result is that many well-intentioned messages get poorly developed and distributed, creating something akin to blowback, a hostile and aggressive form of resistance to the message. I’ve just been witnessing such a case of this with a an organization seeking to promote social innovation that is getting messages sent by people on its online mailing list asking to be removed from it. One of the big reasons for these messages is that these people were never asked to be put on the mailing list in the first place.

I get almost as much spam (or, in some cases, bacn) from well-meaning organizations and individuals hoping to get their message out than I do the usual snake-oil salesmen peddling natural male enhancements, Rolex watches, and “investment opportunities”. The senders of these messages, well intentioned for the most part, are hoping to you’ll “buy” their product, which means adopting their findings into your practice, register for the conference they are organizing, visit their website, or donate to their cause.

This reflects a fundamental lack of knowledge about social media, social marketing and knowledge translation in the modern age. Effective messages are a matter of content shaping and distribution, but also relationship development. When you send out messages unsolicited asking for something — time, mindspace, referrrals, whatever — you are hoping to develop a relationship, even a superficial one, with that person. Treating them with the disdain that comes from throwing content at people without their consent is violating that relationship. It is no surprise that miniscule things like one simple thing like an unsolicited email can unleash some fury among its recipients.

And for those people and organizations who think putting a tiny statement on their registration form or website in 8pt font saying that you must opt out of communications or presuming people want this, I’m sorry but that doesn’t cut it.

Building social marketing on relationships is something that our field needs to build literacy and competence in quickly as the number of these unsolicited campaigns seems to be growing. If we don’t improve our messaging, we’re going to have a lot harder time getting the right people to attend to the right messages or risk having them treat all of what we send with the same care as those messages from some Nigerian Prince in exile.