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http://hpp.sagepub.com/content/13/2/159The online version of this article can be found at:

 DOI: 10.1177/1524839911433467

2012 13: 159Health Promot PractMichael C. Fagen

Brad L. Neiger, Rosemary Thackeray, Sarah A. Van Wagenen, Carl L. Hanson, Joshua H. West, Michael D. Barnes andUse of Social Media in Health Promotion : Purposes, Key Performance Indicators, and Evaluation Metrics

  

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Health Promotion PracticeMarch 2012 Vol. 13, No. 2 159 –164DOI: 10.1177/1524839911433467© 2012 Society for Public Health Education

Despite the expanding use of social media, little has been published about its appropriate role in health promotion, and even less has been written about evalu-ation. The purpose of this article is threefold: (a) outline purposes for social media in health promotion, (b) identify potential key performance indicators asso-ciated with these purposes, and (c) propose evaluation metrics for social media related to the key performance indicators. Process evaluation is presented in this article as an overarching evaluation strategy for social media.

Keywords: Internet/electronic interventions; social marketing/health communication; technology

The term social media refers to activities among people gathered online who share information using conversational media that make it easy to

create and share content in the form of words, pictures, videos, and audios (Safko & Brake, 2009). Categories of social media defined by Sterne (2010) include the fol-lowing: forums and message boards, review and opin-ion sites, social networks, blogging and microblogging, bookmarking, and media sharing.

The use of social media is expanding rapidly. Sixty-five percent of adult Internet users now report using a social networking site such as MySpace, Facebook, or LinkedIn compared with 29% in 2008 (Madden &

Zickuhr, 2011). Public health is also expanding its use of social media as evidenced by the finding that 60% of state health departments now use at least one application (Thackeray, VanWagenen, Koch Smith, Neiger, & Prier, 2011). In addition, one third of adults use social media to access health information, and nearly 80% of physicians who consult with patients online use social media chan-nels to create or share medical content (Hughes, 2010).

As use of social media develops within health pro-motion settings, it will become increasingly important to track key performance indicators (KPIs) and metrics, both common measures in web analytics research. A metric is any single variable that gets measured (e.g., number of posts, tweets, fans, etc.), whereas a KPI is a unique form of a metric identified by an organization as central to its assessment of social media and related benefits (Sterne, 2010). Although KPIs are often expressed as specific measurements such as ratios or averages (e.g., the average number of comments to a post) they can also represent broader or more general constructs (e.g., influence or engagement).

433467 HPPXXX10.1177/1524839911433467Neiger et al. / MeasuriNg the iMpact of social Mediahealth promotion practice / Month XXXX

1Brigham Young University, Provo, UT, USA2University of Illinois at Chicago, Chicago, IL, USA

Associate Editors, Evaluation and Practice DepartmentMichael Fagen, PhD, MPH, is a Clinical Assistant Professor, Community Health Sciences, in the School of Public Health at the University of Illinois, Chicago.

Brad L. Neiger, PhD, MCHES, is a Professor and Associate Dean in the College of Life Sciences at Brigham Young University, Utah.

Use of Social Media in Health Promotion: Purposes, Key Performance Indicators, and Evaluation Metrics

Brad L. Neiger, PhD, MCHES1

Rosemary Thackeray, PhD, MPH1

Sarah A. Van Wagenen, BS1

Carl L. Hanson, PhD, MCHES1

Joshua H. West, PhD, MPH1

Michael D. Barnes, PhD, MCHES1

Michael C. Fagen, PhD, MPH2

Evaluation and Practice

159

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160 HEALTH PROMOTION PRACTICE / March 2012

Process evaluation, or the measurement of factors that contribute to the success or failure of a program, including tracking the number of products, services, or participants (McKenzie, Neiger, & Thackeray, 2009), as well as KPIs and metrics, is recommended here as an overarching evaluation strategy for social media. Since social media is a communication or promotions tool and not a causal factor in behavior change or improved health status, summative evaluation (i.e., impact or out-come evaluation) is not viewed as relevant. Conversely, attention to process evaluation will provide decision makers and other stakeholders with a data collection strat-egy to assess the implementation of social media with various types of interventions or as a stand-alone tool.

Despite the expanding use of social media, little has been published about its appropriate use in health pro-motion. Even less has been written about evaluation. Accordingly, the purpose of this article is threefold: (a) outline purposes for social media in health promotion, (b) identify potential KPIs associated with these pur-poses, and (c) propose evaluation metrics for social media related to the KPIs.

Five broad purposes for use of social media in public health/health promotion have been proposed: (a) com-municate with consumers for market insights (Centers for Disease Control and Prevention [CDC], 2010, Kruse, 2010); (b) establish and promote a brand with consumers (Kruse, 2010); (c) disseminate critical information (CDC, 2010); (d) expand reach to include broader, more diverse audiences (CDC, 2010); and (e) foster public engagement and partnerships with consumers (CDC, 2010).

>>CommuniCate WitH Consumers for marKet insigHts

Social media can be used to gather both primary and secondary data during the formative research process to ensure that programs, products, and services are consumer oriented. A primary data collection strategy might involve a product/services review website, an ongoing blog or a social networking group to elicit input or feedback from consumers. For example, a question could be posted on an organization’s Facebook wall requesting a response. A Facebook “group” could also be created to acquire information from a segment of the population that has experience with a particular topic. Discussions on these Facebook walls could also provide insight.

An example of secondary data could be a content analysis of posts and comments on social media sites that are not initiated by the organization. For instance, researchers analyzed Twitter posts to identify people’s

misunderstandings of antibiotic use (Scanfeld, Scanfeld, & Larson, 2010). This information was used to develop strategies to promote positive behavior change and share accurate information about antibiotics. Similar content-related blogs that focused on specific audience segments (e.g., breast cancer survivors) could be particularly insightful.

>>establisH and Promote a brand WitH Consumers

Health promotion programs embedded within larger organizations often struggle to create a mean-ingful brand (i.e., a distinguishing feature) for a pro-gram, product, or service and are adversely affected by a lack of brand awareness or the degree to which consumers are aware of the brand and have an under-standing of what it represents (Farris, Bendle, Pfeifer, & Reibstein, 2010).

Kelly (2011) suggests that use of social media to enhance brand awareness progresses through four stages: exposure, influence, engagement, and action. An example of these stages to enhance brand awareness is drawn from “the 84” campaign from the Massachusetts Department of Health. According to Silverman (2011), to promote the social norm that most adolescents do not smoke (84%) and to promote positive alternative behaviors, the cam-paign has featured a website that reflects a youth-oriented voice and user-generated applications such as forums, user profiles, and a special interest blog to promote “the 84” brand. Since 2007, more than 700,000 adolescents in Massachusetts have become involved through both online and off-line activities, including social networking via MySpace and YouTube, and the movement has grown every year since its inception (Silverman, 2011).

>>disseminate CritiCal information

With the ubiquity of digital devices and social media applications, health promotion practitioners are recog-nizing social media’s capacity to reach large audiences, almost instantaneously, using cost-efficient methods. Many health-related organizations maintain a Facebook profile for the sole purpose of disseminating health information to friends and fans. For example, Bender, Jimenez-Marroquin, and Jadad (2011) report that of the 620 identified breast cancer Facebook groups (totaling 1,090,397 individual members), 236 or 38% of the groups existed for the purpose of raising awareness about breast cancer. The CDC (2011a) has used Twitter to share flu-related updates and information with 160,528 current followers.

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Analysis of CDC’s Twitter presence across five pro-files (i.e., CDC eHealth, CDC Emergency, CDC Flu, CDCgov, and CDC Espanol) since 2008 revealed more than 1,617 updates, 1,411,359 followers, and 48,125 clickthroughs (CDC, 2011b). After launching a Facebook profile in January 2009, the CDC site grew to 68,014 friends by December 2010 (CDC, 2011b). In addition, CDC has maintained over 100 videos on YouTube resulting in almost 3.6 million views (CDC, 2011b). During the 2008-2009 outbreak of salmonella-contaminated peanut butter and peanut products, the FDA developed a database that allowed consumers to enter a product name or barcode to determine if the product had been recalled. CDC then developed a widget that could be posted on a website or blog that also gave access to the database, thus significantly increasing access to the tool and to vital information (Currie, 2009).

>>exPand reaCH to inClude broader, more diverse audienCes

Although social media cannot eliminate health dis-parities, it can help provide a voice for disproportion-ately affected audiences and provide better access to those in need of programs and services. Seventy-three percent of online American teenagers now use social networking websites compared with 55% in 2006 (Lenhart, Purcell, Smith, & Zickuhr, 2010). In addition, use of digital communication is increasingly detached from desktop computers, which is especially true for people of color (Smith, 2010). In fact, among Internet users, Blacks and English speaking Latinos use social media applications more often than Whites and minor-ity Americans are also more likely to use social media to keep abreast of activity in their neighborhoods (Smith, 2010).

ultimately, health promotion efforts to engage diverse audiences such as minority populations and adoles-cents may be most successful if they involve social media applications that interface easily with mobile devices. Individuals from these demographics are less inclined to use applications such as blogging that involve sometimes-lengthy posts and responses. Rather, adolescents in particular are increasingly involved with microblogging through applications such as Facebook or Twitter. Moreover, the shift to microblogging and other processor-lite applications will likely increase exposure to African Americans and Hispanics because both groups are rapidly adopting the Internet, using handheld devices (Hughes, 2010).

In addition to microblogging, video sharing via YouTube holds potential to reach adolescents. In 2004, Dove launched the Campaign for Real Beauty and

established the Dove Self-Esteem Fund to develop pro-grams that raise self-esteem among girls and young women. To promote the fund, several YouTube videos were created, including Evolution, which has received more than 13.5 million views and nearly 7,000 com-ments. using YouTube as a promotional platform led to high exposure and generated strong engagement from viewers (Dove, 2004).

>>foster PubliC engagement and PartnersHiPs WitH Consumers

Engagement in this context is defined as establishing a connection with others to contribute to a common good. Social media can be used to build online partner-ships and engage communities in support of causes and to respond to crises. Social media research indi-cates that engagement may be prompted when anchored in blogs and social networking sites and this is espe-cially true if participants are at least somewhat active in off-line community participation (Smith, Schlozman, Verba, & Brady, 2009). Merchant, Elmer, and Lurie (2011) summarized how social media has engaged and even mobilized populations in emergency prepared-ness/response efforts. They cite speak to tweet (voice messages sent out as tweets) communication about safety and health within days of the 2011 Egyptian uprising and use of crowd sourcing to link health care providers to those with supplies after the 2010 earth-quake in Haiti.

Social media can also be used to bring health profes-sionals together to establish a foundation for public engagement. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) has created Social Health Hub with the premise that peer learning and sharing is fundamental to the long-term success of public engagement (SAMHSA, 2011). SAMHSA maintains a depository of social media tools, including a directory of the principal hashtags used by its Twitter account as well as blog posts related to its public awareness and support strategic initiative (SAMHSA, 2011).

>>Key PerformanCe indiCators and metriCs

The five purposes of social media in health promo-tion highlighted in this article (market insights, estab-lish a brand and create brand awareness, disseminate critical information, expand reach to more diverse audiences, and foster public engagement and partner-ships) are all associated with one or more of the follow-ing KPIs: insights, exposure, reach, and engagement.

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These four KPIs are defined in this article as follows. Insights pertain to consumer feedback from social media applications that can be derived from practices such as sentiment analysis or data mining that use algo-rithms to extract consumer attitudes and other perspec-tives on a particular topic from social media sites. Exposure measures the impressions or number of times the content on a social media application is viewed, and reach is the number of people who have contact with the social media application.

Engagement is a measurement that links social media to action and can range from low to medium to high. Low engagement assesses the degree to which people are merely acknowledging an agreement or pref-erence for content. Medium engagement means people are involved in creating and sharing content with the capacity to influence others. For example, Klout.com (2011) scores use data from social networks to measure how many people are influenced, how much users influence others, and the influence of a personal net-work. High engagement relates to actual participation in off-line interventions either as a consumer or as a program partner, volunteer, or sponsor and results from some exposure to a social media application.

With respect to social media, evaluation metrics are often application specific and give an initial indication of social media’s ability to communicate with and engage consumers (see Table 1). For example, to assess the activity level of blogs, metrics will likely relate to the frequency of posts and comments. Likewise, met-rics associated with a microblogging application such as Twitter will generally relate to the frequency of tweets and retweets, and so forth. Some social media applications have associated analytic tools available at no charge, whereas other third-party programs are available at varying costs, depending on the sophistica-tion of analysis required. For websites or blogs, web analytic software such as google Analytics or Omniture are used to collect data related to traffic sources includ-ing visitors, views, time on page, and so forth. This software can be free or require a subscription. Social networking sites have similar analytic software availa-ble to all page users (e.g., Facebook Insights), which provides data on number of fans, unsubscribed fans, fan interactions, and fan demographics. Twitter’s cor-responding analytic is called Twitter Analyzer.

As organizations track KPIs through various metrics, process evaluation represents an approach that can bring added value to the assessment of social media’s usefulness in communication and promotional efforts. As described by Saunders, Evans, and Joshi (2005), process

evaluation measures variables such as fidelity, dose delivered, recruitment, reach, and context. For exam-ple, an organization could begin a process evaluation by first determining why it wants to use social media (i.e., purposes). This relates to fidelity, which tracks the implementation of social media to ensure both content and applications are designed and delivered appropri-ately and that they match the intended purposes.

Next, KPIs would be selected. For example, if an organization wanted to use social media to establish a brand and create awareness for cervical cancer screen-ing, it might decide that low, medium, and high engage-ment would serve as KPIs. Low involvement would relate to the extent to which women were acknowledg-ing and agreeing with content, medium engagement would relate to women actually creating and sharing content and trying to influence other women, and high engagement would relate to the number of women using social media applications who actually visit a health care provider for screening.

As a final step, the organization would identify met-rics to measure KPIs (see Table 1). This would involve elements of process evaluation, such as dose delivered, recruitment, and reach. These variables, respectively, would relate to the extent to which social media appli-cations are actually delivered, the manner in which women are invited to participate with the social media applications (and the extent to which all women in the priority population have an opportunity to participate), and the percentage of women in the population who actually participate. Finally, context would be assessed by examining factors that both promote and inhibit use of the social media applications.

>>ConClusion

Health promotion organizations and practitioners must be able to match their program needs with reason-able expectations for what social media can deliver. For example, social media should not be viewed as a solu-tion to the complexities of behavior change and improved health outcomes though there are certainly applications that can support the change process. Rather, use of social media in health promotion should be valued for its potential to engage with audiences for enhanced communication and improved capacity to promote programs, products, and services. These out-comes are more likely to occur when a comprehensive process evaluation strategically tracks variables related to KPIs and metrics and then informs improvements in the use of social media.

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table 1Key Performance indicators and metrics related to social media use in Health Promotion

Key Performance Indicator Definition Metric

Insights Consumer feedback from social media applications

Number and types of suggestions or recommendations

Exposure

The number of times content on a social media application is viewed

VisitsClickthroughsNumber of commentsNumber of ratingsNumber of reviews on rating siteFacebook impressionsViews on a videoViewed blog posts (page views)Asset popularity (which content is viewed most often)Proportion of posts and videos viewed

Reach The number of people who have contact with the social media application and the related content

Fans/page likes Number of people participating in discussions unsubscribed fans Number of followers or subscribers Demographics of subscribers/fans/followers Virality (growth rate of fans, followers, and friends)Engagement (low)

The number of people who acknowledge agreement or preference for content

RatingsLikes on Facebook postsLike ratesFrequency of favoritesLikes or dislikes on videos

Engagement (medium)

The number of people who par-ticipate in creating, sharing, and using content and the degree to which they influ-ence others

Posts or tweets by usersuser-generated content (e.g., videos)Comments on postsComment rateNumber of threads on discussion topicsFrequency of new discussions, new topicsDownloadsuploadsKlout scores (see Klout.com)Number of retweetsRetweet rateMentionsThe number of times a post, video, or link was shared

Engagement (high)

The number of people who engage in offline events (which may be in addition to continued online activity) as a consumer or as a program partner, volunteer, or sponsor

Number of people who register for services/make an appointment

Number of people who participate in off-line advocacy events as volunteers or sponsors

Number of people who attend off-line events as parti-cipants

Number of people assisted Number of participants satisfied

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referenCesBender, J. L., Jimenez-Marroquin, M., & Jadad, A. R. (2011). Seeking support on Facebook: A content analysis of breast cancer groups. Journal of Medical Internet Research, 13(1), e16.

Centers for Disease Control and Prevention. (2010). The health communicator’s social media toolkit. Retrieved from http://www.cdc.gov/healthcommunication/ToolsTemplates/Social MediaToolkit_BM.pdf

Centers for Disease Control and Prevention. (2011a). CDC flu. Retrieved from http://twitter.com/#!/CDCFlu

Centers for Disease Control and Prevention. (2011b). CDC eHealth metrics dashboard. Retrieved from http://www.cdc.gov/metrics/

Currie, D. (2009, October 13). Public health leaders using social media to convey emergencies: New tools a boon. The Nation’s Health. Retrieved from http://thenationshealth.aphapublications.org/content/39/6/1.2.full

Dove. (2004). Campaign for real beauty. Retrieved from http://www.dove.co.uk/campaign-for-real-beauty.htmlFarris, P. F., Bendle, N. T., Pfeifer, P. E., & Reibstein, D. J. (2010). Marketing metrics: The definitive guide to measuring marketing performance (2nd ed.). upper Saddle River, NJ: Pearson Education.Hughes, A. (2010). Using social media platforms to amplify pub-lic health messages: An examination of tenets and best practices for communicating with key audiences. Retrieved from http://smexchange.ogilvypr.com/wp-content/uploads/2010/11/OW_SM_WhitePaper.pdf

Kelly, N. (2011). Measuring social media for brand awareness. Retrieved from http://www.slideshare.net/hootsuite/measuring-social-media-for-brand-awareness-8248650/

Klout.com. (2011). The Klout score. Retrieved from http://klout.com/corp/kscore

Kruse, K. (2010). Social media metrics and ROI: The definitive guide for life science companies, hospitals and public health organizations. Retrieved from http://www.kruresearch.com/ebook/social-media-metrics-and-roi

Lenhart, A., Purcell, K., Smith, A., & Zickuhr, K. (2010). Social media and mobile internet use among teens and young adults. Retrieved from http://www.pewinternet.org/Reports/2010/Social-Media-and-Young-Adults.aspx

Madden, M., & Zickuhr, K. (2011). Social networking sites report. Retrieved from http://pewinternet/org/Reports/2011/Social-Networking-Sites.aspx

McKenzie, J. F., Neiger, B. L., & Thackeray, R. (2009). Planning, implementing and evaluating health promotion programs: A primer (5th ed.). San Francisco, CA: Pearson Benjamin Cummings.

Merchant, R. M., Elmer, S., & Lurie, N. (2011). Integrating social media into emergency preparedness efforts. New England Journal of Medicine, 365, 289-291.

Safko, L., & Brake, D. K. (2009). The social media bible: Tactics, tools and strategies for business success. Hoboken, NJ: John Wiley.

Saunders, R. P., Evans, M. H., & Joshi, P. (2005). Developing a process evaluation plan for assessing health promotion program implementation: A how-to guide. Health Promotion Practice, 6, 134-147.

Scanfeld, D., Scanfeld, V., & Larson, E. L. (2010). Dissemination of health information through social networks: Twitter and antibiotics. American Journal of Infection Control, 38, 182-188.

Silverman, J. (2011). Case study: Building an online youth tobacco control movement. Retrieved from http://www.hria.org/services/health-communications/cs-the-84.html

Smith, A. (2010). Technology trends among people of color. Retrieved from http://www.pewinternet.org/Commentary/2010/September/Technology-Trends-Among-People-of-Color.aspx

Smith, A., Schlozman, K., Verba, S., & Brady, H. (2009). The Internet and civic engagement. Retrieved from http://www.pewinternet.org/Reports/2009/15--The-Internet-and-Civic-Engagement.aspx

Sterne, J. (2010). Social media metrics: How to measure and opti-mize your marketing investment. Hoboken, NJ: John Wiley.

Substance Abuse and Mental Health Services Administration. (2011). SAMHSA’s social health hub. Retrieved from http://www.samhsa.gov/socialmedia/socialhealth.aspx

Thackeray, R., VanWagenen, S., Koch Smith, A., Neiger, B., & Prier, K. (2011, August). Adoption and use of social media among state health departments. Paper presented at the National Conference on Health Communication, Marketing, and Media. Atlanta, gA.

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