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An Overview of Social Media

[Announcer] This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer, healthier people.

[Erin Edgerton] Thank you for joining me for this edition of Health Marketing and Interactive Media. I’m your host, Erin Edgerton. Today I’m talking with Fard Johnmar who is the founder of Envision Solutions. He has developed and implemented programs for global and domestic pharmaceutical companies, non-profits, medical associations, and government organizations. He also holds a Masters of Arts degree from New York University. Welcome, Fard. Let’s begin with a definition of social media.

[Fard Johnmar] The terminology around social media, Web 2.0, new media, emerging media…it’s really changing. So, what I’d like people to remember about social media is that it involves technologies that enable people to collaborate and participate in global conversations around a range of topics.

[Erin Edgerton] When you’re talking about social media for these types of collaborations, how is that effecting the way that public health professionals are interacting with their target audiences, both within the United States and internationally?

[Fard Johnmar] Well, I’m not aware of a lot of public health professionals who are utilizing social media. There are some evangelists out there who really focus on how and why public health professionals need to be using social media more broadly. What I can give, in terms of specific examples, is some of the public health work being done, of course, by the CDC, and I won’t get into that too much because I think the audience will be well aware of the podcasts that CDC, including this one, is producing. CDC also has a blog which is widely read. CDC, also with its new website, has done a really good thing, and I think it really gets to how people use health information in terms of seeking out information that their peers feel is important with the tagging of…and basically that’s just a very simple diagram that shows people what the hot topics of the day are. That’s what the CDC is doing, and when you think about public health, in terms of focusing on the opportunities to receive information about health that will then influence behavior, are the things I think public health professionals working through social marketing or health communications can do to really utilize social media in the most effective way.

[Erin Edgerton] Looking outside of public health, are there other industries that are using social media well?

[Fard Johnmar] One example, actually, that I would give is a wiki called the Flu Wiki, which some of you may be aware of, which has actually become the major source of information about bird flu. When the main stream media, and even the CDC, were kind of still gathering resources and getting information out there, and so a physician looked at that and said, “Well, from a public health perspective, people are very concerned about bird flu. How can we get information out there so that people can start to learn about it and become informed in a responsible way?” So what ultimately happened with the Flu Wiki is that information was highly indexed by search engines, and so anyone - reporters, concerned parents, travelers, other folks - concerned about bird flu or wanting to get more information, went to that wiki.

Another example is a social network that I refer to quite often called Sermo. And Sermo is a physician-only social network that has more than 10,000 physicians within the network. And basically what they are doing is they are sharing information on a global scale about treatment, about epidemiology, about side effects, about medications, and a range of subjects that are starting to, I think, to shape how people treat disease. I think that, you know, in the past what we saw is that physicians were very isolated in terms of how they shared information, but now with the social network, they can start to get, you know, questions answered from their peers. “Well, in my region I practice this way. Well, what do you do here?” And that starts to inform how people actually practice medicine, and it will start to get more people talking about the art of medicine and, then, potentially influence the science as studies start to come out to confirm some of the observations that people are making on Sermo.

So those are two ways I think that people in public health can really look to…at social media’s examples of things that are happening right now.

[Erin Edgerton] What impact are social media sites having on traditional authoritative sources for medicine and the way that people are understanding their health and the options that they have for healthcare?

[Fard Johnmar] Well, I’ll preface that answer by citing a study that came out of the UK recently that actually looked at how people seek information online. And what they found is that people tend to ignore information from…well not necessarily ignore it, but maybe count it less…information from advertising because they distrust the point-of-view. But surprisingly, they tend to sometimes dismiss information from government websites. So the National Health Services website, you know, which has a lot of great information on a range of subjects, is maybe discounted by some users. However, when information was presented from their peers, or people who actually had the disease, they paid a lot more attention to that because they felt that that source was more authoritative than the received wisdom coming from the journals, and the doctors, and those kinds of things. And you know why? It’s because what we tend to forget, I think in general, but especially in health, is that it’s all about me…my feelings, my problems, my situation, and everyone feels that, you know, “Well, my doctor tells me but maybe they don’t really understand.” So I think authoritative sources…we need to find ways to not only integrate some peer information to really contextualize the information that’s coming from authoritative sources in order to make the information more valuable. And sometimes that might be even integrating some of the peer-related information into areas where people are finding authoritative information so that you have that back-and-forth in terms of having content.

And one, actually, one social network that’s actually trying to do this, is a social network called OrganizedWisdom which is a social network for patients. And what they do is that they understand this dynamic, and they have created WisdomCards that can be created by peers and also created by authoritative sources like, you know, if you consider a pharmaceutical company an authoritative source, or the CDC, or a non-profit. So side-by-side, you have both sources of information, and so all of a sudden it’s not, “Well, I go to one site and then I click to another site in order to get the full range.” It’s side-by-side and that’s a way that you can actually participate. So, I think the way that people who create authoritative, or quote unquote “authoritative” information can react to this as understanding this dynamic that I’ve just described and then finding ways to responsibly engage content creators and have your content where people are going for information.

[Erin Edgerton] Could you talk a little bit about the different types of social media that are available and the different levels of control that are offered by the different types of media?

[Fard Johnmar] You know, for an organization like the CDC, it would not be responsible for the CDC to cede control completely of messaging of information because it’s viewed as one of the most authoritative sources around for a range of health topics. However, it can…organizations like CDC, and other public health organizations…can engage with social media by understanding what I call “the continuum of control.” And, if you look at major types of social media, and some of these are blogs, which are websites that are easily updated by folks, and they basically enable people to share information and have conversations on a global scale through a kind of one-way medium that then goes out and becomes part of the larger world. There are also video sharing websites. Everyone’s heard of YouTube. People are posting videos on that website on a regular basis and sharing them with others. There are podcasts. I don’t need to define that because folks are listening in on one and kind of can get what that is, and then there’s also wikis, like Wikipedia, where people are creating documents en masse.

So, if you think about the continuum of control, if you’re interested in participating in social media and retaining some aspect of control, you can understand that video sharing websites and podcasts probably offer you the most amount of control if you want to participate in social media. The issue with podcasts is that many times they’re one-way type of dialogues. There needs to be ways to actually get people to comment and participate and share the information; that’s how it becomes more social. In the middle are blogs. You have some control over what…absolute control over what’s posted on a blog, but unless you heavily, heavily moderate comments, you won’t have control over what people say about that. And you also won’t have control over how people refer to the information on your blog because they’ll link back to your information and talk about it in their own way, so blogs are kind of in the middle of the continuum. And then the types of technologies that provide the least amount of control are message boards. These are very old technologies where people are posting information online or on a range of topics. You don’t have much control over that. You can post whatever you want, but when people get in and start using these, and also social networks, on a regular basis, they’re gonna have conversations about things that you may not want them to talk about or you may, you know, have little expertise in, so you really don’t have much control over that, but there’s still a value in being involved. And then, finally, you don’t have a lot of control…sometimes if you’re looking at a social reality or a virtual reality like Second Life, you can set up your environment, but you can’t really control who comes or, you know, what they do with that information once you’re finished with it.

[Erin Edgerton] What about the digital divide, and how does that effect communications when we’re looking to reach a very broad and diverse audience?

[Fard Johnmar] Before I answer your question in full, I’d like to define what the digital divide is, and we define the digital divide as the gap between minority populations…Southeast Asians, African Americans, Latinos, and the general population…if you define the general population as Caucasians in terms of access to technologies. And usually we define access to technology as access to computers and, then subsequently, access to the internet. The digital divide is real, but the digital divide is not as widespread as it once was. There was a study that came out from Pew…I think it was a couple of months ago…the Pew Internet and American Life Project, focusing on the digital divide specifically and, you know, people tend to think that African Americans, for example, don’t have internet access or don’t use the internet as much as the general population if you define the general population as Caucasian. That’s not true. Hispanics or Latinos tend to use the web less than African Americans and Caucasians. Asians use the internet quite significantly. So, if you really look into the data, the digital divide is …there’s still a divide, but it’s narrowing and the kind of misperceptions that people have about different ethnic populations and groups in terms of access is…they’re many times misplaced, especially when you focus on younger populations because younger populations are using these technologies much more so than maybe middle aged or even, of course, the elderly. So it certainly exists, but it’s less widespread than one would think.

Now that does not mean though, that when you’re developing a campaign, that you don’t keep in mind that some people don’t have access to these technologies. So, if you’re thinking about social media technologies, one of the technologies that really is underutilized but can be used more is mobile technology, and Jay Bernhardt of CDC has focused a lot on mobile, and I think that is certainly correct because the penetration of mobile technology, especially text messaging, is so much higher in some respects than that for internet access here in the United States. So if you’re thinking about using mobile technology as a social medium to transmit information and encourage people to share…it’s really underutilized in health and in other areas, and that’s certainly something that we need to be thinking about as a means of overcoming, or leapfrogging, the digital divide.

[Erin Edgerton] With new social media sites appearing almost every day, how can public health professionals evaluate these sites and determine where they should spend their time and resources?

[Fard Johnmar] Well, what I would say is that if I were developing a campaign and thinking about the most well-established or the best type of media…social media…to get involved in, I would focus on the older technologies like blogs and social networks and message boards and texting and those kinds of things. I would prefer those because more people are starting to use them. When you’re evaluating different types of technologies, you really have to have a good understanding of what the user base is, if it’s significant enough, and they need to be able to give you a sense of, you know, who’s using it, how long are they spending on it, and what are they getting out if it…those kinds of things. And again, there are new social networks being introduced all the time. I would try to get that kind of information because that can tell you whether or not the effort is going to be worthwhile.

So…and then in terms of just learning about social media and social networks, the best way to do it is just explore on your own. Just, you know, go to MySpace and find out what’s happening there. Go to YouTube and find out what kinds of videos are being posted. I mean, there’s nothing more educational and informative than having first-hand knowledge of what’s happening. I understand that people don’t have time to look at every single site, but at least have some familiarity with what’s happening on these…on the major sites and the major types of technologies…to understand why people are using it and how they’re doing so.

[Erin Edgerton] For ongoing campaigns and social media, how do you really start to evaluate the impact that they have on behavior, outside of page views or click-throughs? How can you tell if your messages and social media are having an impact on real world actions and decisions?

[Fard Johnmar] The first thing I think that should be done, and CDC emphasizes this…and its…in terms of when it’s doing a social marketing campaign or any type of public health communications, that the importance of understanding your target audience before you go in, understanding what are the types of behaviors they are engaging in already, understanding what types of communications channels they actually use…to really understand before you go in whether or not the intervention is going to result in people actually using the information.

Let me give you an example. We know that Latinos or Hispanics use radio significantly, you know, much more so than other types of communications channels. We also know that they’re not on the internet as much. So, if you’re looking to do a Spanish language type of program, you have to understand that. Now, that doesn’t mean that it’s not effective to utilize social media, but you have to realize it may be you might be getting folks who are more educated, who are more bilingual, who are more, you know, that’s the group that you’re going to be getting, and so if that’s what you want to do, okay. You have a good rationale for going out and doing that. If you’re looking to really get folks who are of a lower socioeconomic status, they may be recent immigrants and those kinds of things, putting together a social media campaign, not maybe the best thing to do. You might want to work with radio and newspapers and other forms of…other communications channels. So the biggest thing, and my biggest thing that I always talk to people about is don’t get over enthusiastic about social media because it’s so new, and you get excited about the new.

Now let’s get to how do you measure behavior. I do still believe that it’s hard to find out actually what people are doing unless you observe them, and doing observational studies of that kind are just way too expensive. So, you know, the least expensive way to do is to do a pre- and post-survey of, you know, of a group that has not been exposed to the messages and then a group that has been exposed to the messages, and we see this happening all the time in public health. There was a campaign, I think, that was done in San Francisco focusing on safe sex for people who are homosexual in order to decrease the transmission of HIV/AIDS, and they did this campaign, it was a provocative campaign, and elicited a lot of emotions, but they did a pre-survey and looked at awareness, and they did a post-survey, and they saw that not only were people aware of the campaign, but they actually changed their behaviors because of it. So, that there tells you that…it’s expensive to do that kind of thing, but if your budget can handle it, you know, I would say that’s one way to do it.

I also just want to talk about, you know, interim types of measures that you can use because behavioral, the ultimate, you know, the outcomes are the ultimate goals. So, you want to look at the kinds of information you’re having as outputs, but then there’s use, and if no one’s picking it up or using it, that’s an early indication that you have to change track; you have to change it.

So, to summarize my answer, the ways to measure a campaign is to use tried and true measurement methodologies that people use all of the time, do your research before you go into a program around social media, understand who’s going to use it and whether it’s gonna be effective based on the existing data. Then, while you’re involved in the campaign, you need to be measuring how people are using it and whether they’re doing so and, if they’re not, then you need to figure out ways to change course, and there are a variety of ways to do that. And then, finally, if you really want to measure behavior, the best way to do that is to do…maybe do a post-survey of a target audience to understand whether they are aware of the campaign, what impact it had, and then if they changed their attitudes and behaviors.

[Erin Edgerton] I’d like to express my appreciation to Fard for joining me for this addition of Health Marketing and Interactive Media. For more information about this podcast series, please visit the CDC’s health marketing website at www.cdc.gov/healthmarketing.

I’d also like to remind our listeners that use of trade names or commercial sources during this podcast is for informational purposes only and does not constitute an endorsement by the United State Department of Health and Human Services or the Centers for Disease Control and Prevention. Views expressed by guest participants are not necessarily the views of the CDC. Thank you.

[Announcer] To access the most accurate and relevant health information that affects you, your family and your community, please visit www.cdc.gov.