Social media: potential and problems

BOSTON--A wide variety of speakers presented their research projects during the Medicine 2.0 Congress and proved that while mobile health has much potential, it raises many questions as well.

For example, Lisa Gualtieri, PhD, assistant professor in the Department of Public Health and Community Medicine at Tufts University School of Medicine in Boston, said that although official numbers indicate that many people have downloaded health-related mobile apps (10 percent of those with a smartphone), it’s much less reported that just 10 percent of those downloads are ever actually put to use.

Such questions as are incentives necessary for people to use the apps and if so, which ones work lead to more questions, she said. Can apps help you achieve your health goals? Which features are most useful and is short-term use good or should we be designing apps that encourage sustained use?

Lots of providers are hesitant to direct their patients online because they question the quality of the information, said Daniel Swayze, DrPH, MBA, vice president of the Center for Emergency Medicine of Western Pennsylvania, an affiliate of the University of Pittsburgh Medical Center. He monitored discussion threads for 90 days and found that 168 unique members created 272 threads and 3,605 replies. Those numbers indicate that ”the opportunity is outstanding,” he said.

For example, more than 23 million Americans have diabetes and those with Type 2 provide 99 percent of their own healthcare, said Constance M. Johnson, PhD, MS, RN, lead faculty for the nursing informatics specialty of the MSN program at Duke University School of Nursing in Durham, N.C., during her presentation. Those numbers alone indicate great “potential for cost-effective internet interventions,” she said.

She presented her findings from her study of an interactive virtual environment for diabetes self-management that included a grocery store, pharmacy and open chat areas, among other destinations. While she found virtual environments to be feasible and accessible, she also found that the environments have to achieve a fine balance of not being too flat/not interactive enough but not being too intimidating. It seems her team was successful since many users wanted them to keep the virtual environment open for their use after the study was completed.

Meanwhile, technology, including online health communities, are playing an increasingly role in our daily life, said Jackie L. Bender, a doctoral student at the Dalla Lana School of Public Health at the University of Toronto. Despite that growth, there is “still limited empirical evidence on its impact on health status and health outcomes.” The key characteristics of things like online communities may not be measurable. In fact, a new tool may require new thinking, she said.

Another question is how to ethically study online communities. Are they public, private or hybrid spaces? How can researchers study them without influencing the participants? Should consent be obtained at one point in time or over time? How should anyone act on potential harms of these communities and how can they address their concerns and mitigate any harms?

Bender’s co-presenter, Osman Hassan Ahmed, PhD candidate at the University of Otago in Dunedin, New Zealand, questioned whether physicians should be recommending online communities to their patients and if so, how? Also, if a physician takes part in a community, that raises logistical issues. While many communities are global, a clinician typically works out of and is licensed in one place and best practice varies by region.

Another factor influencing online health are those ubiquitous videos and images. “Viral memes are abundant,” said Amelia Burke-Garcia, senior director of digital media for Westat, a research firm headquartered in Rockville, Md. Citing the “feminist Ryan Gosling” images and humorous cat videos currently making the rounds on the internet, Burke-Garcia said that interventionists can tap into viral memes to change health behavior.

She discussed an effort to increase the rate of flu vaccine among several high-risk populations by asking members of Meetup, an online group organizing website, to designate one of their regular get-togethers as a meeting to get the vaccine. Reminding her audience that social media is larger than just Twitter and Facebook, Burke-Garcia said the intervention was a success. The groups studied reported a 12 percent increase in the number who received the flu vaccine and a 28 percent decrease in negative views of the vaccine. Plus, more than half shared information about the vaccine with someone outside of their Meetup group.

“Interactive technologies can and do change attitudes and behaviors,” she said. There’s a movement underway to use social media for behavior change and it offers an opportunity to connect online and offline worlds, she said.