Social Media and Health Promotion by Fattori

HealthPromotionandSocialMarketing

Healthpromotionisaglobalprocesswhi chgoesbeyondthegenericsafeguard ofhealth,butreferstoaspecificstrategywithreferencesataninternational level.Followingthisdirection,theOttawa Charter,thefinalactoftheFirstInternationalConferenceonhealthpromotion, representsastartingpoint:onthisoccasiontheconceptof healthpromotion wasrecognizedforthefirsttimeasa processallowingpeopletogaingreatercontrolovertheirownhealthandtoimproveonit.

Followsthe1988Adelaideconferenceandthe1997JakartadeclarationdevelopedontheindicationsprovidedattheOttawaconference,supportingtheimportanceofshareddecisionsandtheneedforwiderparticipationinhealthprocesses. Fosteringcitizensparticipationisrecognizedaskeycomponenttoempowertheindividualsandtheircommunitytotakeactioninpromotingthehealthoftheentire population.Anewanddifficultchallengeconsideringthatmosthealthpromotion activitieshavehad,andcontinuetohave,theobjectiveofactingoneachsingleindividual(Raphael2006,p.236).Informedandawarecitizenstodayareatalower riskofbecomingpatientstomorrow.

Furthermore,theconceptofhealthpromotioncannotbefullyunderstoodifitis notconsideredinabroaderperspective,asa program:thismeanstoradicallyreview boththestrategyforitsdevelopmentandthemeansforitsimplementation.Designingandimplementingahealthpromotionprograminvolvesputtingtogetherscientificevidence,interventionstrategiesandsustainabilityoftheresultsachieved.

Healthpromotion,definedasthescienceandarttohelppeoplechangetheir lifestylestowardsanoptimalstateofhealth,isanextremelyinclusivediscipline.It isthisflexibilitythatmakeshealthpromotionsuitableforfacingthechallengesthat newtechnologiesseteveryday.Aclearpathishoweverrequired,togetherwiththe understandingofhowtechnologiesareintegrated,sharedandimplementedinthe fieldofhealth.

Healthpromotionbegantodevelopasearlyastheeighteenthcentury,inorderto reducethecomplicationsthatplaguedworkersemployedinunhealthyenvironments. Themosteffectivepromotersofhealthweretheparishpriestsandteacherswhoused thelanguageofordinarypeopletospreadawarenessforthepreventionofcertaindiseases.Theneedtoliveinhealthisconfrontedwiththeneedoftradeandprofit:the convictiontodoawaywithsmokingcontrastswiththeinterestsofcigarettemanufacturers,aswhencenturiesagotheclosureofacity’sgatesstemmedanepidemicbut haltedcommercialtrade.

Apluralityofdisciplines,amongwhichitispossibletoincludemedicine,sociology,psychology,anthropology,communicationsciencesandsocialmarketing, haveexploreddifferentaspectsofcommunicationcampaignsonsustainablelifestyles.Thesecampaignshavethefundamentalpurposeofprovidingindividuals withtoolstogaingreatercontrolovertheircondition,actingonthedeterminantsof

health,namelythelivingconditionsofacultural,social,economicandenvironmentalnatureand,finally,onpersonalandsocialbehaviour.

Attheendofthetwentiethcenturywestartedtoconsiderhealthasphysical,social andpsychologicalwell-being,aswellasaresourceforhumanlife(Nutbeam1988, p.27).Thisapproachalsounderlineshowsocietiesfoundedonprinciplesofsocialequity,thatdevelophealthpromotionasavaluetodefend,arethemostsuccessfuland offerthosewhoarepartofit,betterlifeprospects.However,healthpoliciesneed meanstoachievetheirgoalsand,fundamentally,alsocoordinationwithinthedifferent levelsofplanningandoperations,inanorganizationalmodelinwhichmanagerialand productionresponsibilities aredefinedandassessable.

Socialmarketing isoneoftheseleversandisrapidlybecominganintegralpartof healthpromotionstrategies.Eventodaythedefinitionsof ‘healthpromotion’ and ‘socialmarketing’ arebeingdynamicallyadaptedtotakeaccountoftheinevitabledifferencesbetweenthedifferentcommunitiesandbetweenthedifferentsegmentsofthe population(Griffiths2008):a workinprogress whichperhapswillnevercometoan end,asthepointofarrivalofthetheoreticaldiscussionsisincontradictionwiththe perpetuallyevolutionarycharacterofsociety.

Thelogicalmodelsusedinplanningandevaluatinghealthpromotionandmarketinginitiativeshavebeendescribedinthedifferentphasesoftheplanning,development,implementationandevaluationprocess(Griffiths2008):

– Logicalmodelofexplanatoryfactors:onthenatureandoriginofaquestion;

– Logicalmodelofchangeprocesses:onunderstandingbehaviourchangeprocesses;

Logicalmodelofprogram/action:ontheformationofthepracticalprogram;

Logicalmodelofoutcome/evaluation:onexpectedresults.

PositioningofSocialMarketing

Socialmarketingisadisciplineinitself,distinctfromcommunication,education, commercialmarketingandothereconomicandsocialsciences,fromwhichhoweveritdrawsapproachesandcontributions.Specifically,itbegantotakeshape fromanarticlebyKotlerandZaltmanintheearly1970s.

Socialmarketingistheuseofmarketingprinciplesandtechniquestoinfluenceatargetgroup toaccept,reject,modifyorabandonabehaviourvoluntarily,inordertogainanadvantagefor individuals,groupsorsocietyinitscomplex. (Kotler1971,p.3)

Itstartsfromthefundamentaldefinitionofsocialmarketing’sanalysisoftheterminologyadoptedtoindicatethecurrentsofthoughtandactionsaimedatpromoting amorecorrectbehaviourtowardsone’sownbodyandtowardsthedeterminantsof individualandcollectivehealth.Variousauthorshavealsopaidparticularattention totheconceptof societalmarketing asalsobeingthecommitmentthataprivate companyundertakestoassuregoodenvironmentalorsocialbehaviour.

Theconceptofsocietalmarketingstatesthatthetaskofacompanyistodeterminetheneeds, desiresandinterestsofthetargetmarketsandtofulfilthemmoreeffectivelyandefficiently thantheircompetitors,inwaysthatpreserveandstrengthenthewell-beingoftheconsumer andthesociety. (Adel1974,p.316)

Theattentionoftheprivatesectortowardsitsownsocialresponsibilitycanextendbeyondthemeresaleoftheproductandinvolvesqualityassurance,healthandsafety compliancy,acceptablecosts,aproductionchainthatdoesnotexcessivelydamagethe environment,theeliminationofharmfulmaterials,thenon-exploitationofchildlabour andenergysavings.Theextentinwhichtheseelementsareadoptedcangreatlyimpact onthelong-termpositioningofacompanyinthemarketastheyreflectitssocialrole andresponsibility.

Insocialmarketing,therefore,thesystematicapplicationoftheconceptsof marketinganditstechniqueshasasitsgoaltheimprovementofthegeneralquality oflife,payingparticularattentiontothemostvulnerablesectionsofthepopulation: strategiesthatarenot ‘random’,butattentivetotheWeakintermsofeconomic,socialandculturalcapitaltopromotegreaterhealthequalityamongpeople.

Itisopportunetohighlighttheroleof thepartners duringtheprocess:local authorities,institutions,theworldofhealth,theenvironment,sport,volunteers, entrepreneurs,tradeassoci ations,tradeunions,individualcitizenswhocontributetogether,ifinvolved,tothedefiniti onandtherealizationoftheconceptof ‘ well-being ’ ,alsothroughthemodificationofbehavioursandoftheestablished healthobjectives.

Socialmarketingaimedattheadoptionofhealthylifestylesthereforeintendsto encouragetheconceptofsharingbetweencitizensandthecommunitywithinthe territoryinwhichthepromoterorganizationoperates,ofawiderrangeofalternativebehavioursthatguaranteemoreappropriate,freeandmindfulchoicesthataffecttheirstateofhealthandwhichisdefinedascommunityempowerment(Freire 2018).Empowermentmeansasocialprocessthatpromotestheparticipationofindividuals,organizationsandcommunitieswiththeaimofincreasingindividual,socialandpoliticalcontroloverhealth,improvingthequalityoflifeandsocialequity (Griffiths2008).

Healthpromotionandsocialmarketingcanguaranteestrategiesandpractices toimprovecommunityhealthinaneffectivewaythroughtheempowermentofcitizens(bottom-up);however,empowermentinterventionsmustbecomparedwith theobjectivesdefinedbytheinstitutionsforissuessuchashealthandtheenvironmentthatarisefromtop-downpolicies.

Laveracketalmakethetwomodesofinterventioncoexistbyintegratingina sustainablemannertheprogramsandthetop-downobjectiveswiththebottom-up requestsandneedsinthefieldof paralleltracking (Laverack2019).Paralleltracking shiftsourfocusfromthetop-down/bottom-updichotomybylinkingpublichealth andempowermentinallphasesoftheprogrammingcycle:goalsetting,strategic approach,management,implementationandevaluation.

Thepathwayforthedefinitionofsocialmarketinganditsstrongcharacterizationinthefieldofhealthpromotion(understood,asalreadyunderlined,astheoutcomeofapluralityofphysical,environmentalandculturaldeterminants)canbe facilitatedbyitspositioning(Maibach2002,p.437)ina ‘BehaviourManagement Continuum’ thatconsistsofthreelevers,alternativeorintegrated:communication, socialmarketingandlaws,allaimedatproposingahealthylifestyle.

Theleversofinfluenceontheproposedlifestyles(socialmedia,socialmarketing,regulatoryinterventions)canbedistinguishedwithrespecttotheattitudeof therecipients:

– inthecaseofwillingrecipientsmotivatedtowardsaspecificbehaviour,coupled withweakcompetition,communicationthrough socialmedia maybesufficient toperceivetheadvantagesandmotivateaction;

– whenobstaclestochangepresentthemselves,inasituationthatcanbedefinedasintermediatebetweenpropensityandresistance,aswellaswithpresentandactivecompetition,itisusefultoresortto socialmarketing ,amore refineddevelopmentofthesystem,tohelphighlighttheadvantagesofadoptingaspecificactionandreducingitsbarrierstoadoption.Considerthatthe interventionscanbestructural:ifthe consumptionoffruitandvegetablesis low,itiscertainlyimportanttocommunicatetheadvantagesofamorevaried andbalancednutrition,butitmaybenecessarytoincreasethepossibilitiesof accesstosuchfoodsthrough,forexample,thediversificationoftheofferof vendingmachines,widelypresentinplacesoflifeandwork(Fattori2009, p.149);

– incasesofgreaterresistanceonthepartoftherecipientsandofasituationin whichcompetitionisunmanageablethechoicefallsona regulatoryapproach to reducethesocialcostsofabehaviourthatisbeingrepressed.Themoredifficult itistoinducechange,themorethelegislativesanctionswillbeused:asmoking campaignwillbeaccompaniedbypenaltiesforfailuretocomplywiththerules, whileviolenceagainstwomenorsexualorethnicminoritiesmayleadtoimprisonmentoftheoffender.

Insupportofthisreflectionitisopportunetopointoutthatthedifferentlevelsof changecanbe:

– cognitive (informationcampaignsthatincreasethedegreeofawarenessona specificissue,suchasracism,nutritionalvalues,etc.);

– action (initiativesthataimtohaveconcreteactiontakeninacertainperiodof time,favouringanamortizationofthecoststhatthereferencepopulationwill face;forexample,inthefieldofvaccination,orbloodandorgandonation);

– behavioural (towhichsocialmarketingprojectsaim,insearchofstablechanges inindividualandcollectivehealthbehavioursthatbenefittheindividual,societyandtheenvironment.Considertheapplicationontopicssuchasdrugs,alcohol,smoking,contraception,wasterecycling,violenceagainstwomen);

– values (changesinmoralopinions,suchasracial,sexual,religiousprejudices) dependingonthelevelofpenetrationthatonewantstoachieveintheconscienceoftherecipients(Lee2019).

Thefieldsinwhichsocialmarketinghasthegreatestuseare(Hastings2018)above allenvironmentalones(airandwaterquality,natureprotection,recycling,renewableenergysources,sustainableurbanplanning),thoseofpurelysocialinitiatives (goingtothepolls,preventionofdomesticviolence,volunteering,facilitatingaccesstoinformationandservicesfortheweakestsectionsofthepopulation),public health(HIV/AIDS,alcohol,smoking,obesity,tuberculosis,unwantedpregnancies) andaccidentprevention(roadaccidents,accidentsintheworkplace).

HealthandWeb2.0

Withthebirthofsecond-generationwebservices,commonlyknownasWeb2.0,avirtuallyunlimitedpossibilityofinteractionandsharingwasprovided,especiallythanks totheuseofsocialnetworks(Instagram,Facebook,Twitter,ForumandBlog)andof mobiletechnologies.Thistechnologicalandinformationrevolutionhasalsolargelyinvolvedthefieldofhealthanditspromotion:themethodoftransmissionofknowledge betweenusersandprofessionalshas radicallychanged(McDaid2011).

Theinnovationscitedhavecontributedtothespreadofsocialmediainhealth promotion.Socialmediasignificantlyfacilitatetheexchangeofdataandexperiences regardingone’shealth.Itisatthisleveloftheprocessthatthepromotionshouldbe inserted:informativechangedictatedbytechnologicalinnovationsandbythenetworkcannotfailtocorrespondtoadifferentwayofpromotinghealthwhichtakes intoaccountthenewscenario.

Ifthegoalofahealthpromotioncampaignistoinformandraiseawarenessin individualsaboutaspecificprobleminordertocreatethenecessaryconditionsto changeideasandbehaviours,itisnecessarynotonlytousethemostsuitablemessages,butalsotochoosethemostappropriateandeffectivechannelsandmeans. Untilnow,healthpromotioncampaignshavebeenbasedontraditionaltoolsand haveusedveryfewnewhigh-involvementtechnologiessuchassocialmediaand mobileapplications.

Itisunlikelyhoweverthatthesamemessagecaneffectivelyreachaheterogeneoustargetwhichincreasinglyrequirestargetedandengagingcontent.Theuseof newmedia,inparticularofWeb2.0tools,cansignificantlyhelptoeffectivelyreach thetargetaudience;itisthereforenecessarytofavouranewideaofpromotionthat takesintoaccountandvalorisessynergisticallythegreatpotentialthattechnologyoffersus.Itisnecessarytoreaffirmthatinnovationistheonlywaytoredesignanorganizedhealthsystembasedonthecitizens’ newrequestforhealthandwell-being.

Newparadigmsinthefieldofhealthenterthescene;publicandprivateinnovatorsconnectandconsultwitheachother,givingaconcretedemonstrationofhow thecitizensandtheirneedsmustbeplacedatthecentreofthesystem.

Theintroductionoftheinternetinthefieldofhealthhashadadisruptiveeffect asithascreatedaveritabledividebetweentheconceptofclassichealthandwhat wecouldcallHealth2.0today:healthpromotionmustalsotakethisrevolutioninto account.Asearlyas2006KerryE.Everswasoneofthefirstauthorsinliteratureto addressthisinterestingsubjectmatter.Inthearticle ‘eHealthpromotion:theuseof theInternetforhealthpromotion’ theuseoftheInternetforthepromotionofhealth and,inparticular,thereproducibility,andtheevaluationstrategiesforonlineinterventionsareanalysed(Evers2006,p.1).

Evers’ worklaidthefoundationsforwhatwouldhavebecometheevolutionof healthpromotioninthefollowingyears:shiftingmoreandmoretowardse-health promotioninterventions.PeterKorpalsosupportedEvers’ ideasin2006inthestudy ‘HealthontheInternet:ImplicationforHealthPromotion’ whichfocusesinparticular ontheconceptofempowerment(Korp2006,p.78).

ThankstotheadventoftheInternet,informationiseasiertoaccess,moresocial contactsandnetworksarecreated,thecitizensaremoreinformedabouttheirhealth. However,thereisnoshortageofproblematicaspectssuchasthedigitaldivide,the assessmentandreliabilityofsources,thestrongcontroloftechniciansandexperts, anexcessiveincreaseinmedicalizationandhealth.Thetaskofagoodhealthpromoter,therefore,istodesignstrategiesthatareabletostrengthentheusers’ abilityto evaluatethevarioussourcesofinformationinrelationtotheirinterestsandneeds, ratherthaninrelationtoscientificand/orprofessionalstandards.

Withthespreadoftheinternet,therefore,eHealthentersthescenewitheHealth Promotion.ProgramsbasedoneHealthpromotionautomatedatacollectionsandensuregreaterinteractivityandflexibility.EffortsmustthereforebefocusedoncombininghealthpromotionwitheHealth.InarecentreportbytheEuropeanCommunity Commission,eHealthisdescribedasausefultoolforbothhealthprofessionalsand patients.

Inreferencetointeractivecommunicationtechnologies(Ratzan2011,p.1)we areexperiencinganeraofopportunitiesneverbeforeexperienced.So-called participatorytechnologies,suchasWeb2.0anditsextensions,mustbewellexploitedand usedbybothpotentialpatientsandstakeholders.Thankstotheever-increasing digitalhealth,wearenowabletodevelopeffectivecommunicationstrategiesforhealth inpreventing,helpingandsupportingpatientswherevertheylive.

Ofallthetoolsintroducedinrecentyears,undoubtedlyappsandsocialmedia aretheonesthathavehadthemostsignificantimpactinhealthcare.Somuchso thatwecantalkaboutapreandpostWeb2.0,aswellasapreandpostandHealth.LeeAase,inthetext ‘ BringingtheSocialMediaRevolutiontoHealth Care ’ ,isoneofthefirsttobelieveinthepowerofsocialmediainhealthcare (Aase2016).

Hospitalsmustfaceandmanagethisradicalchangebylearningtousethese toolsofdialoguewithcommunities,redesigningtheirorganization,encouraging participation,buildinganetworkofprofessionals,sharingideas.Apioneerinthe useofsocialmediainmedicineisBertalanMeskò,founderof Webicina andauthor of ‘SocialMediainClinicalPractice’ (Meskò2013).AccordingtoMeskò,socialmedia havechangedtheworldofhealthcare.Web2.0,internet,socialmediaarerepresentationsofthesameconcept:digitalcommunication.

Socialmediacanfacilitatecommunication,doctor/patientinteraction.TheultimategoalisnotthateveryhealthcareprofessionalbecomesabloggeroraTwitter expertbutthateachofthemcanchoosetheplatforms,tools,solutionsthatfacilitate theirownandpersonalcommunicationflowwithpatients,withcommunities.

AnimportantmedicalassociationliketheASCO(AmericanSocietyofClinical Oncology),throughitsportalhelpsoncologiststounderstandanduseTwitter,supportingmutualenrichmentforthosespecialistswho,thankstosocialmedia,can betterconferwithcolleagues,patientsandcaregivers.

Thethemeisthereforeverycurrent,especiallyifmobileapplications,which haveoflatebecomeprotagonistsintheeHealthfield,comeintoplay.Flexibility, innovativenessandeasyintegrationwithallportabledevices(smartphones,tablets) havemadethemthecornerstonesofthenewconceptofelectronichealth.Inthe sameappwefindpreventionandhealth; mobilehealth isnolongersimplyaphenomenon,butarealitywithwhichwemustconfrontourselvesinasocietythathas discoveredtheincrediblepotentialofsmartphonesandtabletsanddoesnotwant (andperhapscannot)dowithoutthemanymore.

Theappsavailabletodayinthehealthareaaredividedmainlyintofivemacroareas:diet,exercise,healthandpersonalcare,sexualityandsleepdisorders.Allthe applicationsallowagreaterdiffusionofinformationamongthepopulationandmake userspronetotheimplementationofcertainbehaviours.Alongsideresearchthatsuggeststheuseofappsandlooksuponthempositively,therearestillstudiesthatshow criticism.AnarticlepublishedbytheJournalofMedicalInternetResearch ‘There’san appforthat:contentanalysisofpaidhealthandfitnessapps’ analysedsomesmartphoneapplicationsdedicatedtohealth,inparticularfitness,assessingthepotential impactofeachinbehaviouralchange.Acriticallookthatunderlineshowfewapplicationsaredevelopedrespectingthemostconsolidatedtheoriesofhealthpromotion (West2012,p.12).

Currentlyacademicliteraturepresentslittleanalysisontheuseofappsinhealth promotion(Hasman2011,p.322).ThepotentialoftheInternetbegantobeunderstoodattheendofthenineties;today,healthcarecompanies,hospitals,researchinstitutes,shouldpresideovertheplacesinwhichpatientsexchangeinformationand supporteachother,whileembracingandfacingthesocialrevolution.Atthisfurther levelthestrategybecomesafocalpoint.

SocialmediaareInternet-basedtoolsthatarecreatedandexploittheideologicalandtechnicalpremisesofWeb2.0andallowtheproductionandexchangeof

‘usergeneratedcontent’ (Kaplan2010,p.59).Adaptingtothesechangesbecomes essential,especiallyifwetalkabouthealth.Thecomplexityofthecommunication, theinteractionsandtheimplicationsthatcanbegeneratedthroughthedirectcontactofhealthprofessionalswiththeuser/patientmustberecognized.

WiththeunionbetweenWeb2.0andhealth,anewresearchsectoriscreated, inwhichhealthpromotionplaysacentralrole.

Giventhecomplexityofthetopic,theintentistotraceanddescribeapaththat startsfromtheconceptofhealthpromotionandendsineHealth,passingthrough Web2.0andsocialmedia.

ItwouldbeuselesstotalkaboutHealthPromotionanditsdevelopmentsifthe competencessharedatinternationallevelwerenotestablishedandpossessedby allthosewhowishtooperateinthesector.Inthisdirection,theproject Developing CompetenciesandProfessionalStandardsforHealthPromotionCapacityinEurope (CompHP)whichseestheparticipationof24countriesaroundtheworldcoordinatedbytheEuropeanOfficeofInternationalUnionforHealthPromotionandEducation(IUPHE),aimstoidentifythebasiccompetencesofoperators(healthand non-health)forhealthpromotion(Speller2012).Theprojectproposessomerelevant objectivesfortheprofessionaldevelopmentoftheHealthPromotionsectorand presentsitsprofessionalstandards.Thedocumentdescribestheprograms,policies andotherhealthpromotioninterventions.

EthicalvaluesarefundamentalforactionsinHealthpromotionandformthecontextinwhichallotherskillsarepracticed.Theyinclude:equity,socialjustice,respect forautonomyandthechoiceofindividualandgroupworkprocessesbasedoncollaborationandconsultation.TheninestandardsidentifiedbytheCompHPProjectare:

– Promote behaviourchangethrough empowerment andcitizenparticipation;

– Improve healthandwell-beingbyfacilitatingcommunitiesandgroupstoarticulatetheirneedsandsupportthedevelopmentofpoliciesandproceduresinall sectorswhichhaveapositiveimpactonhealth;

– Mediate throughpartnership,buildsuccessfulpartnershipsthroughcollaborativeworkandfacilitatethedevelopmentandsustainabilityofcoalitionsandnetworksforhealthpromotionaction; – Communicate healthpromotionactionsthroughtechniquesandtechnologies suitableforaheterogeneouspublic;

–

Leadership,throughworkwithstakeholderstoagreeonasharedvisionand strategicdirection;

– Analyse theneedsandresourcesincollaborationwithstakeholders,withinthe frameworkofpolitical,economic,social,cultural,environmental,behavioural andbiologicaldeterminants;

– Plan throughthedevelopmentofhealthpromotionobjectivesthatarebothmeasurableandbasedontheassessmentofneedsandactivitiesincollaborationwith stakeholders.Mobilize,supportandinvolvetheparticipationofstakeholdersin theplanningofhealthpromotionactions;

–

Implement effectiveandefficientactionsincollaborationwithinterestedparties;

– Evaluate theimpactandeffectivenessofhealthpromotionactions.

Inhealthpromotion,socialmediacanbeusedasamediumtopromotecitizen empowerment,improvehealthandwell-being,mediatethroughpartnerships,communicate,analyse/collectdata,implement,evaluateandresearch.

FromSocialNetworkstoSocialMedia

Thehistoryofsocialnetworksbeginslongbeforetheinternet,Euler ’sworkand hisgraphtheorythatunderliestheentiretheoryofnetworksoftodaydatesback to1736.Thesocialnetworkismadeupofagroupofpeopleconnectedtoeach otherthroughdifferentkindsofrelationsh ips(personal,professional,religious, etc.).Sincetheseearlystudies,socialnetworkshaveneverstoppeddeveloping;in theearly2000s,thefirstcollaborativeservicessuchasWikipedia,YouTubeand Facebookappearedonthescene.

Web2.0wasrisingfromtheashesofthe2001crisis.Startingfromtheearly yearsofthenewmillennium,thesocialnetworktimelinehasbeenacceleratingvery fast:in2003LinkedInwasintroduced,in2004Facebookwentonline,in2005YouTube,in2006aminimalistmicrobloggingservicelikeTwitterwaslaunched,Instagramin2010.

Thenetworkinteractionmode(profile,connectionorfriendship,message,status, comment,etc.)hasquicklyestablisheditself,becomingthestandardwithwhichpeoplehavebecomeaccustomedtointeract.Takingastepforward,SocialNetworksare oneofthekeyelementsofabroader ‘revolution’ thatshouldbepigeonholedunder thenameofSocialMedia.Thistermmeansagroupoftechniquesandrulesforcreatingandsharingonlinecontent.Itisachangeofroles:theusersalsobecomeproducersofcontent.

Bettermanagingsocialmediameansdevelopingmulti-channeldigitalcampaigns withsocialmedia,websites,apps,mobile,wearabletechnologywheresocialmediais integratedwithtraditionalcommunicationtools.Nowwewilltrytodefinethescope ofactionandlearnaboutthesocialmediamostinusetoday.

SocialMedia

Socialmediaisaconstellationoftoolsandtechnologiesthatenablepeer-to-peer conversationsandco-creation.Eachofthesetoolshasdifferentcharacteristicsand findsdifferentapplicationswithrespecttohealthpromotion.Tothisend,social mediahavebeendividedinto(DeAngelis2018,p.1):

– collaborativeprojectssuchas Wikipedia:thesearewebsitesthatallowusersto add,removeandmodifytext-basedcontentandenablethejointandsimultaneouscreationofcontentbymanyendusers;

– contentcommunitiessuchas Youtube, Instagram and Podcast:theseallowusers tosharemultimediacontentsuchasvideos,photosandaudio; – blogandmicrobloggingsuchas Twitter: thesearespecificwebsitesthatprovideinformationindifferentformats,particularlyappreciatedbyprofessionalnetworks;

socialnetworksuchas Facebook: theseareapplicationsthatallowuserstoconnectbycreatingpersonalinformationprofiles,invitingfriendsandcolleaguesto accesstheseprofilesandexchanginge-mailsandinstantmessages;

– virtualworldssuchas Secondlife:theseareplatformsthatreplicateathreedimensionalenvironmentinwhichuserscanappearintheformofpersonalized avatarsandinteractwitheachotherasinreallife;

– discussion forums:theseallowparticipantstoconverseusingpostedmessages; theyhavebeenconsideredaformofsocialmediaastheyincorporateusergeneratedcontent.

Socialmediaisnotjustameansofentertainment,itisnowpartofourlives.Itis thereforenecessarytoadoptaprofessionalapproachtosocialmediaandadopta socialmediastrategy.

Socialmediastrategiescanbetracedbacktosomemorecommontypes:

– Monitoringstrategies aimtoestablishasmuchaspossibleabroadandsolidparticipationofthecompanyintermsofcontentandwithoutapredefineddeadline. Thesearecostlystrategiesbothintermsofeconomicsandresources(dedicated staff,etc.).Onceadopted,suchstrategiesrequireaninnovativeandprecisemetricsystemtocalculatetheROI(ReturnonInvestment).AservicelikeFacebook lendsitselfwelltodevelopingsuchastrategy;

– Promotion strategiesarethoseundertakenbycompaniestosupportthelaunch ofacampaignorinitiative.Oftenthesestrategiesaresupportedbyasignificant investmentonaverage.Theyaretargetedstrategiesandhavetimelimits

– Project strategiesarealwaysofatemporarycharacterbutarelesslimitedtoa specificsubject/topic.Theorganizationtendstoworkonthespecificobjective tobeachieved.Suchstrategiescanonlysucceediftheyareaddressedtotheappropriatecommunity.

– Listening strategiesarethewayforthosecompaniesthathave,bychoiceorby waiting-and-seeing,decidedtoonlyconfrontsocialmedia ‘passively’.Thelimits oflistening-onlystrategiesareobviousbecausetheydonotusesocialmediafor communication.Inanycase,theydonotprecludethepossibilityofintervening atalatertimeandrepresentanoptionthat,ifmanagedwell,canbeuseful.

Inhealthpromotion,preciseindicationstodeterminestrategicobjectivescannotbe ignored.Theimportanceofestablishingprioritiesandobjectivesisalsoemphasized

byLeeAaseoftheMayoClinicCenterforSocialMediainthesevenpointstobeconsideredforasocialmediastrategy(Aase2016):

– Startfromprioritiesandgoals;

– Becomefamiliarwiththetools;

– Startastrategyfromobservationandlistening;

– Askforhelp;

– Payattentiontothecommunityrules;

– Don’tbeoverwhelmedbypurists;

– Rememberthatplanningismoreimportantthanplans.

Socialmediachangesthewaypeoplecommunicateandorganizationalgoalsneedto beredesignedtoengagepeople.Furthermore,thechoiceofthereferencetargetwill influencethechoiceofthechannel.Spendingtimedevelopingandmaintainingsocialmediapresencewillbeunproductiveifwedonotdecidehowtousethechosen channel.

Inparticular,wemustdefinetheobjectives(forexample,promotethecompany orcreateapersonalonlinepresence)anddesignagoodstrategybasedonourneeds: Twitter,forexample,canbeusedforbriefconversations,whileblogsarepreferable forsharingopinions,essaysandpresentations.

Someimportantindications(Meskò2013):

– Donotmixprofessionalandpersonallifeonline;

– Beopentodiscussions;

– Communicateasyouwouldinreallife;

– Beconsistent;

– Alwaysshowintellectualrigorandbecommitted.

SocialMediaandHealthPromotion

TheguidelinesoftheCentersforDiseaseControlandPreventionofAtlanta(CDC 2011)proposetheinnovativeuseofSocialMediainhealthpromotion.Inthisdirection,socialmediaandmobilecommunicationtechnologiesfavour:

– theimmediacyofinformation; – sharingcontentwithpartners; – personalizationofmessages;

– facilitatingtheintegrationbetweendifferentorganizationsandinstitutions;

– supporttowardthechoicetoadopthealthybehaviours.

Socialmediadonoteliminatethedisparitiesbetweengroupsbutduetothelow costandthegrowingspreadoftheInternettheycanreducetheinequalitiescaused bythedigitaldivideandthedifferentlevelsofhealthliteracy(Bodie2008,p.175). PopularplatformslikeFacebookInstagramorTwitterhaveallowedamyriadofnew

voicestoemergeinthesocialmediaspherewhereindividualscanbeequallyas presentasbigcompanies,researchersandgovernments.

Theevolutionofthemediaintroducesnewproblemsduetothetruthfulnessof thedata,tofakenewsandtoprivacyissues.Healthpromoterscannolongerbase theirauthorityonlyonsocialpositionassocialmediaoffersthepublicequalor greatermeansthanprofessionalstoactoncontroversialissuessuchasvaccinations oralternativemedicine.

ByintegratingWeb2.0intohealthpromotiondynamics,theaspectofevaluationisrelevant.Intheplanningphase,thereasonforwhichyouintendtousethat particularsocialnetworkandtorecognizethecontributionthatthelattercanoffer intheadoptionofhealthylifestylesshouldbeestablished.

Despitetheincreasinguseofsocialmedia,westillhavealongwaytogoregardingtheappropriatenessoftheirusetopromotehealthandontheirevaluation.In ordertoexaminethisdimensionindepth,thefollowinghavebeenevaluated(Neiger 2012,p.159): – thepurposeofsocialmediainhealthpromotion; – thepotentialKPI(KeyPerformanceIndex)associatedwiththesepurposes; – evaluationmetricsforsocialmediarelatedtoKPI.

Experiences

Socialmediaareextremelywidespread,buttherapidityinwhichtheychange makesitdifficulttoevaluatethemwithincomplexpublichealthissues.Wehave selectedvariousprojects,eachoneforitsdistinctivefeatures,thathavechosen differentplatformsofsocialmediaforhealthpromotionbutarealwayslinkedto sharedpublichealthobjectives.

Addressingat-riskpopulationsamongInt ernetusersisparticularlyimportant becausethoseseekingsexontheInternetmaybemoresusceptibletoHIV.This 12-weekinterventionshowedthatparti cipantswhoreceivedinformationonHIV preventionviaFacebookweremorelikel ytorequireHIVtestingthanthosewho hadreceivedgeneralhealthinformation. Theseinterventions,throughthepeer figureoftheonlinecommunity,haveallowedtheuseofcondomstoincrease andthenumberofunprotectedsexualrelationstodecrease.CommunitiesonsocialnetworksareconsideredeffectivetoolstoincreasetherequestforHIVtestingamongat-riskpopulations(Young2013,p.318).

SocialNetworkingTechnologiesasanEmergingToolforHIV Prevention

Onthesubjectofobesity,asofMarch2010,morethan12,000videoshavebeenfound andthemostpopularofthesehavebeenviewedmorethan9milliontimesbyYouTube users.ThesearchontheYouTubesitewasdoneinMarch2010usingthekeywords ‘obesity’ and ‘obese’.Researchthroughthekeyword ‘obesity’ produced38,000results, whilethosewiththeword ‘obese’ 37,500.

Obesepeopleareassociatedwithnegativecharacteristicsmuchmorethannormal-weightonesandaresubjecttomanymorenegativejudgmentsand/orstigmatizations.IneverysinglevideocategoryofYouTube,unhealthynutritionandasedentary lifestylehavebeenportrayedasthemaincausesofobesity.

Thevideosthemselves,inallthedifferentformats,havethereforerecommended thatthebestsolutiontocombatobesityistomodifyindividualbehavioursdoing physicalactivityorhavingahealthydiet(Yoo2012,p.86).

RemoteandWeb2.0InterventionsforPromotingPhysical Activity

Doinganinsufficientamountofphysicalactivityleadstoanincreasedriskofchronic diseasesandbothphysicalandmentalproblems.Regularphysicalactivitycanproducesocial,physicalandemotionalbenefitsandassuchshouldbeagoalforall adults.Fromatotalof11studies,5,862apparentlyhealthyadultswererecruited,and itemergedthattheuseoftechnologyisappreciatedwhensupportingadultstobecomemoreactive,followaweeklyrecommendedfitnessplanorbeinbettershape. Changescanbeobtainedwiththehelpfromaprofessionalandthroughpersonalsupportbyphone,e-mailorwritteninformation(Foster2013).

Traditionalhealthpromotioninterventionscannotproduceimprovementsinthe lifestylesofthepopulationasmuchasinterventionsbasedontheuseoftheInternet,whichinsteadcanbewidelydisseminatedatareducedcost.

Onlinecommunities,likethoseforwalkingprograms,allowparticipantstocommunicatewitheachotherbysendingandreadingmessages.Allparticipants(n=324) worethepedometerforthe16weeksanduploadedthedataonline.Therecoursetothe onlinecommunityforawalkingprogramusingtheInternethasnotincreasedthenumberofstepscountedonaverage,buthasreducedtheabandonmentbytheparticipants.

Onlinecommunitiescanbeapromisingapproachtoreducingtheabandonment ofhealthactivities,particularlyinpopulationswithlowsocialsupport(Richardson 2010).

Web2.0andBeyond:RisksforSexuallyTransmittedInfections andOpportunitiesforPrevention

ThecontinualgrowthoftheInternetasameansofcommunicationhasalsohadimportantimplicationsforthetransmissionandpreventionofsexuallytransmittedinfections(STIs).Thepurposeofthisreviewistodescriberecentdevelopmentsina rapidlyevolvingfield.

ThemeetingpointbetweentheInternetandsexuallytransmitteddiseases(STDs) isdescribedinthreeperspectives:theInternetasariskenvironment,aplacewhere sexualpartnerscanberecruited;Internetasaplacewherepublichealthprevention interventionscanbeperformedaimedatpreventingsexuallytransmitteddiseasesand HIV;InternetasanincreasinglyimportantworkenvironmentforallMSTprevention disciplines.

Thereviewhighlightsrecentdevelopmentsandidentifiespotentialavenuesfor futureresearch.ThegrowinginteractivityoftheInternet,inparticularthesocial networkingsitesthatallowuserstocloselyshareunlimitedamountsofpersonalinformationwiththeirpeersonthenet,increasesthepotentialoftheInternetasan environmentbothforSTIsriskandforitsprevention(Rietmeijer2009,p.67).

Smokingcessationprogramsbasedontextmessagesfrommobilephonescanincreasesmokingcessationintheshortterm.Smokerswillingtomakeanattemptto quit(5800)wererandomlyassignedtoacontrolgroup,usinganindependenttelephonerandomizationsystem:thesmokingcessationprogramwascalled txt2stop. Themessagessentweremotivationalandbehavioural.

Onthebasisoftheresultsobtained,itisclearthatthetobaccocessationprogramtxt2stophassignificantlyimprovedthedivestmentratesoveraperiodof6 monthsandcanbeincludedintheservicesaimedattobaccocessation(Free2011, p.49).

YouthDrinkingCultures,SocialNetworkingandAlcohol Marketing:ImplicationsforPublicHealth

Millionsofpostsonnotice-boards,profilesandphotosthatgoaroundaboutalcohol playanimportantroleinthenormalizationofdrinkingalcoholwithinthelifeand cultureofyoungpeople.SocialNetworkscanbeusedpositivelyinhealthcaretoencourageyoungdrinkerstoresponsiblychangetheirhabits.

UsersofSocialNetworksontheonehandcanbenefitfromthecreationand sharingofcontent,ontheothertheyrepresentaneasytargettobereachedbyalcoholsellers.TheunregulatedandprobablyuncontrollablecharacteristicsofSocial Networksmakethempopularwithalcoholproducersastheyincreasinglybring theminclosercontactwithconsumers(McCreanor2013,p.110).

SocialMediaandOrganDonorRegistration:TheFacebookEffect

AstudypublishedintheAmericanJournalofTransplantationbyresearchersat JohnsHopkinsUniversityinBaltimoreshowedthatFacebookhaseffectivelymade citizensawareoforgandonation.OnMay1,2012,thesocialnetwork,Facebook, changeditsplatformtoallowmemberstospecifyOrganDonorstatusontheirprofile.Thischoicewassharedonthefriends’ pagevianotificationandwasfurther enhancedbysendingeducationallinksonthethemesofthedonation.

Onthefirstdayofthe ‘OrganDonor’ initiativeonFacebook,therewasanincreaseintheactualnumberofnewdonorsof21.1times,goingfromanaverageof 616dailyregistrationsto13,054.Overallintheobservationperiod(thestudylasted 13days)therewere39,818registrations,ofwhich32,958attributabletotheFacebookeffect.

Newapplicationsthroughsocialmediacanthereforeprovetobeeffectiveinincreasingorgandonationratesandsimilarlycouldbeusedinotherpublichealth fieldswherecommunicationandeducationareessential(Cameron2013,p.2059).

Prenatalexposuretoalcoholcancausearangeoflifelongphysical,behavioural, andintellectualdisabilities,collectivelyknownasfetalalcoholspectrumdisorders (FASD).FASDisrecognizedtobeaninternationalpublichealthproblem.Increasing awarenessabouttherisksofdrinkingduringpregnancyisconsideredthefirststep towardsFASDprevention.Aninternationalawarenesscampaignwasorganized, called ‘TooYoungtoDrink’ (Figure10.1).

Figure10.1: TooYoungtoDrink – Fabrica.

Source:Availablefrom:https://web2salute.com/tytd/(Viewed3July2020)

Thecampaignusedtheoreticalmodelsofsocialmarketingappliedtohealthpromotion.Theapproachaimedtospreadinformationamongthegeneralpopulation, sharingideasandusingthepoweroftheInternetandsocialmedia.Thelaunchfollowedthemethodsof ‘guerrillamarketing’.Socialmedia,mainlyFacebookandTwitter, werethedrivingforcetothediffusionofthecampaign.

Findingsfromthecampaign ‘ TooYoungtoDrink ’ showedthatitwaspossibletodevelopandcarryoutaninternationalactionplantoraisepublicawareness ofFASD,usingsocialmarketingstrategiesandsocialmediatospreadmaterials andinformationontheissueamongdifferentcultureswithalowbudget(Bazzo 2017,111).

BreastfeedingwithStart4LifeonAmazonAlexa

InEngland,breastfeedingratesareamongthelowestintheworld.75%ofwomenstart breast-feedingwhentheirbabyisborn,unfortunatelybetweenthesixthandeighth weekthisdropsto44%.Expectantmotherswhoaresupportedproperlybreastfeedlonger.England’sPublicHealthStart4Lifeprogramprovidessupportforparentstoadopt healthybehaviours.

ForthefirsttimetheAmazonAlexavoiceserviceisalsoavailable.Motherscan askAlexa(Figure10.2)aseriesofquestionsaboutbreastfeedingandtheanswers willbetailoredtotheirchild.Thismeansthattheycanreceiveusefuladvicealso throughvoicecommands(PublicHealthEngland2018).

Asurveyshowedthat24-houraccess7daysaweektobreastfeedingsupportvia aphoneline,websiteorchatbotmaymorelikelyresultin: – havingapositivebreastfeedingexperience; – decidingtotrybreastfeeding(59%); – breastfeedinglonger(58%).

Source:Availablefrom:https://twitter.com/PHE_uk/status/970628333665968128?s=20 (Viewed3July2020)

#FridaysForFuture ‘OurHouseisonFire’

#FridaysForFutureisaverypresenttopiconsocialmedia,youngpeoplehaveused Instagram,Facebook,TwitterandYouTubetosupporttheircause.Socialmedia havefacilitatedknowledgeofclimatechangeandmobilizationofactivistsbyprovidingplatformsfordiscussionandsharing(Thunberg2019).

Theabilityoftheseplatformstospreadvideos,imagesandtextandtobeonline haveenabledthecreationofaworldwidemovement.Youngpeopleaskedtostep upactionstotackleglobalclimatechangeandusedsocialmediatopromoteoffline activities.

Socialmediacangivevisibilitytosocialissuesandhavearealeffectonpublic opinion.TheGlobalStrikeForFuturetookplaceonFriday,15March2019,with theparticipationof1.5millionstudentsinmorethan2,083citiesin125countries (Figure10.3).

TheTechnological(andSocial)Revolution

Throughsocialmedia,humanrelationships,conversationsandinformationovercomespace-timebarriers:inadditiontothetechnologyrevolution,wearefacinga

Figure10.2: Start4LifeBreastfeeding.

Figure10.3: Schoolstudentsgoonstrikeoverthelackofactiononclimatechange. Source:Availablefrom:https://twitter.com/GretaThunberg/status/1106638130290049024?s=20 (Viewed3July2020)

socialrevolution.Anewworldtoknowandtointerpret;beyondtheobstaclesto innovation,weseeenormousopportunitiesforsocialmediaandhealthpromotion.

Thenewhealthprofessionaliswitnessingthemostimportantrevolutionofall time;rules,hierarchies,skillschange.Allatasurprisingspeed. ‘Dr.Google’ is changingthepatientmedicalrelationshipandtherelationshipsbetweencitizens. Socialmediapromoterscandevelopstrategiestoengagethepublicandencourage learning(Norman2009).

Evenwhensocialmediaiseffectiveinproducingpositivehealthoutcomeswe mustcontinuallyfollowitsevolutionandchangetheapproachofoperatorsandpolicymakerstoadapttothesenewrealities.Allsectorsofsocietyareinvolvedandwe havealsoseenthathealthpromotersaredefiningwhichskillsandvaluestoadopt internationally.

Inthepreviousstorieswehavedescribedsocialmediaexperiencesforhealthpromotion.Todaywehaveanewally,aprotagonistwhowantstositatthetableof ‘rules’ tohelpdefinehisfuture, PatientDave whotellsus ‘nothingaboutmewithout me’;thecompetentcitizenisinterestedinparticipatingin ‘Citizenincluded’ research andprevention.

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Social Media and Health Promotion

GiuseppeFattori

10SocialMediaandHealthPromotion

Introduction