[Ryan Weber] Welcome to 10-Minute Tech Comm. This is Ryan Weber from the University of Alabama in Huntsville. Today I’m pleased to welcome Dr. Aimee Roundtree, an Associate Professor of English at Texas State University. We’re talking about her newest study in the Journal of Technical Writing and Communication, titled Social Health Content and Activity on Facebook. Her study examines the off and online health related activities of Facebook users who use Facebook for health-related purposes. She wanted to know if people were behaving online the way that medical communicators expected them to, and she found that often they are not. I had the chance to sit down and talk with her at the recent Pro-Comm Conference in Austin, Texas.
[Weber] Thanks so much for joining me today Aimee. What led you to study health-related interventions on Facebook? What did you find interesting about it and how did you go about doing your study?
[Aimee Roundtree] Need inspired this story. I was working, doing consulting, in the Texas Medical Center.
[Roundtree] At MD Anderson, and we were submitting grants for public health interventions. This was right at that peak of social media frenzy in public health education programming. People were interested in using these new technologies, Facebook in specific, because Facebook is a technology that in some ways parallels interventions very familiar in public health, like support groups, online listservs. Those were already pre-established genres of venues for public health education. So, we were interested in finding ways to leverage Facebook in the same regard. So we were submitting grants for Facebook interventions in internal medicine and primary care and grant funders were not having it.
[Weber] Okay. They were not interested, yes.
[Roundtree] Also in writing these grants, I found that it was very difficult to establish in the background section of the grant, efficacy of Facebook. Many of the studies were case studies, small controlled trials, with mixed results. Still the interest sustained. This interest in Facebook sustained, so I was very concerned that perhaps we were putting the cart before the horse. That we were very interested in new technology because it’s shiny and not sure of its efficacy, and that’s what sustained this. So most of the studies that used Facebook as a method of intervention, public health intervention, most of them had a couple of presumptions. They presumed that Facebook paralleled face-to-face interaction.
[Weber] Okay. That it just mimicked, it took that space on, yeah.
[Roundtree] That it took the space. They also had the presumption that people were comfortable using online technology for social health, social interaction, and so my study challenges or tests those assumptions.
[Weber] Okay, okay. So, you’re looking at whether online and offline behaviors are similar?
[Roundtree] That’s right.
[Weber] Sort of what offline behaviors get imported online.
[Roundtree] Absolutely and I-I found, I think that this is one of very few, what I am calling validation studies, so in science of course you know there are issues of reproducibility and replicability.
[Roundtree] And that’s-really, it’s a point of controversy recently in medical health. There are too few studies that have been replicated or reproduced and often when replicated and reproduced, the findings are disparate.
[Roundtree] So I felt like it was important for our field to do the same thing. When we’re dealing with applying emerging technologies, we shouldn’t, we shouldn’t get caught up in the excitement of its potential. We should have a very stayed and careful application of it and take a really critical look at the assumptions we have about that technology.
[Weber] Great. So how did you set up your study?
[Roundtree] I designed the survey based on a couple of pre-existing models of health behavior and decision making in medicine and in public health.
[Roundtree] The first is the health behavioral model, which essentially says that there are cues in the social influences that make you decide whether or not you’re going to behave a certain way.
[Roundtree] Whether or not you’re going to make a health decision. And there’s also a model called the patient activation model, and essentially it says that in order for you to own your own decision, your health decisions, you have to have certain factors, social influence being one of them. And I surveyed anyone I could. It’s a convenient sample, so a sample of anyone I could.
[Roundtree] Most of which from listservs, the patients, from online researchers, anyone who would take it, which I think is also an asset of the study. Most studies have these presumptions about how patients use social media or how patients use technology. Often those are faulty assumptions.
[Roundtree] This study is the first of its kind. So, most studies similar to this one always sample from the patient population, but that’s a self-selecting group, and they have their own biases, right? So, if you enroll a participant, if you enroll a patient in a Facebook intervention, they’re going to use it.
[Roundtree] They’re going to use it as you prescribed, right? So that is a paradox.
[Weber] Right, right.
[Roundtree] They’re going to use it as you see flt. So this is the first study that’s just, “Look, I just want to know how people generally use Facebook and if they use it, for social health behavior. Sharing information, sharing updates about your health status, swapping resources, swapping the names of providers of interest, I wanted to see whether or not people-how they use that in the wild, in native.
[Weber] Great, great. Because you’re talking about if you’re taking a self-identified group that’s been identified by someone else as patients-.
[Roundtree] As patients, yep.
[Weber] Then you’re missing all of this sort of behavior of people who don’t flt within that particular classification.
[Roundtree] And it might have, and I found it did, it might have determined the efficacy of this Facebook intervention, which isn’t right. So, the-the model is you have a problem group, you have a group that has a need for health information. So, you build an intervention for them on Facebook or some other technology.
[Weber] So as an example people who have diabetes or heart disease.
[Weber] Those examples of the kinds of groups that you’re looking at?
[Roundtree] So, this diabetes group with information needs, you build a group for them on Facebook or another interface and then you expect them to perform online the way that they would in their own communities, face-to-face.
[Weber] So, it sounds like you found that that wasn’t always the case.
[Weber] That people did not behave online the same way they did offline. What did you find?
[Roundtree] So there were about four or five domains that I investigated. I coined the term “social health activity”. So, this is a very broad term that encompasses both patient activation and health behavior.
[Roundtree] And the presumption is, particularly in Facebook interventions, that how you behave offline is how you’ll behave online, and so you’d expect then that people with high social activity, social health activity offline, would have the same, would have parody behavior online, which was not the case.
[Roundtree] So, I found that in most groups where there was lots-high activity, high social health activity offline, they were more than comfortable telling their parents where to-which doctor to use. So more than comfortable sharing treatments and alternative treatments with their friends and family, this was not the case online.
[Roundtree] They did not use Facebook.
[Roundtree] In any degree of parody for social health activity as they did offline.
[Weber] So, what were they doing on Facebook? Anything related to medical?
[Roundtree] Very high activity.
[Roundtree] We also found that the same group had lots of activity on Facebook. They interacted with Facebook, very regularly, daily, if not hourly.
[Weber] Sure, yeah.
[Roundtree] They were more than willing to share news, to share personal information for example anecdotes about their lives.
[Weber] Sure, what they did that day.
[Roundtree] Absolutely. They were just not comfortable sharing their personal, private health information on Facebook. So obviously in the conclusion, I posit that probably it’s the case that how Facebook handles your personal information, how they archive it, how they make it accessible to third-parties, probably was a factor.
[Roundtree] In this regard, although it didn’t ask specifically.
[Roundtree] And another thing that I found was that even though there was low social health activity on Facebook, when social health activity occurred, it was correlated with very particular Facebook activity.
[Weber] Okay. What kinds of things?
[Roundtree] News, sharing news.
[Roundtree] Giving their Facebook network advice and input.
[Weber] So those are the things they’re willing to do. They might share some information.
[Roundtree] That’s right.
[Weber] But not, not as much as we might hope or expect or anticipate. So, what’s the lesson for medical communicators, because this seems, it seems a little distressing or you know that there’s the intervention that we might have planned might not be as effective as we’d hope.
[Weber] What kinds of interventions might be more effective?
[Roundtree] I don’t think it’s depressing.
[Weber] Okay, that’s good.
[Roundtree] I do believe that technical communicators, health communicators, social media managers, who are tasked to design these interfaces be mindful, and they should use these technologies strategically.
[Roundtree] If there’s an occasion for just such an intervention to improve public health education for a very specific audience, to make that a successful intervention, you have to be very strategic, and you have to target a particular profile or particular demographic of user before you build that interface. I think that we have to be careful not only in how we design the interface or design the Facebook intervention to help increase information or to help convey the health information in a new way or a novel way, but I think we also should be careful about our expectations for what such an intervention can accomplish.
[Weber] So you’re saying perhaps more modest goals or different goals than the kinds of goals that we may have, which is what you really want is to increase interaction with the patients, among each other, and increase sort of information sharing, that kind of thing as opposed to maybe having direct measurable medical outcomes from social media interventions.
[Roundtree] And we have to require, as a part of the intervention, recruiting super users or allies in or population who’d be just as invested in the success of the intervention.
[Weber] Is there any possibility, I know your study doesn’t cover this, but is there any possibility another platform might be better off? You know we always assume, like let’s just put it on Facebook, but maybe there’s a different platform that would encourage more interaction?
[Roundtree] Perhaps, but even in that case I say look before you leap.
[Roundtree] Right. Test your assumptions, talk to users, conduct the kind of survey that I did before-.
[Roundtree] -you design the intervention.
[Roundtree] Trust but verify.
[Weber] Excellent, well thanks so much Aimee. I really appreciate this.
[Roundtree] A pleasure.
[Weber] It’s very interesting work and we’re excited to see what’s next.
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