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Effective Use of Digital Media to Advance Population Health Goals
As digital media transform the landscape for health communication, public health professionals are seeking new and more effective ways to engage audiences. During the second panel, two digital media experts described a variety of health communication projects in digital space and identified a number of strategies for success. Dana March, editor-in-chief of 2×2, a digital media project at Columbia University’s Mailman School of Public Health, described the school’s fellowship program and discussed some of the stories featured on the project’s website. Based on her experience with 2×2, March provided suggestions for effective health communication using digital media. Carlos Roig, executive vice president for media content strategy for Home Front DC, discussed the predominance of digital communication in the 21st-century media environment, and he reviewed factors to consider when planning digital communication initiatives. After describing several successful projects, he offered advice on using digital and social media effectively to advance population health goals.
The 2×2 Project
Established in 2012 by the Department of Epidemiology at Columbia University’s Mailman School of Public Health, the 2×2 project presents findings from emerging public health research in engaging, easy-to-read
online stories designed for lay audiences. Its goal is to spark conversation among thought leaders and policy makers about important public health issues and to help translate scientific research findings into practice. The project focuses not only on topics typically associated with public health, such as obesity, but also on social issues such as poverty, education, and gun violence that have a major impact on health. The project uses a variety of storytelling methods, including visual strategies, in addition to traditional journalism.
The Fellowship Program
The 2×2 project is staffed by journalists participating in the Communicating Health and Epidemiology Fellowship (CHEF) at the Mailman School of Public Health. The CHEF program, which supports four or five fellows each year, provides training on topics such as communicating with lay audiences about public health issues, using social media effectively, generating conversations across digital platforms, and writing commentary aimed at stimulating action.
March collaborates with CHEF participants to develop stories through a brainstorming process called “idea lab.” The project uses three social media platforms—Instagram, Facebook, and Twitter—and it soon will add an audio platform called Clammr.
Timely Content Linked to Popular Culture
The 2×2 project recently published a week-long series on the public health implications of Internet addiction, gambling, and gaming. The series included a lengthy, in-depth story called “Gambling with America’s Health.” Pacific Standard magazine re-posted the story on its website.
Another week-long series focused on gun violence. Stories explored the role of advertising in promoting gun violence and described advocacy group campaigns to make gun ownership and shooting attractive to children.
The 2×2 project also publishes commentary to provide context for conflicting media reports about the risks and benefits of popular treatments such as hormone replacement therapy. When the latest research findings conflict with previous reports, 2×2 journalists provide insights on the evolving landscape for evidence-based care.
Journalists participating in 2×2 review health-related documentaries produced by the PBS program Frontline. The project’s stories about League of Denial—a documentary about traumatic brain injuries in the National Football League—discussed the potential for the sports-related injuries to become a global epidemic. Additionally, 2×2 produces a feature
called PHresh, which reviews the week’s public health news, discusses the media’s portrayal of population health issues, and spotlights various important topics, some of which have been covered by the media and some of which have not.
Strategies for Success
As March was describing other 2×2 stories, she highlighted several effective digital communication strategies.
Produce timely, engaging visual content Because Instagram, Facebook, and Twitter are visually driven, the 2×2 project produces provocative content to support visual information sharing. For example, it posted an open letter to LeBron James featuring an altered image of the athlete to show how much weight he would gain if he consumed the amount of sugar contained in the Coca-Cola and McDonald’s products he advertises. Citing data showing that celebrity endorsements of unhealthy foods have a negative impact on public health, the letter urged James to drop the endorsements.
The format of digital content should reflect the fact that people get most of their online news through mobile devices, March said. By creating websites that are optimized for such mobile devices, population health professionals can maximize their opportunities to generate conversations in digital space.
Content based on current news stories can also help generate interest in public health issues, she said. By adding to discussions that are already under way in the news media, the 2×2 project seeks to capture public attention and foster continued dialogue.
Incorporate relevant data Stories are strengthened by data, March said, and data are more powerful in the context of stories. Online communications about public health topics should reflect this synergy between stories and data.
Speak with a unified voice across digital platforms Covering events live on Twitter can help foster engagement, March said. Live tweeting creates easy-to-read content for people at the event, she added, and it helps build networks of people who are interested but unable to attend in person. To stimulate conversation across the digital landscape, health journalists should speak with a consistent voice across online platforms.
Build relationships The most successful social media strategies are those that build relationships and foster continued dialogue about pub-
lic health. Therefore, March suggested, communications projects should seek not only to distribute content but also to generate conversation and promote ongoing engagement. Because people throughout the world use social media, population health professionals should seek engagement on a global scale.
COMMUNICATING EFFECTIVELY IN THE 21ST-CENTURY MEDIA ENVIRONMENT
The Predominance of Digital Media
Roig began his presentation by noting that digital media are no longer new, emerging technologies. Rather, they now are standard tools for mass communication. Therefore, health communications professionals should rethink their process of designing and distributing content to engage audiences.
Because most people now access breaking news through digital media, traditional news organizations such as The Washington Post are struggling. As a result, Roig said, the market value of traditional media companies has fallen dramatically. Whereas Amazon recently purchased The Washington Post for $250 million, the purchase price for Instagram—a social platform for photo sharing—was $1 billion. Facebook acquired WhatsApp, a text messaging platform, for $19 billion. To engage people on public health topics in a communications environment dominated by digital media, Roig said, population health professionals need to understand and use social media platforms effectively.
Each social media platform has a specific audience and function in the digital space. Instagram and Tumblr, a multimedia blogging platform, tend to have younger audiences than other platforms. Reddit is a platform for community-generated news and commentary. It includes a feature called the Ask Me Anything event, which President Obama and other prominent individuals have used. Pinterest enables visual bookmarking for do-it-yourself projects, recipes, and fashion. Facebook provides opportunities for interpersonal connection and engagement. Twitter allows users to create short messages, or tweets. Twitter’s value, Roig said, is derived not solely from the tweets themselves but rather from their ability to direct people to related content. LinkedIn is a professional networking site where people post résumés online.
Use of Digital and Social Media for Health Communication
Factors to Consider
Communicating through social media should not be one’s only strategy in efforts to advance population health goals, Roig said. Instead, social media should be viewed as an important component of a broad set of communication strategies.1 When planning health communication initiatives, he said, it is important to set clear goals and assess whether social media can help achieve those goals. Population health professionals should conduct preliminary research to understand the environment and identify the target audience. Coordination with communications, marketing, and, public relations staff should occur early in the planning process.
Roig advised workshop participants to select digital and social media platforms for particular projects based on their potential to reach and engage the intended audience. Content should be tailored to the platform, and engagement plans should be based on both the content and platform. As they develop content and execute engagement strategies, communications professionals should assess the quality, volume, and impact of those channels on a regular basis. High-quality content—which may include photography, advertising, video, and infographics—should be distributed steadily and consistently to achieve maximum impact (see Figure 4-1).
Successful Initiatives
To show how digital and social media can be used effectively, Roig reviewed several successful projects.
NewPublicHealth.org In order to reach their target audiences with a steady stream of public health news and information, the Robert Wood Johnson Foundation created a site called NewPublicHealth.org. Former journalists and professional communicators produce content for the site, which features public health news roundups, recommended reading, question-and-answer sessions with public health leaders, and highlights from many public health conferences, including the American Public Health Association’s annual conference. Users can comment on, share, and e-mail each article. In 3 years, more than 1 million pages were viewed on the website, and the Twitter account associated with the site grew by more than 200,000 followers.
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1 For a more cautious assessment of the potential reach and impact of social media, see the summary of Robert Hornik’s presentation in Chapter 2.
FIGURE 4-1 Quality, volume, impact.
SOURCE: Carlos Roig’s presentation, September 22, 2014.
Outbreak Week To highlight gaps in the public health system that could hinder its response to infectious disease outbreaks, Trust for America’s Health and the Robert Wood Johnson Foundation created a week-long series called Outbreak Week. The series featured engaging infographics, online articles posted on NewPublicHealth.org, animated GIFs, a 15-second video, and a Twitter hashtag.2 The associated Twitter account has grown by more than 3,400 followers.
Google Hangouts Home Front collaborated with TEDMED to plan and execute more than 40 moderated events called Google Hangouts, which were broadcast live on social media platforms. The events, designed to shape public conversation on important health topics, featured representatives from the U.S. Department of Health and Human Services, Kaiser Permanente, Seimens, and Cigna, among others. More than 10,000 people participated live in the events, and more than 50,000 people viewed post-event videos.
Public safety A project with Toyota and the Cincinnati Children’s Hospital included Web-based and social media tools to promote the safe
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2 The campaign generated more than 47 million impressions on Twitter. Impressions are the number of times a user receives a tweet. A hashtag (metadata tag) is a word or a phrase that is preceded by a pound sign (#) and allows users to search for and identify messages on a specific topic.
installation and use of children’s car seats. Within 6 months, the number of Facebook fans for the project grew by more than 3,000 percent.
Digital branding An online project with the Carnegie Endowment for International Peace focused on social media to create personal brands—that is, strong, recognizable identities—for foreign policy experts in the digital space. Carnegie emerged from virtually no presence on social media to getting recognized by the University of Pennsylvania in its 2013 index of think tanks for best use of social networks.
Key Strategies
Based on his experiences with these and other projects, Roig identified a number of strategies for success in digital space.
Segment audiences To maximize the impact of communication efforts, public health professionals should identify target audiences by category and develop engagement strategies for each audience. One strategy for engaging with a variety of audiences is to organize events in social media and to participate in online events conducted by other organizations.
Curate from multiple sources and add unique content Because so many individuals and organizations outside of the media industry have become digital publishers, health communication projects no longer need to rely exclusively on the news media to distribute content. Effective projects curate content from a variety of sources and add value with original material. Audiences often are attracted to online platforms that distill important information from across the Internet and provide links to other websites for more information.
Create individual brands Organizations seeking to increase their effectiveness in the digital space should create strong digital identities, or brands, for key members of their leadership teams. Professionals with strong digital brands can become online thought leaders and play a significant role in shaping conversations about important issues.
Coordinate online and offline efforts to build a foundation for future engagement Population health professionals should develop strategies to engage with target audiences, online and in person, before and after implementing digital media projects. By cultivating relationships with organizations and thought leaders who can act as informal ambassadors, health communication professionals can create active online networks, increase public engagement on important issues, and build a founda-
tion for future efforts. The early stages of planning and implementing digital and social media campaigns can be difficult, Roig said, but once an organization establishes a strong foundation and audience base, it can more easily experiment with new ideas. It is important to track both quantitative and qualitative metrics for online communication initiatives, although there is no single best measure of success.
In conclusion, Roig challenged workshop participants to think about how to make digital media a central component of their work.
During the discussion following the presentations, panelists answered questions about how to design and implement effective health communication projects.
In response to a question from moderator Michelle Larkin of the Robert Wood Johnson Foundation about how to create messages with a lasting impact in the digital world, March and Roig suggested a systematic approach. First, they said, it is important to identify the target audience. When planning communication initiatives, public health professionals should determine the people they want to reach, the information they seek to convey, and the actions they wish to promote, Roig said. Digital communication strategies for an 18- to 24-year-old audience differ from those targeting The New York Times readers, March added. Repetition is important, but audiences stop paying attention if the same messages are repeated too often, she said. To keep people engaged, health communicators should find new and innovative ways to present information across the digital landscape. For example, said March, it may be useful to continue conversations on Facebook rather than on an organization’s home page. Communication initiatives should include mechanisms to regularly seek and incorporate audience feedback.
When Sanne Magnan of the Institute for Clinical Systems Improvement asked how to find the right balance between in-person and social media strategies for relationship building, Roig and March agreed that reciprocity is critical. Public health professionals should not focus solely on publishing their own digital content. Instead, March said, they should curate content from multiple sites. The same principles that apply to building relationships in person apply across the digital landscape, Roig added. Just as professionals giving presentations at conferences should avoid excessive self-promotion, public health professionals communicating in the digital space should move beyond disseminating their messages and think about how to provide value to the target audience. When deciding whether to pursue partnerships in person or in the digital space, Roig said, public health professionals should first determine whether the indi-
vidual or organization of interest has a strong digital presence. If not, cultivating a relationship in person would be preferable. March encouraged workshop participants to reach out, both in person and online, to discuss their work with journalists and thought leaders with a shared interest in public health. Larkin noted that face-to-face meetings can enhance online relationships. For example, people attending conferences sometimes use their Twitter accounts to connect in person with other attendees.
When asked about public response to the 2×2 project, March said she has received excellent feedback. The project is on the cutting edge of journalism, publishing scientifically grounded, sometimes provocative pieces to stimulate conversation about important public health topics. March said she welcomes all input, including the negative feedback she received from gun activists in response to stories that presented gun violence as a public health issue. The project’s leadership is considering new ways to expand its audience across a broader political spectrum by, for example, publishing point/counterpoint pieces to represent different perspectives. Furthermore, 2×2 is seeking additional funding to expand and sustain its activities.
Responding to a participant’s question about how to develop individual and organizational brands that appeal to specific audiences, Roig stressed the importance of knowing the audience. Some people are interested in reading lengthy, in-depth research reports about population health issues, while others prefer shorter pieces. To reach the broadest possible audience, health communication initiatives should use a combination of digital platforms, including some that tell the full story about an issue and others that summarize key points. Moreover, public health professionals should build websites based not on the preferences of their colleagues and peers, but rather based on the characteristics of their target audience. Communication with the target audience should differ from communication with peers.
To achieve measurable results, population health professionals should identify the specific demographic groups they wish to reach and the behaviors they seek to promote, Roig said. Based on those decisions, professionals can choose the digital and social media platforms that are best suited to their target audience. Just as fashion industry professionals engage with fashion trendsetters to influence people’s style preferences, public health professionals should seek dialogue with opinion leaders to disseminate public health messages in a strategic way, March said.
Answering a participant’s question about the use of social network analysis and other analytic tools to define online audiences, Roig said that the tools for social media analysis continue to evolve, and there is no single best source. He therefore uses a mix of paid and free platforms for analysis. Analyzing and responding effectively to audience feedback on
social media is a challenging process. In some cases, traditional research methods, such as focus groups, can provide valuable insights. Though costly, these methods are warranted for large campaigns and social marketing efforts, he said.
Larkin summarized the session’s key points. First, she said, it is important to plan health communications efforts systematically. Population health professionals should first set goals for behavior or policy change, decide what they want audiences to focus on, and use social media strategically to promote engagement. Research is necessary to understand which strategies and messages are most likely to influence audience behavior. Health communications projects should engage audiences in ongoing dialogue, address audience feedback, and stimulate lively debate about effective solutions to complex problems.
Larkin concluded by challenging the workshop participants to expand their networks beyond the colleagues and peers they work with regularly. To advance the goals of population health, she said, public health professionals should build broad networks, seek input from people with different perspectives, and keep an open mind about new and innovative approaches to important issues.
