Article ID: WMC002936
ISSN 2046-1690
On Social Media in Health Literacy
Corresponding Author:
Prof. Maged N Kamel Boulos,
Associate Professor, Faculty of Health, University of Plymouth - United Kingdom
Submitting Author:
Prof. Maged N Kamel Boulos,
Associate Professor, Faculty of Health, University of Plymouth - United Kingdom
Article ID: WMC002936
Article Type: Review articles
Submitted on:28-Jan-2012, 04:21:37 PM GMT
Published on: 29-Jan-2012, 11:12:10 AM GMT
Article URL: http://www.webmedcentral.com/article_view/2936
Subject Categories:HEALTH INFORMATICS
Keywords:Social media, Health literacy
How to cite the article:Kamel Boulos M N. On Social Media in Health Literacy . WebmedCentral HEALTH
INFORMATICS 2012;3(1):WMC002936
Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original
author and source are credited.
Source(s) of Funding:
None.
Competing Interests:
The author declares that he has no competing interests.
WebmedCentral > Review articles
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On Social Media in Health Literacy
Author(s): Kamel Boulos M N
Abstract
This short, non-exhaustive article considers health
literacy in the era of the Social and Mobile Web. We
briefly discuss with some examples the important role
that social media are playing today in health literacy,
the associated risks, and the workarounds to mitigate
those risks. We conclude by providing some
guidelines and pointers to key online resources and
bibliography about the subject.
Introduction
In 2011, about 30.2% (2.1 billion) of the world’s
population had access to the Internet (78.3% of North
America’s and 58.3% of Europe’s populations) [1], and
searching for health information online became
increasingly common; for example, about two-thirds of
US adults look online for health information according
to figures released in 2010 by the Pew Internet &
American Life Project [2,3].
Large proportions of adults in developed countries
have limited health literacy skills (even among native,
non-immigrant communities and some university
graduates) [4]. For example, in the USA, 88% of adults
do not have the necessary skills to manage their
health and prevent disease, according to the US ‘2003
National Assessment of Adult Literacy (NAAL)’ survey
[5]. In 2004, the US Institute of Medicine (IOM)
published a shocking video (available on YouTube at
[6]), based on their report released in the same year
and entitled ‘Health Literacy: A Prescription to End
Confusion’ [7].
Internet users include people with limited health
literacy skills, although a US ‘2007 Health Information
National Trends Survey’ found that Internet users
tended to be more educated, with higher income, and
preferred numbers rather than words to describe
chance [8].
There have been many definitions of ‘health literacy’
[9], but for the purpose of discussing the role of social
media in health literacy, we will refer to the following
working definition of health literacy from the US
Department of Health and Human Services’ report ‘
Healthy People 2010’ [10]: “The degree to which
individuals have the capacity to obtain, process and
understand basic health information and services
needed to make appropriate health decisions”.
WebmedCentral > Review articles
Skills needed for health literacy on the Internet include
all the conventional health literacy skills, in addition to
computer and Internet literacy skills, and skills for
locating and appraising online health information [11].
But having access to the Internet and mastering the
essential computer and Web skills does not
automatically guarantee that a person will be able to
properly evaluate and understand online health
information.
Role of social media
Social media and social networking now reach four out
of five (i.e., 80% of) active Internet users in the USA,
according to a Q3 2011 report by Nielsen [12]. Using
the above definition of health literacy, social media can
potentially improve users’ capacity to (1) obtain, and (2)
process and understand health information and
services needed to make appropriate health decisions.
But it is particularly the first of these two capacities,
the capacity to obtain/access health information, which
can be immediately improved by social media. The
second capacity to process and understand health
information depends on factors that vary widely across
the Web, namely the content quality and presentation
of online health information and the degree they match
the needs and health literacy levels of target
audiences.
Viral social marketing (reaching out to many more
people, more quickly and with minimal costs,
compared to other forms of marketing/advertising) is
among the strongest aspects of social media and can
play an important role in health education, promotion
and outreach programmes [13]. For example, viral
marketing and other social media techniques have
been successfully used to promote condom use in
Turkey [14]. Online social networks and participatory
communication methods can also provide excellent
opportunities for peer-to-peer support (patients and
members of the general public supporting each other)
[15,16] (Figure 1), and thus contribute to reducing the
burden on conventional healthcare systems.
m-health (mobile health)
A Morgan Stanley presentation published in 2010 is
predicting that mobile Web access via smartphones
and other small form factor Internet devices, such as
the Apple iPad and clones of small touch-screen
tablets, will overtake conventional desktop Internet use
by 2015 [17]. UK mobile Internet use is already
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nearing 50%, according to a 2011 ONS (Office for
National Statistics) report [18]. Smartphones and their
applications or ‘apps’ (e.g., Figure 2) are rapidly and
radically transforming healthcare, particularly the care
of patients with long-term conditions, enabling it to
become more mobile at the point of need and more
participatory by engaging all involved stakeholders,
including patients, non-clinical carers, the general
public, clinicians and various organisations [19-22].
The potential of many of the available and planned
specialised mobile apps in reducing healthcare costs
and improving clinical outcomes is huge [23,24].
The reader is referred to [25-32] for an overview of the
different types of social media available today and a
more thorough discussion of the potential roles that
social media, including 3-D virtual worlds such as
Second Life® [27,28], can play in health literacy,
education and ‘crowdreaching’ [32]. However, a
discussion of the use of social media for health literacy
purposes remains incomplete without also addressing
the potential risks, pitfalls and workarounds that are
involved in the process
Risks of social media and
workarounds
Social media pose higher risks compared to other
conventional media (e.g., TV and print material), due
to the much wider outreach of the Social Web and its
partly uncontrollable/non-moderated nature (‘anyone
can publish whatever they want’). The risks include
spreading misinformation (very rapidly through viral
messages and videos/e-WOM—Electronic Word of
Mouth and/or through hacked/compromised social
media accounts [33]), disseminating biased or
incomplete (and thus potentially risky)
information—see, for example, [32,34-39], or
publishing information that is hard to understand by its
intended audience or is presented in such a way that
makes misunderstanding a likely possibility
(misunderstanding can have serious negative
consequences—see, for example, [6]).
There is no easy way to remove or stop all the ‘bad’
information out there, but we can always provide and
advertise good information and educate people about,
and expose, misleading online material (or
representative examples of it). Consumer education
can be effectively done using the same social media
tools, while “pushing” plenty of good material can be
achieved by creating trustworthy social media
channels for this purpose, and socially marketing
these channels; see, for example, the official NHS
Choices (National Health Service in England) and US
WebmedCentral > Review articles
CDC (Centers for Disease Control and Prevention)
channels and special campaigns on Facebook [40,41].
(The NHS in England/DH (Department of Health) also
spent £2.7m on a Google AdWords campaign in
2009/2010 to promote NHS Choices, but a few groups
criticised them for doing so [42].)
However, with users being able to freely write text and
post comments on an organisation’s social media
presence, e.g., on a Facebook ‘Wall’, maintainers of
social media pages should regularly monitor and
moderate their content for any forms of spam, abuse
or patient privacy violations (turning off all user
posting/commenting is not a good option as this will
remove the ‘social’ from social media). Account
admins should also protect their presences with strong
passwords to avoid their accounts getting hacked by
spammers [33].
Other workarounds and strategies include connecting
social-media technologies to evidence-informed online
resources, matching new applications with the correct
user populations, and integrating health
communication best practices, including addressing
health literacy issues in the relevant social media
content [4,30,31]. Organisations should allocate
sufficient personnel time and resources to look after
their social media presences (this can be a very
demanding task), and develop and enforce clear
policies and guidelines regarding what their members
of staff can post on various social media [25].
Guidelines and resources
Social media content and choice of medium (e.g.,
using a blog article vs. a YouTube video vs. using both
media vs. a dedicated mobile app, etc.) need to be
tailored to suit the profiles and preferences of target
audiences and their ‘reading with understanding’
levels. Involving representatives from the target
audiences in planning, implementing, disseminating
and evaluating online health information and services
is of prime importance [4]. A strategy based on
‘shared-audience information sets’ (based on
evidence-based material originally compiled for
clinicians) [43] can be adopted to maximise the
efficiencies of content authoring and delivery vs.
varying degrees of patient literacy, from the ‘expert
patient’ to the completely illiterate layperson (Figure
3). The US CDC offers a number of excellent health
literacy, social media and social marketing training
materials, guidelines and toolkits that can prove very
helpful to social media content developers and public
health practitioners in general [44-47] (Figure 4).
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Coda
Today, the question is no longer whether or not to use
social media (among other tools) for health literacy
purposes. Rather, the question is which social media
to target (within available budget and resources) and
how to best do so. With more than 800 million active
Facebook users (half of them log on each day) [48]
and 100 million active Twitter users [49], healthcare
and public health organisations cannot afford to ignore
social media as a powerful means for reaching out to
their stakeholders, including patients, lay carers, and
the general public. Health organisations should go
where people already are online (on social media),
rather than just build their own isolated Web islands of
‘read-only’ information and expect people to come and
visit.
Illustration legends
Figure 1. Run jointly by UCLA School of Public Health
and Health Net, Inc. in the United States, T2X
(Teen2Xtreme - http://www.t2x.me/) offers a
Facebook-linked, teen-only community of users, with
teen and professionally produced content,
competitions, games, quizzes, blogs, (YouTube) video
sharing and other interactive and participatory
communication methods. T2X covers lifestyle issues
for teens, such as nutrition, fitness, stress
management, substance abuse and sexual behaviour
[16].
Figure 2. The Plain Language Medical Dictionary
iPhone app from the University of Michigan's
Taubman Health Science Library converts medical
language jargon into everyday English. The app is free
(http://itunes.apple.com/us/app/plain-language-medica
l-dictionary/id443405990?mt=8).
Figure 3. Shared-audience information sets for
maximising the efficiencies of content authoring and
delivery vs. varying degrees of patient literacy from the
expert patient to the completely illiterate layperson (by
the author; originally published in [43]).
Figure 4. Screenshots of a US CDC online course
(free) entitled ‘Health Literacy for Public Health
Professionals’ [46].
References/bibliography
1. World Internet Usage Statistics News and World
Population Stats. Miniwatts Marketing Group, 31
March
2011.
Available
at
http://www.internetworldstats.com/stats.htm
2. Fox S, Jones S. The social life of health information.
Pew Internet & American Life Project, June 2009.
Available
at
WebmedCentral > Review articles
http://www.pewinternet.org/Reports/2009/8-The-Social
-Life-of-Health-Information
3. Fox S. Crowdsourcing a Survey: Health Topics
(Commentary). Pew Internet & American Life Project,
July
2010.
Available
at
http://www.pewinternet.org/Commentary/2010/July/Cr
owdsourcing-a-Survey-Health-Topics.aspx
4. Kamel Boulos MN. British Internet-derived Patient
Information on Diabetes Mellitus: Is it Readable?
Diabetes Technology & Therapeutics. 2005
Jun;7(3):528-35.
http://dx.doi.org/10.1089/dia.2005.7.528
5. National Assessment of Adult Literacy (NAAL) What is NAAL? Available at http://nces.ed.gov/naal/
6. IOM Health Literacy Video. Available at
http://www.youtube.com/watch?v=39A9oU-gOOA
7. Nielsen-Bohlman L, Panzer AM, Kindig DA, eds.
Health Literacy: A Prescription to End Confusion.
Washington, DC: Board on Neuroscience and
Behavioral Health, Institute of Medicine, National
Academies Press, 2004. Available at
http://www.nap.edu/openbook.php?isbn=0309091179
8. Koch-Weser S, Bradshaw YS, Gualtieri L, Gallagher
SS. The Internet as a Health Information Source:
Findings from the 2007 Health Information National
Trends Survey and Implications for Health
Communication. Journal of Health Communication.
2010;
15(S3):279-293.
http://dx.doi.org/10.1080/10810730.2010.522700
9. Berkman ND, Davis TC, McCormack L. Health
Literacy: What Is It? Journal of Health Communication.
2010;15(S2):9-19.
http://dx.doi.org/10.1080/10810730.2010.499985
10. US Department of Health and Human Services.
Healthy People 2010. Washington, DC: US
Government Printing Office, 2000. Originally
developed for Ratzan SC, Parker RM. Introduction. In:
Selden CR, Zorn M, Ratzan SC, Parker RM, eds.
National Library of Medicine Current Bibliographies in
Medicine: Health Literacy, January 1990 Through
1999. NLM Pub. No. CBM 2000–1. Bethesda, MD:
National Institutes of Health, US Department of Health
and Human Services, 2000. Available at
http://www.healthypeople.gov/2010/Document/HTML/
Volume1/11HealthCom.htm
11. Glassman P. Health Literacy. US National Network
of Libraries of Medicine, June 2011. Available at
http://nnlm.gov/outreach/consumer/hlthlit.html
12. Social Media Report: Q3 2011. Nielsen,
September
2011.
Available
at
http://blog.nielsen.com/nielsenwire/social/
13. Gosselin P, Poitras P. Use of an internet “viral”
marketing software platform in health promotion. J
Med Internet Res. 2008 Nov 26;10(4):e47.
Page 4 of 12
WMC002936
Downloaded from http://www.webmedcentral.com on 04-Feb-2012, 09:07:26 AM
http://dx.doi.org/10.2196/jmir.1127
14. Purdy CH. Using the Internet and social media to
promote condom use in Turkey. Reprod Health
Matters.
2011
May;19(37):157-65.
http://dx.doi.org/10.1016/S0968-8080(11)37549-0
15. Fox S. The Social Life of Health Information, 2011:
Peer-to-peer Healthcare. Pew Internet & American
LifeProject, May, 2011. Available at
http://pewinternet.org/Reports/2011/Social-Life-of-Heal
th-Info/Part-3/Section-1.aspx
16. Wongvipat Kalev N, Quiter E, Prelip M, Glik D,
Fiore M, Robinson-Frank E. T2X: Using Social Media
to Improve Adolescents' Health Literacy. In
Proceedings of IHA's 10th Annual Health Literacy
Conference, 5-6 May 2011, Irvine, California. Available
at
http://ihahealthliteracy.org/index.php/en/poster-abstrac
ts/doc_download/53-t2x-using-social-media-to-improv
e-adolescents-health-literacy
17. Meeker M, Devitt S, Wu L. Internet Trends.
Morgan Stanley, April 2010. Available at
http://www.morganstanley.com/institutional/techresear
ch/pdfs/Internet_Trends_041210.pdf
18. Mobile internet use nearing 50%. BBC News, 31
August
2011.
Available
at
http://www.bbc.co.uk/news/technology-14731757
19. Kamel Boulos MN, Wheeler S, Tavares C, Jones
R. How smartphones are changing the face of mobile
and participatory healthcare: an overview, with
example from eCAALYX. BioMed Eng OnLine.
2011;10:24.
http://dx.doi.org/10.1186/1475-925X-10-24
20. Leslie I, Sherrington S, Dicks D, Gray N, Chang
T-T. Mobile Communications for Medical Care Mobile
Communications for Medical Care: a study of current
and future healthcare and health promotion
applications, and their use in China and elsewhere
(Final Report, April 2011). University of Cambridge
and China Mobile, April 2011. Available at
http://www.csap.cam.ac.uk/media/uploads/files/1/mobil
e-communications-for-medical-care.pdf
21. Kamel Boulos MN. Smartphones in diabetes care
and management. CyberTherapy & Rehabilitation
(C&R)
Magazine.
2011;4(3):20-21.
http://www.vrphobia.eu/index.php?id=CandR
22. Kamel Boulos MN. Quo vadis smartphones and
apps in emergency medicine? International Hospital
and Equipment (IHE). 2012; Mar/Apr issue (in press;
published by PanGlobal Media, a Brussels-based
spin-off from the Reed Elsevier publishing company).
IHE
URL:
http://www.ihe-online.com/magazine/index.html
23. Wodajo F. Apps for management of diabetes could
be vehicles for reducing health care expenses in future
WebmedCentral > Review articles
[mHealth]. iMedicalApps.com, 2 February 2011.
Available at http://tinyurl.com/5snfo9u
24. Liang X, Wang Q, Yang X, Cao J, Chen J, Mo X,
Huang J, Wang L, Gu D. Effect of mobile phone
intervention for diabetes on glycaemic control: a
meta-analysis. Diabet Med. 2011 Apr;28(4):455-63.
http://dx.doi.org/10.1111/j.1464-5491.2010.03180.x
25. Kamel Boulos MN. Social media and Web 2.0 –
how will they impact governance for health? Expert
report commissioned by WHO EURO/Graduate
Institute Geneva for a study on ‘Governance for Health
in the 21st Century’ to inform the European Health
2020 Policy, June 2011. Available at http://bit.ly/jty9D3
26. Kamel Boulos MN, Wheeler S. The emerging Web
2.0 social software: an enabling suite of sociable
technologies in health and healthcare education.
Health Information and Libraries Journal 2007
Mar;24(1):2-23.
http://dx.doi.org/10.1111/j.1471-1842.2007.00701.x
27. Kamel Boulos MN, Toth-Cohen S. The University
of Plymouth Sexual Health SIM experience in Second
Life®: evaluation and reflections after one year. Health
Information and Libraries Journal. 2009;26(4): 279-288.
http://dx.doi.org/10.1111/j.1471-1842.2008.00831.x
28. Kamel Boulos MN, Ramloll R, Jones R,
Toth-Cohen S. Web 3D for Public, Environmental and
Occupational Health: Early Examples from Second
Life®. Int J Environ Res Public Health. 2008;
5(4):290-317. http://dx.doi.org/10.3390/ijerph5040290
29. Fordis M, Street RL, Volk RJ, Smith Q. The
prospects for web 2.0 technologies for engagement,
communication, and dissemination in the era of
patient-centered outcomes research: selected articles
developed from the Eisenberg conference series 2010
meeting. J Health Commun. 2011 Jul 29;16(Suppl
1):3-9.
http://dx.doi.org/10.1080/10810730.2011.598398
30. Metzger MJ, Flanagin AJ. Using Web 2.0
Technologies to Enhance Evidence-Based Medical
Information. Journal of Health Communication
2011;16:(sup1)45-58.
http://dx.doi.org/10.1080/10810730.2011.589881
31. Chris Gibbons M, Fleisher L, Slamon RE, Bass S,
Kandadai V, Robert Beck J. Exploring the Potential of
Web 2.0 to Address Health Disparities. Journal of
Health Communication 2011;16(sup1):77-89.
http://dx.doi.org/10.1080/10810730.2011.596916
32. Kamel Boulos MN, Resch B, Crowley DN, Breslin
JG, Sohn G, Burtner R, Pike WA, Jezierski E, Chuang
K-YS. Crowdsourcing, citizen sensing and Sensor
Web technologies for public and environmental health
surveillance and crisis management: trends, OGC
standards and application examples. Int J Health
Geogr.
2011;
10:67.
Page 5 of 12
WMC002936
Downloaded from http://www.webmedcentral.com on 04-Feb-2012, 09:07:26 AM
http://www.ij-healthgeographics.com/content/pdf/1476072X-10-67.pdf
33. Cluley G. NHS Direct Twitter account
compromised by Acai Berry diet spammers (17
October
2011).
http://nakedsecurity.sophos.com/2011/10/17/nhs-direc
t-twitter-account-compromised-by-acai-berry-diet-spa
mmers/
34. Clauson KA, Polen HH, Kamel Boulos MN,
Dzenowagis JH. Scope, completeness, and accuracy
of drug information in Wikipedia. The Annals of
Pharmacotherapy. 2008 Dec;42(12):1814-21.
http://dx.doi.org/10.1345/aph.1L474
35. Scanfeld D, Scanfeld V, Larson EL. Dissemination
of health information through social networks: twitter
and antibiotics. Am J Infect Control 2010
Apr;38(3):182-8.
http://dx.doi.org/10.1016/j.ajic.2009.11.004
36. Steinberg PL, Wason S, Stern JM, Deters L, Kowal
B, Seigne J. YouTube as source of prostate cancer
information. Urology. 2010 Mar;75(3):619-22.
37. Knösel M, Jung K. Informational value and bias of
videos related to orthodontics screened on a
video-sharing Web site. Angle Orthod. 2011
May;81(3):532-9.
38. Liang BA, Mackey TK. Prevalence and Global
Health implications of social media in
direct-to-consumer drug advertising. J Med Internet
Res. 2011 Aug 31;13(3):e64.
39. Briones R, Nan X, Madden K, Waks L. When
Vaccines Go Viral: An Analysis of HPV Vaccine
Coverage on YouTube. Health Commun. 2011 Oct 27
[Epub
ahead
of
print].
http://dx.doi.org/10.1080/10410236.2011.610258
40. NHS Choices on Facebook. Available at
http://www.facebook.com/NHSChoices - see also
http://www.facebook.com/NHSDirect.uk
and
http://www.facebook.com/NHSSmokefree
41. US CDC on Facebook. Available at
http://www.facebook.com/CDC - see also
http://www.facebook.com/cdctobaccofree
42. NHS online Google Ads come under fire (February
2010).
Available
at
http://www.publictechnology.net/sector/nhs-health/nhsonline-google-ads-come-under-fire
43. Kamel Boulos MN, Harvey FE, Roudsari AV,
Bellazzi R, Hernando Perez ME, Deutsch T, Cramp
DG, Carson ER. A Proposed Semantic Framework for
Diabetes Education Content Management,
Customisation and Delivery within the M2DM Project.
Computer Methods and Programs in Biomedicine.
2006;83(3):188–197.
http://dx.doi.org/10.1016/j.cmpb.2006.07.003
44. What We Know About Health Literacy. US CDC,
WebmedCentral > Review articles
July
2009.
Available
at
http://www.cdc.gov/healthcommunication/ToolsTempla
tes/HealthLiteracy.pdf
45. Simply Put—A guide for creating
easy-to-understand materials. US CDC, April 2009.
Available
at
http://www.cdc.gov/healthcommunication/ToolsTempla
tes/Simply_Put_082010.pdf
46. Health Literacy for Public Health Professionals. US
CDC
online
course.
Available
at
http://www.cdc.gov/healthliteracy/training/index.html
47. US CDC Gateway to Health Communication &
Social Marketing Practice. Available at
http://www.cdc.gov/healthcommunication/
48. Facebook Statistics (accessed 27 December
2011).
Available
at
https://www.facebook.com/press/info.php?statistics
49. One hundred million voices (Twitter blog, 8
September
2011).
Available
at
http://blog.twitter.com/2011/09/one-hundred-million-voi
ces.html
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