Today, social media enthusiasts aren’t just common, they’re a job title. Technology has penetrated so quickly that our offline and online lives have  merged inseparably. I know I can barely keep up with each latest tech development, let alone take time to ponder the risks.

But I do often wonder:

Are there times we should recommend more social media, and times we should recommend less?

We’ve all heard ad nauseum about internet and social media “addiction.” Other oft discussed detriments include slactivism, reputation destruction, declining productivity, loss of face to face interactions, and of course the end of personal privacy. These effects aren’t trivial, and are worth balanced consideration. But they are also sensationalized and can sometimes border on fear mongering toward the detriment of an open, social web. In any case, conversations around extremes are usually unproductive.

But this much is irrefutable: social, especially mobile social, media are increasingly invading all aspects of our lives. For good or bad, the psychological and social impacts of social technologies are real. I wish we understood more about these impacts. They relate to our health, to our every day well-being.

One hypothesis by author David Zweig suggests we are living in a time of increased self-consciousness to the point of depersonalization. He posits we are living in sort of semi-reality because of ubiquitous social media and mobile. Instead of living in the moment, he suggests we now experience life through filtered media, which can alter how we see ourselves.

The extreme of this: rather than enjoying any given moment–say playing with our kids, watching films, or even attending conferences–we constantly rehearse moments in our minds as tweets and Facebook posts. The events then become real or meaningful only once they’ve been shared online. This is total theorizing, but you have to admit there’s something to it, right?

Other compelling (though somewhat sinister) theories include suggestions that social media can induce envy and fear of missing out or, worse, reduce humanity to quantifiable numbers of influence.

Social media is not a drug. We will not be getting rounds of testing, clinical trials, and panels toward approval and a label that tells us all known risks and benefits. There won’t be any recalls.

It would be nice, though, to know for sure that the benefits outweigh the risks in most cases.

The common cure to counteract social media overexposure seems to be “unplugging,” where you purposefully disconnect for a few hours or days. When it’s a long period, the standard practice is to announce your offline plans to friends and family. I think most would agree that even by having this conversation (not to mention the need for a National Day of Unplugging), we are acknowledging some of the larger implications of social media’s impact on our lives.

My hope is that there’s some middle ground of mindful social media use, somewhere between mandatory unpluggings and near constant connection. If we got there (wherever that is – I really don’t know), maybe we wouldn’t need to forcibly unplug? Maybe there’s a way to co-exist with technology more peacefully?

Anyway, getting back to my original point:

As people who care both about others’ health and in the power of social media for good, are there situations professionally or otherwise when it’s more responsible to recommend less social media use, instead of encouraging more?

When I think of an idealized health communication social media effort, I think: draw upon peer-reviewed research, converse with end consumers’ to learn their points of view, understand human behavior online, and tie work to theoretical models. I think: measure the clicks, sentiments, retweets, likes, mentions, and comments that matter, and ignore those that don’t.

I know we haven’t figured out all these elements just yet. I do think we can get there.

Some say the only numbers that matter are the ones that tie back to outcomes. We tend to think of outcomes as changing a desired health behavior — getting necessary screenings, exercising more, quitting smoking, etc. (We also tend to think of ROI, but I have no idea how to calculate that for health care social media. Do you?)

But let’s face it: measuring for behavior change is a challenge that goes well beyond digital media to offline and takes a cross-discipline approach to solve.

For now, for every day, perhaps it’s time to:

• Be realistic about behavior change as an outcome from most of today’s social media health communication efforts.
• Read these 5 Fictions About Social Media for Public Health and Healthcare by Craig Lefebvre.
• Ask: is it possible to change health behaviors with social media alone? What type of cross functional effort that includes offline and in-person interactions might be needed for true change?
• Use caution in describing the growth of social efforts that, for example, give badges for reaching daily health goals, as “behavior change” sites while we’re still figuring this all out. These sites are fun and likely help some, but behavior change will become a meaningless buzz word if we’re not careful.

When we overuse the term behavior change it waters down the concept and takes away from the important collaborative efforts to tie theory to practice.

I’ve been thinking more on what health communicators can do and measure with confidence in today’s social media.

I’m not saying we should by any means stop working on innovative health behavior change efforts that include social media. As a matter of fact, I’d devote all my time to this if I could.

But outcomes for communication purposes need to be measurable. They don’t necessarily need to be behavior changing.

I think we have many other valid current uses of social media in public health and health care that can be tied to measurable outcomes. These each deserve a blog post in themselves, but here’s a starting list:

• Moderated and peer social support
• Crisis communication response
• Having open discussions to breakdown stigma
• Health-related digital media literacy education
• Responding to complaints and feedback monitoring
• Correcting health misinformation and misinterpretation
• Professional idea-sharing and learning

I’m sure I’m missing additional measurable, effective uses. What do others think? What are the current best uses of social media for health communication? And what do you think we need to do to move beyond the behavior change buzz?

I’m pretty sure I’ve used this phrase in a social media plan.

In the drive to gain tons of social media followers commenting and interacting, we often turn to these familiar tenets of social media “engagement,” correct?

• Post frequently. On quick moving status streams, your update is gone in an instant.
• Ask questions to encourage conversations and spark discussions.
• Use apps, games, polls, and challenges to increase participation.
• And so on.

But I wonder: how have we seemingly agreed upon rules for communicating when social media is truly in its infancy? I think it’s too soon, and I don’t know these principles are appropriate in many cases.

Do gobs of fans, comments, and clicks matter if they’re not helping you or your organization achieve a real or figurative bottom line (i.e. money or action)? Is the conceptual definition of engagement really what we want to be measuring?

The measures we currently use for engagement are not necessarily correlated with outcomes. We’re still in an experimental phase. We don’t know for sure what works yet and what doesn’t.

Social media may be free, but managing these channels takes time, and time is money. If we really want to justify social media’s use as a communication tool, I think we should be doing more testing from a research perspective, and less marketing with hopes pinned on unrealistic results.

Imagine if:

• We didn’t think of social media campaigns.
• We thought instead of using social media as a research tool.
• We began testing social media “experiments” in our every day use, ideally with academic advice, tying use back to outcomes (when possible)?

NIH is already conducting a series of controlled trials and interventions to test how digital and social media use affect different groups’ health behaviors. These results will shed light.

But what I’m talking about is changing the way we go about typical social media implementations, with research in mind instead of marketing goals.

It seems we are attacking the problem backward to me, especially when researchers are using what practitioners have come up with to measure effective social media use. For example, this study on hospitals’ poor use of social media relies on variables including number of followers, postings, and comments as indicators of engagement.

Language is important, and when we use words like increasing participation and engagement, it influences how people see the value of social media and use the tools.

Regardless, wouldn’t it be nice if researchers and communicators worked together more frequently in the work we do every day?

Am I making any sense here at all, or not? Please let me know.

I’m guessing you’ve heard about social media’s promise for public health? We’ve been talking about this for years now. We’ve been busily incorporating social media in to every health communication and social marketing plan and trying to measure the awareness and behavior change effects.

We’ve seen many great examples.

I mean, more than 1.2 million people currently follow CDC Emergency on Twitter, and that momentum began with interest from consumers during the 2009 H1N1 flu outbreak. That’s something, right? That’s huge!

Among other fact bits, from Pew Internet, we’ve learned that having a chronic illness (once online) is associated positively with working on a blog and participating in online health discussions.

Where are we, then, when it comes to social media’s affects on health awareness and behavior change as part of public health campaigns? Where are the results?

Today “…as yet we have no proof of principle.“

I borrow this quote from an excellent recent literature review conducted by the Peel region Canadian public health department on effectiveness of the use of social media for public health campaigns. I think the crew did quite the bang up job on this paper. The review of 39 articles and studies covering evidence behind domestic and Canadian public health campaigns incorporating social media found:

• Research to date has focused on potential for learning and behavior change. This is largely because of a lag in the research cycle as compared to the rapid speed of social platform development.
• Few peer-reviewed studies have tested social media interventions for desired outcomes, such as adoption of behaviors or even increased learning tied to social media.
• In the several original research studies with evaluative components, results were confounded because researchers couldn’t isolate social media from other communication tactics.
• The authors noted that even in the studies which attempted to evaluate behavior change, results may not be generalizeable from one health issue to another or in a different context.

These MIT researchers told us we can have better health through social networking. I see this referenced quite a bit. This study found that participants were more likely to sign up for an online health information forum through smaller networks of closer contacts than through larger networks of weak contacts. Its self-described limitations: it did not measure actual behavior change, simply likeliness to sign up for a network based on reinforcement from close online friends.

So many questions remain. Does social media work in certain situations, with certain audiences, for certain health outcomes? There’s not one study that I’ve found that shows this is the case, just yet. What about for improved knowledge and awareness but not for behavioral change?

Much of the success in public health we’ve seen were in crises – take 2009 H1N1 flu. Do differences exist in social media’s affects on public information gathering and action during health crises as compared to long-term chronic disease prevention campaigns?

I’m working through these issues because I’ve got my communication thesis topic idea due in 3 months and I’ve yet to come up with any solid research questions I can actually test.

Any one know of any other studies on this topic? Any one else working on one?

Don’t get me wrong. There’s a ton of potential here.

• Evidence exists supporting behavior change games in certain situations for certain audiences.
• Self-efficacy, or a person’s confidence in performing a particular behavior, is part of several behavior theories in which small steps are encouraged to ensure success.
• Folks like persuasion psychologist BJ Fogg at Stanford are looking to the future — how mobile devices can influence behavior in the daily routines, targeted to what someone is doing at the right time and right place.
• The Open mHealth project, among its other pilots aimed at developing an evidence base in support of mobile health, is studying how smartphones can monitor diet, stress, and exercise for prevention in new moms at risk of heart disease.

But can we face reality for a moment, as in today, right now?

First, most apps in the overall marketplace are not exactly Angry Birds.

Of all apps downloaded in 2010, 26 percent were used just once and, according to Pew Internet, only two-thirds of those who have apps use them. 

I hate to think where that leaves health apps, among the least sexy of the apps bunch.

Second, and I surmise here, people who are motivated enough to download and then actually use a healthy behavior mobile app are already healthy people. They may be looking for a minor boost, reminders, or a way to connect with other healthy people just like them.

It’s highly unlikely the typical health app user falls in to the audiences for many behavior change interventions such as youth and low socioeconomic groups. I’d like to see some more research in this area, though.

Lastly, unless there’s a study specifically on a mobile health app that I’ve missed (and I try to pay really close attention to this business), the bottom line is that we don’t really know. Show me some causal evidence, a pretest/post test with control group study, or even a self-reported survey. Anyone?

I’m definitely looking forward to future research results that shed more light on this topic.

So, what do you think? What did I miss?

My latest post is up: Using Google Insights to End a Year-End Blogging Rut.

It’s part of Shonali’s series on Blogging for Grasshoppers.

Public relations and measurement maven Shonali Burke, my former professor and current mentor, has invited me to write for her blog, Waxing Unlyrical.

Here’s my first post: How Google Instant Might Impact Your Small Nonprofit.

I’d love to know what you think!

An effort online is afoot to help people sort through misinformation on the web. Sites such as Snopes, one of the most popular rumor checking destinations online, sort out information ranging from old wives’ tales to current events.

We’ve learned an increasing amount about how to stave off misinformation online. Newer technologies with rapid sharing capabilities, such as Twitter, however, present new difficulties in digital media literacy.

Twitter’s power to inform and connect people is huge. I experience these benefits every day. But let’s face it. Twitter’s power to misinform may be similarly huge. We’ve seen misinformation spread through the network during the 2009 H1N1 flu outbreak and the 2009 Moldova riots. Most recently, a study showed widespread confusion about antibiotics is shared throughout Twitter.

I’m currently taking a grad school class on digital media literacy, and for it, I created this video to help people sort out misinformation from good information on Twitter.

The answer: we don’t yet know, but if Susannah has anything to do with it (and, uh, she does!), we may know someday.

So, what do we know about how social relationships affect health behaviors?

According to Susannah, we know:

• Health is social. In a recent Pew report, two thirds who looked online for health information talked with someone else, usually a peer, about the information they found.
• Chronic disease has an independent negative affect on having access to the internet, but, once online, having a chronic disease is associated positively with using the internet for health, blogging for health, participating in online discussion on health, etc.
• Offline social networks affect behaviors. Obesity can spread through social networks (check out the book Connected, which discusses how obesity spread through the Framingham heart study’s participants’ networks).
• Text reminders can help with medication adherence. A Boston study showed this to be the case in getting people to use sunscreen.

So now what?

According to Susannah, we already have a learning system — social media. While we don’t yet know the effects, we do know that people are using social media, and we can make some inferences based on offline social networks what the effects MIGHT be. Again, the research has not caught up with our eagerness to know.

Susannah concluded with some great food for thought, and an appeal for more research beyond anecdotal examples.

• Can there be a network effect?
• Can people change their health behaviors based on what they see in their personal online social networks?
• What is the power of peer to peer advice and how can we harness it?

I’m sure looking forward to seeing what further research comes out of these questions. You?