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Social Media Overview


I Canadians are online: retrieving and creating online content
II What is social media?
III The impact of social media
IV Health promotion in a social media world
V The role of social media in behavior change
VI Overview of social media tools
VII Conclusion
VIII References

–Submitted by Andrea Kita and Jodi Thesenvitz on behalf of The Health Communication Unit (THCU)

I Canadians are online: retrieving and creating online content

Canadians are online! Internet usage data from Stats Canada demonstrates increased usage rates in all age groups. In 2007, 96% of Canadians aged 16 to 24 went online, and 29% of seniors aged 65 and older. E-mail and general browsing continued to be the most popular online activities from home. (1)

Canadians use the Internet to both retrieve and create information. The web remained popular for finding government or health information, making travel arrangements and for banking, paying bills, and ordering goods or services. (1)

One-fifth (20%) of home Internet users reported contributing content by posting images, writing blogs, or participating in discussion groups. Of these people, over one-half were under the age of 30. (1)

II What is social media?

Social media (or “new media”) are Internet tools that enable users to participate and generate content.

“Social media facilitate collaborations and interactions among others. In its simplest forms, these media can be thought of as digital extensions of interpersonal channels of promotion (word-of-mouth and viral marketing campaigns) and the narrowing of broadcast-type communication.” (2)

Through social media channels, people are able to receive or listen to/view content, as well as generate their own content, for others to receive. Well-known examples of social media include Facebook, Twitter and YouTube.

III The impact of social media

The traditional method of communicating about a topic, program or service is a one-way street. It includes one source, a carefully crafted message, a well-understood intended audience, and a few strategically chosen channels to convey the message.

This linear model of communication often uses “mass media” channels such as radio, television, and newspapers to get the static message to a large volume of people in a systematic and consistent way.

The media is now fractured

Social media has fractured traditional mass media channels.

Networked World: Engagement, Interaction and MultiplexityNow, instead of a few well-attended mass media channels, there are hundreds of television and radio stations, accessible around the world, and millions of social networks, blogs, videos and online social media sites. People can access content on the Internet anywhere using mobile phones, blackberries, iphones, laptops as well as interact with media simultaneously (e.g., watching television while searching the Internet and texting on a mobile phone).

For a visual representation of this new social media world watch the video Did You Know 4.0, which compares the explosion of social media to traditional media: (3) provides an overview of the size of the social media revolution at…. (4)

Complete control is impossible

Traditional media formats allow marketers to control message development, design and delivery. In contrast, with social media, users can create or adapt a message and pass it on as they like.

Like pinball, an engaged communicator now needs to keep making minor corrections as a communication campaign unfolds, adding strategic bits of input here and there while watching the media environment carefully. Unexpected audiences will see and use your message in unexpected ways. Directing, clarifying and engaging with the audience requires constant attention.

The day of focus testing and sending a perfect, intact message out the door is nearly over in the world of social media.

IV Health promotion in a social media world

Craig Lefebvre, a social marketing expert in the United States explains the potential benefits to using social media: “Communication, engagement, transparency, and trust are the four pillars for working in the new media world. If you and your organization can’t bring those to the table, it will not be long before the rest of us figure it out, confront you, and challenge you. If however, you view new media tools (blogs, podcasts, wikis, social network sites, text and multimedia messaging) as complementary to traditional communication activities and recognize the social characteristics of effective communication, then you have a better-than-average chance of succeeding and making new friends and allies in your quest to achieve public health and social change.” (2)

The opportunity

Social media provides public health professionals with many opportunities including:

Fast and inexpensive interaction with clients, allies and stakeholders to help mould a program, resources, service and/or engage in collective problem-solving and knowledge sharing. (5)
The provision of small step ways that audiences can participate in meaningful personal or community change without a substantial time or resource commitment.

Low-cost and fast message dissemination, thus vastly increasing the reach of a given message and/or call to action.
Creation of new social networks, or expansion or solidification of existing social networks to support each other toward a given end – be it personal behavior change, or large community-level environmental or policy changes.

V. The role of social media in behaviour change

Social networks

A network consists of people, groups, organizations (nodes) and relationships, flows, transactions (directional links between nodes) that create connections. (6)

Online, a social network is a cluster of people that can bridge and bond by strengthening the social connection, usually through people that act as a connector. (5)

Visualizing the Social Network

Social networks are an important influence on behavior. “Rogers’ diffusion of innovations research has shown that for a wide variety of behaviours and populations, interpersonal influence continues to be the most significant single factor influencing a person’s decision to accept new ideas and practices.” (7)

For example, Christakis and Fowler’s 2007 article in the New England Journal of Medicine found that a “network phenomena appear to be relevant to the biologic and behavioral trait of obesity, and obesity appears to spread through social ties.” (8)

Craig Lefebvre’s blog posting Maybe IT IS All about Social Networks in October 2007 concurs with the theory: “A cursory look at some of the health behaviors that are the focus of social marketing programs reinforces the fact that all health behaviors are, to a greater or lesser degree, social.” (9)

For decades the health community has prompted behaviour change with assistance from social support networks. (5) For example, asymptomatic screening can be prompted when a spouse encourages a prostate test. A friend or family member can provide support for cessation of addictive behaviours (e.g., quitting smoking).

In another blog posting Craig Lefebvre explains how social networks are influenced by other social networks by pointing out “One of the implications with social networks is that people learn about and choose among behavioral options not only based on directly observing others in their social circle engage in behaviors and the consequences they experience, but also by whom their friends and associates connect with outside that proximal network and then bring that information or those practices back to the immediate network.” (10)

Behaviour change can be supported by social support networks through maximizing the interaction and connections between people by using social media tools. (5)

Social marketers need to take advantage of the influence in a networked world and consider how they can:

Enhance linkages that already exist among people, organizations and communities to allow them to access, exchange, use, and leverage the knowledge and resources of others.
Help develop, nurture and sustain new types of linkages that bring together like-minded people, mission-focused organizations, and communities that share interests to address common problems and achieve positive health and social change.
Identify, encourage and enable the many different types of indigenous helpers that are found in a social network so they can be more effective in promoting health.
Better engage communities in monitoring, problem analysis and problem solving, striving for health and social equity and increasing social capital.
Weave together existing social networks of individuals, organizations and communities to create new sources of power and inspiration to address health and social issues.
Apply a networked view of the world to our usual thinking when engaging people, organizations and communities.

Making and using connections

The Tipping Point by Malcolm Gladwell introduced the terms connector, maven and salesman as three key roles in “tipping” a social epidemic.

A connector is the social glue that brings people together.
A maven provides the group with knowledge and makes the case.
A salesman can persuade decisions about the case. (5)

Each role is important at different stages of interaction. For example, a connector can help build a network such as a coalition; a maven can explain the background information and the impact of this information in a compelling way to the network; and a salesman can motivate and engage people to take action on the issue. (5)

In his book Gladwell presents a case study about an awareness campaign implemented in beauty salons that successfully engaged and supported hair dressers (who were slightly connector, maven and salesman) to influence diabetes and breast cancer prevention with word of mouth messages from a trusted source to a captive audience. (11)

Gladwell states “if you are interested in starting a word of mouth epidemic, your resources ought to be solely concentrated on those three groups.” (11)

Tom Vallente highlights the importance of opinion leaders when designing health communication that generates interpersonal communication (creating a “buzz.”) He notes “it is important to map social networks to identify truly trusted and credible opinion leaders, conduct formative research with opinion leaders, and to do rigorous pre-testing within social networks.” (12)

Applying Gladwell and Vallente’s insight to social media channels can help translate a health promotion idea into a meaningful message for the audience, and ultimately can achieve health promotion outcomes.

For example, a connector may be a person who has many friends on Facebook, belongs to many different types of groups, follows diverse people on twitter and is able to invite a broad group to an event. A maven may be a blogger with an expertise that is shared honestly and often and attracts a loyal following that people connect with when considering their opinions and problem solving. A salesperson may be featured in a top viewed video on YouTube inspiring people to take action on a social issue.

In their article “Building Social Networks Through Network Weaving,” Krebs and Holley state “transformation that leads to healthy communities is the result of many collaborations among network members.” (6) Health communicators and social marketers need to build connections between networks to extend the reach of ideas. (5)

For example, teens use their networks within social media to find and share the funniest video; a spouse reaches out to a network to learn about coping strategies when their partner is diagnosed with cancer; a group of people on Facebook or Twitter share their tips for quitting and provide each other with encouragement as well as receive support from the campaign source (

Vallente advises around engaging the opinion leaders to stimulate buzz by getting them “to help design messages that are understood … and inspire them to talk about the messages with others.“ (12)

The more social media tools a person is using, the more they are communicating. (5) New linkages made through social media can expand the number of sources a person has access to for new information as well as provide support needed for behaviour change.

VI Overview of social media tools

The array of social media tools are always expanding. These tools can be useful for reaching and interacting with clients, networking with colleagues, and accessing information.

The tools described below are in most cases free to use. Additional information about these tools including introductory videos as well as suggestions and examples for application is available on the Health Nexus website. (13) As well, is a comprehensive blog on social media news, resources and guides (

RSS (Really Simple Syndication) is a newsfeed technology that lets subscribers know when a website has added new information.

Web Alerts (e.g., Google Alerts) provide email updates of the latest Google search results (web, news, etc.) based on search settings.

Document sharing services (e.g., Google Docs) store documents online in a secure, private space including options to allow others to edit or view a document and reduce conflicting edits.

Meeting schedulers (e.g., Meeting Wizard, Doodle) gather availability and confirm a meeting time in an easy-to-read table limiting email/phone calls.

Whiteboards let you draw or type online (a virtual flipchart) and share or download the notes.

Wikis provide a place where multiple people can collaborate.

A Forum is a website that centers around discussion between users, organized by topic.

A Blog is a website that’s organized chronologically.

Instant messaging (IM), includes audio and video chat (e.g., Skype). It is like a typed telephone call. You can IM with multiple people on the same IM Service (e.g., MSN) at once, in the same chat or separately. An IM program can record everything, providing a record of your communications. An IM program which enables audio or video chat (such as Skype) can save money on long-distance calls and teleconference charges.

Twitter asks “what are you doing?” with 140 character spaces available to answer.

Social network websites (e.g., Facebook, LinkedIn, MySpace, Crowdvine, Ning, Meetup) allow a user to create a profile description, select other users as friends, contacts, colleagues and share their contacts’ contacts as well.

Slide sharing sites (e.g., Slideshare) provide a place to share slide decks (PowerPoint, Keynote, etc) and view the slides online.

Link sharing (e.g., Delicious) provides a place to store and access bookmarks from anywhere on multiple computers. Bookmarks can be shared with others or kept private.

Photo sharing sites (e.g., Flickr, Picasa) store, organize, search and share digital photos.

Video sharing (e.g., YouTube,, services host and display video files for others to watch, comment on, and share.

Online Surveys (e.g., SurveyMonkey, Zoomerang, Fluid) have advantages over paper surveys including: reduced data entry time and errors as well as reduced analysis time and effort.

Mapping applications (e.g., Google Maps) provide geographically-related information with ease.

Podcasts (.mp3 or other audio formats) are audio files istened to on a computer or mobile music player (e.g., Ipod).

News sharing (e.g., Digg, Reddit, Newsvine) websites let a large group of people decide which news items are the most interesting by highlights the items. It is sometimes called crowd sourcing news.

Webinars (e.g., LiveMeeting, Bridgit, Dimdim) are an online seminar room. You can participate in a lecture using your computer and usually a teleconference at the same time.

A word of caution

When using social media, be aware that in Canada, there are PIPEDA (Personal Information Protection and Electronic Documents Act) requirements about appropriate storage and use of client information. (14) As well, provincial legislation such as PHIPA (Personal Health Information Protection Act) and MFIPPA (Municipal Freedom of Information and Protection of Privacy Act) to consider. (15) (16)

Also, many social media tools are hosted on USA servers and are subject to US laws allowing government access to data without notification.

The Health Nexus wiki provides some considerations for health units on using social media including examples of organizational policies for using social media

VII Conclusion

Using social media requires an investment of time, an ability to trust the process, excellent communication skills and transparency.

Social media also requires an understanding of how people are using it and a thoughtful application that respects the personal element that social media interactions can result with clients. (5)

Craig Lefebvre proposes that “eventually social networks engaged through social media will provide a model for sustainability at the local level to weave together local assets and capacity needed beyond the external start up funding”. (5)

To build online capacity, consider these ten tips for applying social media tools within a health communication strategy:

Focus on reaching and engaging the segment of the target audience that spans boundaries and connect networks such as connectors that can bring new ideas and behaviours to others thus closing the distance between groups and creating links between them. (5)
Highlight examples of positive behaviours to attract imitation and role modeling and promote the action of early adopters to the mainstream. (5)
Find sound, innovative solutions to problems and provide opportunities for innovators to discover the solutions. (5)
Expect and encourage reinvention, co-creating materials and sharing with social media. Provide access to the information you want to share in a format that will allow people to adapt and share while maintaining accuracy. (5)
Embrace interactivity and audience generated content. (5)
Be everywhere! Maximize social media channels. (5)
Support time and energy for discovery, testing, network building, adapting and monitoring social media application. Start using social media by interacting with current partners and colleagues. (5)
Maximize opportunities for collaboration and sharing. Be active, interesting, honest and interesting when participating.
Remember that social media can educate, engage, entertain, empower and well as provide information, inspiration and innovation.
Social media provides an opportunity for knowledge transfer to many by many.
And finally, Craig Lefebvre advises “It’s not about using new media; it’s about using media in new ways.” (5)

VIII References

  1. Stats Canada (2007) [accessed February 28 2010]
  2. Lefebvre, C (2007) The New Technology: The Consumer as Participant Rather Than Target Audience. Social Marketing Quarterly. Volume XIII No.3 [accessed February 28 2010]
  3. Did you Know 4.0. Fall 2009) Media Convergence Conference, The Economist [accessed March 22 2010]
  4. Socialnomics- Social Media Blog [accessed March 22 2010]
  5. Lefebvre, C (2009), The Health Communication Unit Web Cast: New Media with Craig Lefebvre [accessed February 28 2010]
  6. Krebs, V, Holley, J (2006) Building Smart Networks Through Network Weaving [accessed February 28 2010]
  7. Valente‘s reference to Rogers EM (2005) Diffusion of Innovations. 5th ed.
    New York: Free Press
  8. Christakis, N, Fowler, J (2007) The Spread of Obesity in a Large Social Network over 32 Years New England Journal of Medicine [accessed February 29 2010]
  9. Craig Lefebvre (Oct 2007) Maybe IT IS All About Social Networks. Blog On Social Marketing and Social Change by Craig Lefebvre [accessed February 22 2010]
  10. Craig Lefebvre (Oct 2009) Social Models for Marketing: Social Networks. Blog On Social Marketing and Social Change by Craig Lefebvre [accessed February 22 2010]
  11. Gladwell M. (2000) The Tipping Point: How Little Things Can Make a Big Difference. Boston, MA: Little, Brown and Company.
  12. Vallente, T (2006) Mass and Interpersonal Communication: Buzz for Behaviour Change Ontario Health Promotion E-Bulletin, 17 November 2006 – OHPE Bulletin 490, Volume 2006, No. 490 [accessed March 8 2010]
  13. Health Nexus Sante Tools [accessed February 28 2010]
  14. Office of the Privacy Commissioner of Canada, (2004) Personal Information Protection and Electronic Documents Act (PIPEDA) [accessed February 28 2010]
  15. Ontario (2004) Personal Health Information Protection Act, [accessed February 28 2010]
  16. Government of Ontario (1991) Municipal Freedom of Information and Protection of Privacy Act