Health Organizations Providing and Seeking Social Support: A Twitter-Based Content Analysis

Introduction

Internet-based new technologies have become increasingly popular in recent years. While early Internet forums and weblogs are still being widely used, social network sites (SNSs) have increased their user base significantly in the past few years. For example, Facebook, one of the most visited web sites, ¹ has more than one billion users. ² Twitter has become an important source of information, ³ with 340 million new tweets and 1.6 billion search queries produced every day. ⁴ The rise of new communication technologies provides opportunities for exchanging health-related social support. Research on computer-mediated communication has shown that individuals seek, provide, and receive different types of social support through online health communities,^5–8 and also rely on SNSs to find health information and discuss health-related topics.^9,10

Extant research largely focuses on exchanges of health-related social support between individuals while overlooking health organizations. As there is no established formal definition of health organizations, this study proposes a working definition of health organizations as follows.

Health organizations are agencies that are concerned with health on a national or regional level. ¹¹ Specifically, the primary aim of these organizations is to promote healthcare for the public, such as strengthening the national/local health services, providing health education, or conducting research on health problems.^11,12

Many of these organizations use SNSs frequently and play an active role in exchanging health-related social support. Recent statistics compiled by the American Public Health association showed that up until March 2012, 56% of state and 53% of local health departments had a Facebook account and there were 180 health agencies on Twitter. ¹³ Moreover, 16% of online health information comes from health organizations. ¹⁴ Health organizations also use SNSs to communicate with stakeholders and communities they serve,^15,16 and as a result, health-related social support may be exchanged in this process.

Although SNSs provide many new opportunities for health organizations to exchange social support, these opportunities have not been fully utilized. ¹⁷ In addition, most research has focused on receiving social support, but has paid less attention to seeking and providing social support, which are also important components of a support exchange process. It should be noted that seeking, providing, and receiving social support is a complex and dynamic process. ¹⁸ Therefore, examining the types of social support health organizations seek and provide is essential to understanding the process of support exchange.

Hence, this research aims to address these gaps in the existing literature by examining social support exchanges through SNSs at the organizational level. Understanding how health organizations seek/provide social support from/to the general public helps determine whether such online support exchange is effective, thus offering insights on developing strategies for these organizations to exchange support effectively with the general public. Using content analysis, our goal is to explore what types of social support health organizations seek and provide through Twitter, a popular SNS where social support exchange is understudied.

Social support is defined as “verbal and nonverbal communication between recipients and providers that reduces uncertainty about the situation, the self, the other, or the relationship, and functions to enhance a perception of personal control in one's life experience.”^19(p185) Social support does not have to be enacted—perceptions of the availability of social support increase individuals' confidence in combating stress. ²⁰ However, perceived social support can be different from enacted social support, which involves receiving the actual resources. ²¹

This problem suggests that focusing on perceived social support is insufficient. Instead, it is necessary to examine enacted support that has been exchanged. Three main types of social support, found both online and offline, are exchanged between individuals: emotional, instrumental, and informational. ²⁰ Examples of informational support include medical information, ⁷ personal experiences, ²² and referrals to experts. ⁵ Examples of emotional support involve encouragement, caring, understanding, and sympathy.^6,8 Examples of instrumental support involve financial support and helping with tasks.^7,8

These support exchanges that occur during interpersonal interactions may also exist at the organizational level. Because SNSs make it easy to broadcast information to a large audience, health organizations use these sites to disseminate information, ²³ such as medical, organizational, or health campaign-related information. By using SNSs to broadcast information, health organizations are able to provide informational support to others. SNSs can also facilitate communication and relationship development. ²⁴ Research has shown that health organizations not only build online communities^13,25 but also establish intimate/close relationships with their stakeholders on SNS. ¹⁴ Such communities and relationships are often indications of emotional support exchanges. Furthermore, health organizations may also seek support from their SNS contacts, for instance, asking for suggestions on particular activities or issues,^23,25 or mobilizing health-related activities and calling for participation.^24,25 These usages suggest the potential of using SNSs for exchanging informational, emotional, and instrumental support by health organizations. Given the lack of empirical evidence in this area of inquiry, the following research questions are posed:

RQ1: What types of social support do health organizations provide through Twitter?

RQ2: What types of social support do health organizations seek through Twitter?

Method

Results

In response to RQs 1 and 2, all three types of social support were found to be sought and provided by health organizations on Twitter, except seeking emotional support. Table 1 displays the numbers of tweets in each category of support exchange, and the means and standard deviations of the number of each type of support provided and sought among all 58 organizations. The most common type of tweet was providing informational support (76.7%; e.g., “#Acne can be challenging to treat in skin of color. For five key treatment tips, visit http://t.co/JF7NYAy2”). Informational support identified in our sample covered a wide range of topics, such as medical information concerning knowledge of diseases and possible treatments, information about health insurance and health-related services, referrals directing Twitter users to other specific sources, and general information regarding news unrelated to health.

About 11.5% of tweets provided emotional support (e.g., “Today we pause to honor and thank the brave men and women who have served in our Armed Forces”). Most emotional support offered thanks or compliments, and some involved a direct target. Only 0.47% of tweets provided instrumental support (e.g., “We sent $100,000 for Tanzania Red Cross relief operation to support 20K families. Total commitment now=$2.9m #hornofafrica”).

Tweets seeking social support were fewer than those providing social support. A total of 7.6% of tweets sought instrumental support, such as calling for participation in activities (e.g., “Happy Election Day! Make your voice heard by taking time to vote”). Only 0.53% of tweets sought informational support (e.g., “Enough about us, we want to hear about you! Share your story of empowerment w/@CARE\http://t.co/xLEMuOak”). The remaining tweets were coded as others (3.2%; e.g. “What fun activities is your office doing today?”).

Discussion

To our knowledge, this study is the first attempt to examine the types of social support health organizations seek and provide on SNSs. The motivation for this investigation stems from the burgeoning popularity of SNS usage among health organizations and the potential that health organizations may use this new communication technology to facilitate their exchanges of social support. We conducted a content analysis to investigate whether health organizations used Twitter to provide and seek informational, emotional, and instrumental support. As the first content analysis on this topic, our study provided empirical evidence regarding the ways in which social support is sought and provided through SNSs at the organizational level.

We found that an overwhelming amount of tweets sent by health organizations on Twitter provided informational support, consistent with previous findings that organizations use Twitter most frequently to disseminate information.^15,16 This result suggests that health organizations mainly use Twitter to make announcements, indicating that the communication mode between health organizations and their audience on Twitter is one-way interactions. Although we found health organizations also provided emotional support, which indicates two-way interactions and more personal communication, such tweets are less frequent than providing informational support. Thus, our finding shows that health organizations' use of Twitter is limited. Although one important characteristic of SNSs is to encourage two-way interactions and build personal connections, ¹⁷ this advantage has not been used to its full potential by health organizations.

However, a close inspection of our findings provides an alternative explanation. Besides providing a huge amount of informational support, health organizations also provide a noticeable amount of emotional support and meanwhile seek instrumental support. More importantly, the latter two types of support exchange comprise almost 20% of all tweets. From a long-term perspective of relationship development, providing informational support, providing emotional support, and seeking instrumental support represent a three-stage process of engaging Twitter contacts in effective two-way interactions. ¹⁶ Information dissemination, or providing informational support, may only be the first step for this process by laying a foundation for future interactions and relationship development. Building on this foundation, health organizations may communicate on a more personal level with their contacts by providing emotional support, and further engage in community mobilization by seeking instrumental support.

An interesting finding is that instrumental support is the only type of social support health organizations seek. This finding has several implications. First, our results support previous research that found organizations use new communication technologies to call for participation in activities.^24,25 Due to the far reach of information dissemination, new communication technologies provide better access to large groups of people and so are effective for mobilization. However, individuals seeking support can be considered vulnerable or incompetent. ²⁷ The same concern may occur for health organizations, given that sending tweets is a way these organizations present themselves online. Seeking emotional and informational support may lead to an impression of being incompetent and unprofessional. In contrast, seeking instrumental support can present an organizational image of being active in promoting community welfare. Future research can examine online support exchanges among organizations from the perspective of self-presentation. ²⁷

This study has several theoretical and practical implications. We are the first to provide quantitative evidence about enacted social support provided and sought at the organizational level. Complementing research on receiving social support, our study demonstrates a complete and dynamic process of support exchange. The most important contribution is that we suggest a three-step approach to engaging Twitter contacts into effective communication through providing informational and emotional support and seeking instrumental support. This result suggests a theoretical framework for future research on social support exchanges at the organizational level. In addition, our findings indicate that there may be a relationship between exchanges of social support and self-presentation. We hence situate social support exchanges in a broader context of communication, and associate it with self-presentation and public relations of organizations, providing a new perspective of examining this issue on SNSs.

From a practical perspective, this study suggests health organizations use SNSs to their full potential by converting such sites into a tool for two-way interactions. More exchanges of emotional and instrumental support are necessary for relationship development and community mobilization.

Several limitations of this study should be noted. First, our sample was selected by using a list of random numbers. A sampling frame based on the number of employees, size of assets, and the number of followers of health organizations might yield a more diverse sample. Second, our sample size was relatively small, although this sample size was enough for content analysis, considering the exploratory nature of our study. A larger sample may allow for more sophisticated statistical analysis, such as the relationship between the number of followers and types of social support sought/provided. Third, some organizations in our sample were not active users of Twitter, based on the number of tweets sent over 2 months. This may create a bias in our results.

Future research promises to provide fruitful results in many directions. First, each kind of social support can be broken down into additional subcategories. For example, providing informational support might be further categorized into providing medical information, providing advice, or referring to a doctor/specialist. Thus, it would be possible to compare different types of informational support provided. Second, future research may want to examine responses to originally posted tweets. Examining responses can better reveal whether Twitter is an effective tool for exchanging social support between health organizations and their followers. Finally, a potential research area is to explore several types of support exchange that were scant or absent at the organizational level (e.g., providing instrumental support, seeking emotional support), as revealed by the present study. The scarcity of providing instrumental support in the current findings may be due to the technological limitations of Twitter (e.g., the length restriction of tweets), while the absence of seeking emotional support may be due to the organizations' concerns for self-presentation.

In conclusion, this study serves as a valuable initial examination of the ways that health organizations use SNSs to provide and seek various types of social support. Our study contributes to the existing literature by providing evidence that social support exchanges via Twitter exist among health organizations while revealing that the primary types of support exchange are providing informational and emotional support, as well as seeking instrumental support. This study thus offers insights for health organizations on how to use SNSs more effectively and to their full potential in regards to communicating with their audience. This study also sheds light on future research regarding social support exchanges with SNSs at the organizational level.