Advancing the Promise of Digital Technology and Social Media to Promote Population Health

In June of 2018, the Society for Public Health Education partnered with The George Washington University Milken Institute School of Public Health, University of Maryland School of Public Health at College Park, and the Public Good Projects to convene the inaugural Digital Health Promotion Executive Leadership Summit in Washington, D.C. We launched the 2018 Summit for several reasons. First, because of the ubiquity of digital technology and reach of social media, it had become apparent to us that the time was right to bring greater focus to the promise that digital technology and social media hold for improving the public’s health. Second, while other forums were discussing uses of mHealth and eHealth, it was clear the public and private sectors were talking within siloes; thus we believed that more needed to be done to catalyze a dialogue among the academic, industry, and government sectors to share their efforts and to examine the opportunities—and challenges—of forging collaborative partnerships in developing and evaluating the next generation of digital information and health communication technologies. And third, we hoped to facilitate a conversation among leaders from each of these sectors that would result in a consensus on a “Common Agenda” for future actions to advance digital health promotion efforts.

The Summit brought together 30 expert speakers and more than 75 national leaders from the academic, government, nonprofit, and private technology sectors in the United States and other nations to discuss digital technology’s role in addressing a range of pressing public health issues, including the opioid epidemic, suicide, and the impact of technology on children and adolescents (see https://digitalhealthleaders.org/). Those participating in the Summit heard presentations of case studies of successful uses of social media in public health interventions (e.g., emergency response to devastating hurricanes in Puerto Rico and New Orleans) and discussed cross-cutting issues related to digital health and confidentiality, patient protection, and data sharing—all in an effort to scale and strengthen future directions for the use of digital technology to improve public health. Rather than criticizing and vilifying uses of digital health communications by different sectors, we pursued frank, open exchange among the principal players about the promise and pitfalls of what some have called a “Pandora’s box.”

The first Summit produced two important intellectual products: a consensus statement and declaration of principles—“Toward a Common Agenda for the Public and Private Sectors to Advance Digital Health Communication” (Abroms, Allegrante, et al., 2019); and this supplement of Health Education & Behavior (HE&B), sponsored by the National Institutes of Health (NIH) Office of Behavioral and Social Sciences Research. In addition it, also paved the way in setting the stage for the Second Digital Health Promotion Executive Leadership Summit, held in June 2019 (see https://digitalhealthleaders.org/), which brought new public and private health communication experts to the table to discuss additional issues, challenges, and opportunities presented by digital intelligence, the spread of misinformation, online patient communities, censorship in social media, and the emerging global legal frameworks that could shape the contours of the digital space in years to come.

This supplement of HE&B contains commentaries and reports contributed by some speakers at the 2018 Summit as well as others who responded to an open call for papers reporting empirical research in the field of digital health. Over 40 manuscripts were submitted in response to the call for papers, providing ample evidence that digital health is a burgeoning area of interest that will challenge behavioral scientists and practitioners for decades to come. In organizing the supplement, Co–Guest Editors Lorien Abroms of The George Washington University, Robert Gold of the University of Maryland, and John Allegrante of Columbia University—along with an impressive global Guest Editorial Board—have curated a state-of-the-evidence collection of articles showing how digital technology and the ever-growing social media world are shaping the possibilities and promise for promoting public health.

The three commentaries and 11 articles that comprise the supplement, including the revised Digital Health Communication Common Agenda 2.0 (Gold et al., 2019), are intended to further the commitment of the Society for Public Health Education, HE&B, and the profession of health education to advancing the theory and practice of health communication by harnessing the opportunities to promote human health through digital technology. We believe that the scientific contribution of this supplement advances a dynamic area of health promotion and points the way toward the future.

The supplement opens by looking through the wide-angle lens of an editorial by the Co–Guest Editors and three commentaries, each of which brings the issues of digital technology and health into sharp focus. In their editorial, Abroms, Gold, and Allegrante (2019) assert that harnessing digital communication technology and social media in the service of promoting health is perhaps the defining public health challenge of this century. In the first commentary, William Riley, director of the NIH Office of Behavioral and Social Sciences Research, and his colleagues at Office of Behavioral and Social Sciences Research (Riley, Oh, Aklin, & Wolff-Hughes, 2019) highlight some of the research that NIH has been supporting in eHealth, mHealth, and social media; some of the challenges and opportunities in the digital health field; and the need to balance the promise of these technologies with rigorous scientific evidence. In the second commentary, Dina Borzekowski (2019) introduces the construct of “constancy” to conceptualize the ubiquitous and continuous state of being connected to digital communication that pervades the lives of today’s children and adolescents. She notes that such pervasive connections to smartphones and other digital devices and media must be considered in the developmental needs of youth and understanding its effects on cognition and education. And the third commentary by de los Reyes (2019) highlights the challenges and opportunities facing institutional entrepreneurship in digital public health, arguing that public health researchers committed to institutional entrepreneurship need a tool kit—which he proposes—to take advantage of the opportunities in digital public health.

The main articles comprising the supplement take several methodologic approaches and use varied analytic strategies and narratives to address a wide range of topics in digital health.

Kearney, Selvan, Hauer, Leader, and Massey (2019) characterize public Instagram posts about the HPV vaccine and quantify the impact of sentiment and context on engagement through an analysis of “likes,” concluding that Instagram offers a unique opportunity to promote HPV vaccination.

Miller, Guidry, and Fuemmeler (2019) report on a novel program of research that supports the current use and potential future utility of Pinterest as a social media platform for health communication related to breast cancer. Their study has important implications for the development of future health promotion programs at Pinterest that could help reduce breast cancer risk among women.

Utilizing a network analysis methodology, Barker and Rohde’s (2019) report on topic clustering of e-cigarette submissions among Reddit communities advances our understanding of the widespread diffusion of e-cigarette content across social media communities. Their study adds to a growing literature investigating e-cigarettes and vaping on social media, while also contributing to network-level theories by linking communities on Reddit to the diffusion of various depictions of e-cigarettes and vaping.

Bekalu, McCloud, and Viswanath (2019) analyze the integration of social media into users’ social routines and map their emotional connections to social media sites as a normative social behavior. Using data from a nationally representative sample of American adult users, their findings reveal that while routine use is associated with positive health outcomes, emotional connection to social media use is associated with negative health outcomes. Their report suggests that the link between social media use and health may neither be captured nor adequately explained by the conventional dose–effect approaches, which are often observed in various health interventions.

Next, Evans, Thomas, Favatas, Smyser, and Briggs (2019) examine how the rapid growth and diffusion of digital media technologies have transformed the landscape of market segmentation, including its use to promote prosocial and health behavior changes. In an analysis of three case studies of digital segmentation that were originally presented at the inaugural Digital Health Promotion Executive Leadership Summit, they demonstrate that digital segmentation efforts in the not-for-profit, government, and academic sectors increase reach and frequency of messages delivered to priority populations in public health.

Carlyle, Guidry, Dougherty, and Burton (2019) analyzed 700 Instagram posts about intimate partner violence (IPV) using the social ecological model to explore a potential platform for IPV prevention. They examine the ways in which IPV messages on Instagram reflect public health understandings of, and approaches to, prevention and how Instagram users engage with these posts.

Johnson et al. (2019) developed and pretested a mobile multimedia message service communicating message content about the risks of hookah tobacco use to young adult hookah smokers. Their findings showed that young adult hookah tobacco smokers were receptive to tailored mobile multimedia message service messages and that messages evoked the kind of emotional response that facilitates behavioral change.

A report from Australia showcases research on the use of electronic images in social media. Monks, Barnes, Cross, and McKee (2019) explore young peoples’ image-sharing behaviors, particularly in the context of peer relationships and norms, revealing the complexities that young people encounter daily when sharing images in the online environment.

Finally, two studies show how social media can assist people in losing weight. In the first, Power et al. (2019) report on data from an Internet-based intervention, Fit Moms/Mamás Activas, a 12-month cluster randomized controlled trial that demonstrated effectiveness in promoting postpartum weight loss among low-income, predominantly Hispanic women. They found that users who engaged with the website more frequently and attended at least half of the in-person group sessions had average weight losses of up to 7% at 1-year follow-up, suggesting that frequent engagement with Web and mobile programs can produce clinically meaningful weight loss results in low-income postpartum women. And in the second study, the social experiences of adults who use online support forums to lose weight are explored by Reading, Buhr, and Stuckey (2019) in their brief report of a content analysis of Web-administered survey responses from members of two weight loss websites. Their report suggests that online support forums can powerfully benefit individuals attempting to lose weight by offering a place to receive nonjudgmental and socially supportive guidance from others.

Clearly, we are at the infancy of studying and understanding the impact and exciting potential for employing digital communications to improve public health outcomes. We hope the insights gained from the commentaries and studies reported here will advance the field and inform new applications of digital technology to other public health issues. Given the daunting challenges, and our moral, ethical, and legal responsibilities, we must harness the collective knowledge, resources, and investments of academia, government, and industry to pursue a healthier world. We hope this digital health supplement contributes to that pursuit.