“For Me,the Biggest Benefit Is Being Ahead of the Game”:The Use of Social Media in Health Work

Characteristics of Participants

Of the 15 participants working in the field of communicable disease recruited for interviews, the specific areas of work included patient care and diagnosis, research, health education and promotion, infection control, epidemiology, immunization, and disease surveillance. Two participants had direct contact with patients in health care roles (as a specialist and a nurse, respectively), but the former also worked in a senior managerial position in a health care facility. Four other participants worked in management positions in hospitals or health clinics. Six participants held research positions that for several of them included health education or policy roles. A journalist who runs a medical news blog and is a public health activist was also interviewed. Most people (13) were employed in Sydney and Melbourne, with one working in a large regional city and another based in a rural location. Seven participants were female and eight were male.

While all of the participants used social media as part of their working practices, they varied considerably in the extent to which they did so. The most commonly mentioned social media platforms used for work were Twitter (10 participants) and Facebook (6). Two participants had experimented with blogging. One participant used YouTube and Instagram and another said she used SlideShare to share her conference presentations. Those who used Twitter did so primarily to interact with other professionals in their area and with the public and to disseminate health communication messages. Facebook, YouTube, and Instagram were mostly used for running health education campaigns and publicizing infectious disease surveillance initiatives and health services.

Benefits and Value of Social Media

The participants all attested to the value of social media for their working lives. The principal benefits they described were the opportunity to easily access and disseminate information, establish professional networks, and connect and communicate with lay people, groups, and organizations outside of their peer networks.

Most people said that they were neither expected nor encouraged to use Twitter for their work, but this did not stop them from following other people’s discussions and information sharing with other professionals in health care and public health. One feature that many people found helpful was the ways in which Twitter, in particular, could be used to keep up-to-date with the latest research and practice: “to feel the pulse of what’s going on out there,” as M05 put it. F01 commented that she appreciated the instant and real-time nature of Twitter, noting that on the platform, information “comes to me rather than me searching for it.” For several of the participants, Twitter use helped them feel better connected to their peers by expanding their connections and allowing them to regularly engage in exchanges with them on the platform. As F05 noted,

I guess I like that I have a (Twitter) presence and that people are aware of me. And I do like to disseminate my research, and I think that is a positive. However, I really find it very useful for being across what everyone else is doing, other people’s publications. I really use it as a way to keep informed. For me, the biggest benefit is being ahead of the game.

F04, a researcher and health advocate, said that “I feel like I am part of a community within Twitter.” She contended that this platform has provided her with access to networks of peers, helped her to disseminate her research, and “can address professional isolation.” She remarked that her Twitter connections and conversations had “influenced, even instigated” whole research projects. M08, also a researcher who engages in public health communication, engages in live-tweeting at conferences. He said that this use of Twitter helps him to focus on the content of the presentation and can be the catalyst for expanding “my real-life circle of networks.”

F03 drew attention to the participatory and international dimensions of Twitter: “Twitter has really broadened the input. It’s also much more global.” This participant is a journalist who runs an online medical news site. She noticed that she has been able to draw more international attention to the site by using Twitter strategically to publicize new stories. She emphasized that if those using Twitter for professional purposes recognize that “it’s a two-way thing, you’re most likely to get benefit out of it.” Twitter users should view their engagement as a “service to your followers.” She has found that the platform has become her major source of news, but also works to disseminate new information herself via her Twitter engagement.

Beyond establishing and strengthening peer networks, most of those who used Twitter remarked on the possibilities it offered to engage with publics. According to F04, being active on this platform by discussing issues related to her field of work meant that she could communicate with individuals and groups to whom she would not usually have access or would never meet in other circumstances. Some of these individuals and groups disagree with how the health issue she works on is managed, while others are engaged in political activism concerning her area of research. She contended that using Twitter, she was able to be exposed and respond to their views in ways that might not be possible without Twitter. She argued that her Twitter use helps her to monitor what issues are considered important or controversial by members of the public, and thus, “Twitter for me is like a bit of a barometer of sentiment.”

Those people working in outreach and health education roles also commented on the use of social media for conveying messages to the general public or targeted groups. F07 noted that these media offered possibilities for reaching larger audiences than traditional media, and their engagement with the content could be monitored in real-time. For M05, Twitter and Facebook were conceptualized as “push technologies” and as therefore offering opportunities to better target the public with health messages. M04 works in HIV/AIDS prevention and education, and commented that gay men now meet each other using social media and apps rather than initial face-to-face meetings in places such as bars. His work has consequently needed to adapt to these changes to better provide information and resources to his target audience of gay men: “We believe that using online platforms is kind of like the only way in which we could sustain continuous dialogue with the gay community.” This man observed that campaigns using traditional media such as newspaper and magazine advertising, billboards, and posters in gay publications and meeting places no longer have the reach that they used to. His organization makes sure to integrate social media with its website so that the targeted audiences can be offered maximum exposure to the information it offers. The aim of recent social media campaigns was to engage with people by “humanising the whole social media aspect of things. I think a lot of people like to know what their peers are doing.” His organization sought to do this by using its Facebook page to provide narratives of people deciding to seek HIV testing, attempting to emulate the Facebook genre of sharing personal stories.

The clinic at which M03 works also provides health care to people with HIV/AIDS and other blood-borne diseases, as well as acting in a health education role. The clinic uses a Facebook page to encourage people to come in and be tested for HIV, sexually transmissible diseases, and hepatitis and provide details of the clinic’s services. M03 described how new HIV acquisition is commonly among younger people, most of whom are on Facebook. The clinic is therefore using Facebook as a “lure” to attract people in for testing. F02 works in an area that focuses on communicating to the public about the importance of immunization. She observes that the media unit in her department has been suggesting social media to address the “myths” around vaccination promulgated in these platforms by anti-vaccination advocates.

M08’s primary role is as a medical researcher in communicable disease, but he also seeks to engage with the public about his area of research. He does so using social media such as Twitter to attempt to publicize health risks. He has found that Twitter works well as a medium for public health communication: “I guess what I am trying to do is, just sort of, just amplify all of those messages that we would already be doing through traditional media.” This participant referred to his recent experience of publicizing a particular health message to the Australian public using Twitter. He was successful in reaching a wide audience, facilitated by the re-tweeting and sharing possibilities of the platform:

Even though I had, you know, a fairly modest number of followers on Twitter, because of the networks that I kind of moved in, I think, sending out messages to tens of thousands, well, it was at least reaching tens of thousands.

M02 works in communicable disease surveillance. He commented that social media can be a fast and easy way of communicating information about disease outbreaks to the public. He has used Twitter to publicize outbreaks of infectious disease. He gave the example of such an outbreak in a nightclub, noting that Twitter message might be “Were you in such and such a venue on . . . ?” This participant believed that “you’re more likely to get to a younger person through one of these devices” than using traditional media such as radio news or newspaper advertisements.

Drawbacks and Difficulties of Social Media

Several drawbacks and difficulties of using social media in the workplace were identified by the participants. These included problems with access to the Internet at work, the lack of interest in or disdain of social media by managers and co-workers, lack of skills or confidence in knowing how to use social media, worrying about the appropriate content of social media, time pressures, and issues around defining boundaries between private and professional use.

Many of the participants worked for government health organizations (public hospitals, health departments, and health agencies that are part of Australia’s state-funded health care system). Some of these people commented on the difficulty of adopting new approaches in a government agency: “everyone gets a bit twitchy because you’re meant to be a bureaucrat” (F02). It was noted by several people that at some workplaces, employees were prohibited from access to the Internet. According to M02, although he can access the Internet at his workplace, many others in his state working for government health agencies cannot:

That’s one of our sort of big problems in regards to using them more readily. It’s a way of making sure people don’t use it for their own personal use. It’s something that we’re trying to overcome. We need to illustrate that it is critical to our work processes, so that will probably happen over time if outbreaks come up.

M03 observed that his workplace had only just recently acquired Internet access. He said that he and his colleagues previously had to undertake all work-related Internet activities, including information searches, from home: “They, the Ministry, were probably afraid that people would end up abusing Internet usage—we are actually using Internet for what we are supposed to be using it.” This participant observed that “life [at work] has been easier ever since we started using Facebook, Google, and all other Internet access.”

Several participants drew attention to the problem that other employees or supervisors in their workplace held the view that social media are mostly used for trivial or personal matters, or are primarily a young person’s form of communication. For example, F01 commented that Twitter is not a tool that is promoted widely for use in her kind of work and is still viewed as a fringe activity. She considers herself “a bit of an outlier” for using the platform for work purposes, as “the Department of Health is a bit of a dinosaur sometimes when it comes to new technologies.” F04 is also aware that it can be a “bad look” to be seen on Twitter while at work for those who do not understand its benefits: “what does that say about the way you use your time?”

As one of M02’s roles is communicating to the public about disease outbreaks, he finds it frustrating that he and his colleagues are barred from using social media more readily as a communication avenue. He commented that those in managerial positions in the bureaucracy tend to view social media as a “more a younger generation sort of tool.” F02 felt this generation gap herself. She commented that she viewed herself as less knowledgeable than her younger staff members—“the kids”—as she referred to them. She said that she relied on them to lead the way in suggesting ways to use social media and other strategies such as apps for health education.

Most participants related accounts of dealing with colleagues’ lack of knowledge or awareness of the potential of social media. M08 said that he was often questioned about his use of social media for work by colleagues: “They say, ‘Aren’t you too old to be using social media?’ or they are too old, or they don’t understand.” He argued that people really needed to try social media for themselves before they could fully understand their possibilities for work use. According to F05, the general attitude among her co-workers toward social media was as follows: “It’s new, it’s new, it’s new, it’s all too hard and what’s the deal?” She went on to note, however, that “as soon as they start using it, everyone likes it!” F03 thought that the main barriers to health workers using social media effectively were “lack of skills and confidence.” She further observed that the power relationships and rigid hierarchies of health institutions often work against adopting new technologies:

The old communication model was very tightly controlled at the top, very centralised. And, you know, the whole thing about the Internet is power moving out from the centre and the decentralisation of power is difficult to deal with. The best people in your organisation to do social media may not be those central ones.

Another difficulty can be in demonstrating the effectiveness of using social media for health communication. As M07 argued, “If things like Facebook and Twitter are shown to work in terms of, you know, prevention effort, then there should be a big investment in those, but I’m not sure how that’s to be understood or measured.”

Several participants drew a distinction between the relative appropriateness of using Facebook and Twitter for work. Some had decided to keep Facebook as a personal platform while using Twitter for work. According to M08, “generally speaking, I keep Facebook for personal stuff. One of the reasons I haven’t used Facebook for work is, you know, it’s a more complicated beast to manage.” F01, who is a senior manager working in a large public hospital, observed that she did not agree with using Facebook in the workplace because she thought that people mostly used it for personal purposes. Twitter was a different matter—she uses this platform herself and finds it useful to keep in touch and communicate readily with peers. She argued, however, that the Department of Health may see it as the “thin end of the wedge—why would you let people use it?”

Some people also considered the content they created for social media and were aware of the possible pitfalls of disseminating inappropriate, useless, contentious, or inaccurate information. M08 noted that he was aware that he is a government employee, and accordingly moderates the content he posts on Twitter: “I sort of have my own kind of rules that I very rarely, if ever very often, make any sort of political kind of messages, which probably reduces any controversy.” F04 similarly noted that she was careful to present a professional demeanor on Twitter, in line with what she saw as expectations of someone who is a senior academic. She commented that she is “naturally quite a playful person” but “because I’ve got this identity as a senior researcher on Twitter, I feel an obligation to conform my behaviours to that identity” so that she upholds the reputation of her organization, her title, and the university. F01 said that she tended to “lurk” on Twitter rather than actively contribute content, because she felt she could not usefully contribute: “I don’t tweet because I don’t have anything interesting to say. I don’t want to say anything that is really boring.” She also expressed her concern that if people are commenting on work matters, they might say the wrong thing or at least it might be received in the wrong way: “Sometimes the casualness of the language (on Twitter) can betray the seriousness of the conversation.”

The difficulties of managing the time commitments demanded by social media were also identified as a potential barrier to using them for work purposes. For example, F01 noted that one of the challenges of using a social medium like Twitter for work: “there is this information overload. Our lives are very busy, and it’s another thing.” F04 was reflective about how best to negotiate the boundaries between work and personal life. She has found that she has to be aware of how Twitter can tend to eat into her personal time: “You know how work tendrils can get into your personal life with current technologies? Well, Twitter facilitates that, it almost amplifies that—it can be quite addictive.” This participant said that she sometimes struggles to limit the time she spends on the platform: “My family will often complain that I’m on Twitter too much, so I have to actively resist the temptation to check my tweets too much.”

Ethical and Political Issues

Several ethical and political issues related to social media for work use emerged in the participants’ accounts. Some participants recognized some ethical issues, but were relatively unconcerned about them. One example was M05, who observed that the ethical issues associated with using social media are no different from those of other media. Health professionals just need monitoring and training in how to use social media appropriately. He contended that “there will be errors [in tweets], but the errors will be more than made up for by the enhancement of credibility and transparency.” M02 discussed the possibilities that contacting people through social media to communicate health risk messages could be viewed by some people as “an invasion of privacy.” He argued, however, that if people are perceived to be at risk, then it “overrides that ethical dilemma.”

Few people made mention of patient data privacy or security issues when discussing their use of social media for work. One exception was M08, who drew attention to the importance of maintaining patient privacy when using social media. He commented that this may deter health workers: “some people might think that it’s all too hard, or that they’re too scared of inadvertently making a mistake.” F07 noted that the intimacy of personal information exchange offered by social media like Facebook was potentially helpful for learning more about people’s health behaviors and providing further information to them for preventive health. However, this raised issues of data privacy that needed to be considered by health workers. She contended the health workers and health organizations needed to more seriously consider how they represent themselves on social media and to be transparent about how they were using people’s personal information.

Those people who were working in highly sensitive or contentious areas of infectious disease control and management tended to be alert to the ethical and political issues involved in formulating the content of public health messages in social media, as they were confronted with dealing with these issues regularly as part of their working lives. Several of these participants worked in the field of HIV/AIDS and other sexually transmissible diseases. They drew attention to the importance of considering the stigmatized nature of these diseases and the risk groups for infection and the personal and political sensitivities that surrounded them. These participants observed that their staff at their clinics needed to be very careful about what kind of information they uploaded and shared on social media and the tenor of their online communications. According to M02, for example, “we’re limited as to exactly what we can put on Facebook. You know, there is so much red tape—a lot of consultation has to be done.” He went on to say that “this is exactly what limits, you know, a lot of success to be achieved when it comes to talking about health—it’s always so politicised.” M06 also discussed how using Facebook to spread public health messages around sexually transmissible diseases should involve acknowledging that:

It’s not just a one-way delivery of information—you’re getting feedback from people as well. It’s just a bit difficult depending on the topic, like, sexual health I guess is a very personal and sensitive topic, because Facebook is a very public forum.

The sometimes political nature of work in communicable disease means that people who are active participants on social media can be open to criticism and abuse. F03 noted that professional and ethical considerations include basic codes of etiquette for interacting on social media platforms. She commented that “I’m quite amazed often that you see people being really quite vicious on social media.” F04 and F05 work on a communicable disease prevention strategy that is highly contentious and often targeted by dissenters and activists. As a consequence, they have become the target of significant criticism and abuse on Twitter. F05 saw this “bullying” as one of the negative aspects of her Twitter use. She contended, “if you weren’t a strong enough person” such attacks could easily undermine one’s professional confidence and lead one to relinquish Twitter use.

F04 had been the target of extensive criticism on Twitter. She vividly described this experience as “you feel like you’re surrounded by a pack of salivating wolves.” She said that the “pile-on” effect can occupy a lot of time, “especially when I am trying to manage my own distress around it.” She went on to comment that her professional identity and confidence has been sometimes shaken by these experiences.

Future Uses

Despite the difficulties and barriers several participants had experienced in adopting social media, all expressed positive opinions about prospects for the future of these technologies in public health work. Most participants envisaged these media as becoming more acceptable for health work use as their possibilities were progressively realized. According to M02, “I can’t see us going backwards—I can only see us going forwards and we’ll be using them (these technologies) more and more readily.” M03 contended that health care and public health workers who are currently resistant to social media will need to adapt: “they realise that as well.” F04 argued that health workers should be provided with social media training and policies of their organizations should be generated to provide guidelines on how they should use social media productively and ethically.

Several participants acknowledged that they had only just begun to use social media effectively and understand how the public was engaging with these media, and that many possibilities had not yet been realized. According to M06, “we know it is there [social media for public health promotion] but we’re probably not using it as best we can at the moment. So there’s lots of room to work with it in the future I think.” Participants who used social media to disseminate health messages were aware that they were competing for target audiences’ attention and accordingly needed to think carefully about content. The problem of “message fatigue” was identified by F07 who noted that while social media had the potential to reach large audiences, the content needs to be fresh and interesting. M06 similarly noted, “I think getting the ingredients right—actually getting people interested and looking at your page is a real challenge.”

It was recognized by some people that social media affordances are changing, and health workers needed to be responding accordingly. M03 observed that

digital media just evolves and proliferates. People are using more kinds of technologies and combining them in different ways. How are they combining, how are they actually doing it? That is the really big open research question.

F04 outlined several possibilities for the future of these technologies in public health work, such as open peer-review, collaboration of consumers in planning and analysis via a wiki, and analyzing social media for what they reveal about health behaviors and disease outbreaks: “it’s just boundless—it’s such a great time to be in academia, because of the web and web 2.0 in particular.” F07 was also interested in further exploring the possibilities of using big data for disease surveillance or health promotion.