LITERATURE REVIEW ON EFFECTIVENESS OF THE USE OF SOCIAL MEDIA

of the United Nations

the amount currently needed - to help Syrian refugees in Jordan and Lebanon But others also need to step up After all, the Charter talks about we the peoples Disruptive foreign-policy approaches have now also reached the Israeli-Palestinian conflict Many people are keen to make us believe that the negotiated two-state solution is obsolete

Section III CConversations onversations

Parents : Glad to meet you, Mrs Kaul If you need any help, please feel free to ask us We live in K – 92, Greater Kailash Teacher : That’s wonderful I’m in G –13 I’m sure we’ll be seeing more of each other Thank you very much for your offer Parents : Good-bye Word/Phrase Meaning

REMARKS BY THE PRESIDENT TO THE UNITED NATIONS GENERAL ASSEMBLY

REMARKS BY THE PRESIDENT TO THE UNITED NATIONS GENERAL ASSEMBLY The United Nations Headquarters New York,New York September 25, 2007 9:57 A M EDT

AGREEMENT ON CESSATION OF HOSTILITIES BETWEEN THE GOVERNMENT

6 - A Military Coordination Commission shall be established by the OAU and the United Nations with agreement of the two Parties in order to facilitate the functions of the Peacekeeping Mission It shall be composed of representatives of the two Parties and chaired by the leader of the Peacekeeping Mission

Minister ofForeign Affairs andExpatriates

Turkish regime resorted to direct military aggression, attacking cities and towns in northem Syria However, all these actions that undermine Syria's sovereignty, unity, and territorial integrity and violate international law will not stop us from exercising our rights and fulfilling

101 Picture Prompts - Services Éducatifs

that each student gets regular feedback Invite students to help brainstorm the criteria on which the writing pieces will be evaluated (originality? organization? spelling and punctuation?) Enjoy 6 101 Picture Prompts to Spark Super Writing • Scholastic Professional Books arts, math, or art curriculum That means writing can easily fit

LITERATURE REVIEW ON EFFECTIVENESS OF THE USE OF SOCIAL MEDIA

literature review on effectiveness of the use of social media a report for peel public health rebecca schein, phd(1), kumanan wilson msc, md, frcs (2) and jennifer keelan, phd (3)

Sophocles ANTIGONE

With military honors, gave him a soldier’s funeral, And it was right that he should; but Polyneicês, They fought as bravely and died as miserably,-- They say that Creon has sworn No one shall burry him, no one mourn for him, 20 But this body must lie in the fields, a sweet treasure For carrion birds to find as they search for food

Active and Passive Voice

Dr Murray and Anna C Rockowitz Writing Center, Hunter College, City University of New York VERB TENSES USED IN ACTIVE AND PASSIVE VOICE The following is a summary of active and passive forms of all verb tenses

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LITERATURE REVIEW ON

EFFECTIVENESS OF THE USE OF SOCIAL MEDIA

A REPORT FOR PEEL PUBLIC HEALTH

REBECCA SCHEIN, PHD(1), KUMANAN WILSON MSC, MD, FRCS (2) AND JENNIFER KEELAN, PHD (3) (1) ASSISTANT PROFESSOR, CARLETON UNIVERSITY, OTTAWA, ONTARIO, CANADA (2) CRC (PUBLIC HEALTH POLICY), UNIVERSITY OF OTTAWA, OTTAWA, ONTARIO CANADA. (3) ONT MOHLTC CAREER SCIENTIST, ASSISTANT PROFESSOR, CENTRE FOR INNOVATION IN COMPLEX CARE & SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF TORONTO, TORONTO, ONTARIO,

CANADA

2 TABLE OF CONTENTS

EXECUTIVE SUMMARY...........................................................................................................................................3

BACKGROUNDER ON SOCIAL MEDIA USE.........................................................................................................4

RESEARCH METHODS..............................................................................................................................................6

POTENTIAL APPLICATIONS, CURRENT USES, AND UTILITY OF SOCIAL MEDIA FOR HEALTH COMMUNICATION................9

"INFODEMIOLOGY" AND "INFOVEILLANCE".............................................................................................................14

CIRCUMVENTION OF ADVERTISING REGULATIONS THROUGH SOCIAL MEDIA..............................................................18

CHALLENGES / PITFALLS......................................................................................................................................21

SUMMARY ................................................................................................................................................................23

STATS CAN DATA ON CANADIAN INTERNET USE.......................................................................................................32

SOCIAL MEDIA PLATFORMS...................................................................................................................................35

ANALYSIS OF INCLUDED ARTICLES..........................................................................................................................36

CASE STUDIES.......................................................................................................................................................52

COMPETING WITH VACCINE-CRITICAL MESSAGING..................................................................................................61

INFOVEILLANCE / INFODEMIOLOGY: WHO IS SICK..................................................................................................63

Executive Summary

Preliminary data from the field suggests that social media is becoming a powerful addition to the health communicators' toolkit. Although there is a great deal of interest in using social media as

a tool for public health communications, the research evaluating its utility is still in its infancy.

As of yet, few research studies have examined the broader utility of social media for the adoption of health promoting and protective behaviours. One of the chief conclusions of this report is that there is a paucity of peer-reviewed studies testing the utility of social media interventions for desired outcomes. Instead, research has focused on documenting the range of health-related behaviours and the content of health-related discourse on these platforms. Observational studies show an abundance of both informal health conversations related to public health issues and organized health-related activities on leading social media platforms such as YouTube, Twitter, and Facebook. The quality of health information available to users on these platforms is highly variable raising some concerns that social media users are exposed to unopposed viewpoints that counter core public health recommendations and contemporary medical science, such as those opposing immunization and promoting smoking. Social media is currently utilized by public health organizations both as a broadcasting platform to amplify messages from traditional media sources (e.g., radio, television, print media) and as an entirely new way of collaborating and co-creating content with target audiences. In the latter approach, organizations have had to adapt their communications strategies to incorporate user- generated content and feedback. The process of engaging users to co-create content, to rate, rank and comment on communications, more so than the resulting message, is increasingly perceived to give a heightened authenticity to messages, improving trust in, and building users' relationships with, organizations. Social media, unlike traditional media campaigns, provides novel opportunities to embed and interject public health messaging into the daily online conversations of Canadians. In the future, it will also allow public health communicators to deliver a range of health promotion messages and self-monitoring tools through mobile applications, an innovation that will potentially increase the reach to those without computers, and will allow public health messaging to penetrate the day-to-day health conversations and activities of Canadians. The adoption of social media by leading public health organizations reflects a widespread sense that these tools are increasingly necessary to reach demographics who are abandoning traditional broadcast technologies (e.g., telephones, television) such as teens, or a significant portion of the public who are rapidly transforming the manner in which they interact with experts. 4

Backgrounder on Social Media Use

In the era of the 24-hour news cycle, the traditional once-a-day press conference featuring talking heads with a bunch of fancy titles has to be revamped and supplemented with Twitter posts, YouTube videos and the like. The public needs to be engaged in conversations and debate about issues of public health, they don't need to be lectured to." -Andre Picard, The Globe and Mail, June 9, 2010 Statistics Canada data indicate not only that more and more Canadians are using the internet at home in their daily lives (see Appendix 1 for a review of internet and social media usage trends), but that they are engaging in an ever more diverse array of online activities (1,2,3,4,5). These activities reflect the growing integration of online tools into Canadians' personal and professional lives and the shift from static "Web 1.0" platforms to the dynamic, interactive, and collaborative qualities of Web 2.0. In addition to evidence of the accelerating popularity of online platforms like Facebook, Twitter, and YouTube, new data also suggests that organizations can increase feelings of trust and loyalty through social media use (5). Such trends are already generating widespread interest in the use of Web 2.0 and social media platforms in research, policy and practice. The precise boundaries defining these terms, however, are still emerging within the literature. As the number, diversity, and inter-operability of new web-based and mobile platforms continue to proliferate, the characteristics and subcategories denoted by the term "social media" will need to be further disaggregated and refined.

There is general agreement, however,

that the new media environment is characterized by interactivity, user- generated content, and multi- directional communication flows.

Broadly, the transition to Web 2.0

marks a shift from a "one-way conversation" to a "multi-way conversation," in which users participate as both creators and consumers of web content (7,8). The nature of the content produced by users varies considerably across platforms, from passively collected data that can be fed back into the system and reflected back to users in word clouds or other popularity metrics, to content actively created, propagated, and iteratively revised by users in wikis, blogs, and video-sharing or social networking sites, on RSS feeds, or through the creation and circulation of "widgets," "gadgets," and "badges" that can be embedded in sites across the web (9, p.63). As Turnbull notes, the user behaviours

As of August, 2007, there were roughly 1200

Facebook communities advocating for cures for

different diseases. The Canadian Cancer Society's

Facebook community includes, as of the time of

this writing, 14,730 members from around the world (6, p.105). 5 enabled by Web 2.0 architecture have shifted the boundaries between experts/information- providers and laypeople/information-consumers: information is increasingly "... created and co- created by users in a dynamic, collective manner" (8, p.57). Eysenbach began using the neologism "apomediation" (apo: separateness, detachment) to describe the way new online platforms allow users to bypass formal intermediaries, expert gatekeepers, or other middlemen: users do not act entirely without guidance, but rely instead on peers, web tools, and the aggregate knowledge generated by new collaborative platforms (10). The term "social media" is used somewhat loosely to describe an array of new Web 2.0 platforms. Although they are not always clearly distinguished in the literature, the interactivity associated with "social media" should be differentiated from more generalized forms of online user engagement. For instance, many websites invite users to input their own information, customize the layout and look of a page, prioritize certain kinds of content, or keep track of their own online activities over time. Social media, by contrast, is characterized by interactivity across multiple horizontal connections, which produce in aggregate a mutable, collectively generated user experience (11, see also Appendix 2 for a description of the most popular social media platforms). Even within a single platform, users make use, to varying degrees, of the opportunities afforded for collaboration and social networking. YouTube, for instance, can be used simply as a broadcast medium for propagating a movie trailer or public service ad. It is only when other users begin to link to, remix, repurpose, and discuss posted content that YouTube's character as a social media platform comes fully into view. Social media platforms are being studied by health researchers and mobilized for a variety of purposes: recruitment for clinical trials; professional development and training for clinicians; inter-professional communication and coordination; training simulations; health social networks and health and illness support groups; health advocacy and fundraising for health organizations; development of interactive, self-management tools and plugins to popular social media platforms; public health messaging; infectious disease monitoring. This report targets original research, case studies, reviews, and commentaries related to public health communication, although there are at times significant overlaps between this subfield and those listed above. In addition, we summarize information from online sources related to notable public health campaigns (extracted from podcasts, interviews, PowerPoint presentations, and key public health organizations' websites). 6

Research Methods

We conducted a systematic literature search of multiple databases, chosen for their coverage of a range of relevant disciplines, including medicine, public health, psychology, business / marketing, and related social sciences using the keywords "social media" (health databases) or "social media" AND "health" (social sciences/business/periodical databases). Between July 14 and July 16, 2010, we (JK and RS) executed keyword searches (See Figure 1 for the list of databases searched and the keywords utilized and the process of article selection and exclusion). Search results (n=551) were imported into the reference software Endnote and combined into a master database for analysis. The final set of articles (n=39) was analyzed using the following categories: article type, research methodology, and major themes. The reviewer wrote a brief description of each article and, where appropriate, identified any new references (snowball) cited that may be relevant to this report (see Appendix 3). Snowball references were then compiled and vetted using the same procedure as articles found through the database searches. Reviewed papers were also ranked for relevance from "low" to "high" as they related to the core objectives of this report.

Figure 1: Search strategy and inclusion criteria. Exact duplicates were identified and eliminated as well as

articles written in languages other than English. Article abstracts were reviewed for their social media and

health/public health communication content by both JK and RS. A subset of articles was reviewed in parallel by

both (JK and RS) and the results showed 100% agreement in the application exclusion and inclusion criteria.

Articles that appeared to fulfill both criteria were selected to be reviewed in full. When there was any doubt, articles

were selected for full review. Articles without an abstract were also reviewed in full. During the secondary round of

analysis, we excluded articles where, despite the abstract, there was no useful content related to health

communication or social media. Again, agreement between the reviewers was validated by a parallel review of a

sub-sample of articles (by JK and RS). 7

Results

Of the 39 articles we reviewed, we ranked 17 articles as highly relevant, 14 articles of medium relevance and 8 articles of low relevance. Most of the articles included in this review were

original research articles. 22 of the included articles were classified as original research articles,

while 10 were classified as commentaries (or opinion pieces), 4 as reports (including recommendations for action) and 4 as reviews (overviews of the utility of social media) (Appendix 3). Of the twenty-two original research articles, thirteen were case studies either of specific social media interventions or examined discourse, content, and activity on specific platforms. Nine used content analyses to capture current social media behaviours and characterize the quality and reception of health messaging on the platforms (12-20). The most frequent mainstream platforms studied were YouTube, Twitter and Facebook while some studies utilized custom interfaces with social media capabilities (21). One consistent finding of these observational studies was an abundance of both informal health conversations related to public health issues and organized health-related activities on leading social media platforms such as YouTube, Twitter, and Facebook. The quality of health information available to users on these platforms is highly variable, raising some concerns that social media users are exposed to viewpoints (in some cases unopposed by public health experts) that counter core public health recommendations and contemporary science, such as platforms with a significant discourse opposing children's immunization or promoting smoking. The single controlled intervention study in our review failed to isolate the social media component of the communication campaign to assess its precise impact on issue awareness or measured outcomes, such as improved exercise and diet (21). Thus, one of our chief findings for this report was a paucity of peer-reviewed studies testing the utility of social media communication interventions for desired outcomes (e.g., increased issue-awareness, changes in the public's health competency, or adoption of desired behaviours). When controlled research included an evaluative component, the results were often confounded by a failure to isolate the intervention from other communication strategies. A limitation of many social media case studies was the complex and multi-faceted social media interactions described. This made it difficult to identify the boundaries of a particular intervention and to determine how the results of these studies could be generalized from one health issues to a broader public health context (i.e., does social media work well for particular outcome categories such as improved literacy and awareness but not for necessarily for behavioural change?). The literature also provides limited insight into how the utility of social media might vary depending on the particular public health objectives governing an intervention - for example, are there differences in the way social 8 media influences public opinion and action during epidemics as opposed to in a campaign for chronic disease prevention? Nonetheless, a significant number of articles reviewed (28) outlined the potential applications of social media for public health communications (9,11-15,17,20,22,23,25-37) asserting that the participatory web is rapidly transforming the way the public relates to medical professions and how average citizens seek out and consume medical information (10,16,39). A small body of public health researchers have focused their attention on the potential for harnessing these platforms to health protection and promotion objectives and are exploring the role social media can play to increase the reach and relevance of public health messaging. These researchers are beginning to articulate a framework to outline the utility of these platforms and to identify lessons learned from social media campaigns in the private and public sectors. Five major themes were extracted from the article set. They consisted of the following, in order of frequency:

Themes Frequency*

I. Potential applications 28

II. Current uses of social media for health communication 21

III. Infodemiology / Infoveillance 5

IV. The utility of social media for health communication (and potential pitfalls) 4 V. Circumvention of advertising regulations through social media (e.g., Tobacco advertising, junk food advertising to children) 3

Table 1: Thematic domains identified in the literature review. *Number of articles that met this criteria-Some

articles matched >1 category so the sum of hits will exceed the total number of articles reviewed; identified

themes occurring at least twice are listed in the table). In addition to the major themes, we identified several case studies of public health campaigns using social media that illustrate the opportunities and challenges in utilizing these platforms for public health communications. The thematic domains are described below and the selected case studies in Appendix 4. 9 Potential Applications, Current Uses, and Utility of Social Media for Health

Communication

There was a significant overlap in articles describing the current and potential applications of social media for public health communications. Many of these applications related to empirical results underscoring the presumed utility of social media. The sections outlined below (a-e) describe the rationale for adoption, the central areas of opportunity, and challenges described in the literature. a) Current and Potential Social Media Applications Reflect Changing Consumer Expectations There has been a fundamental shift in what citizens expect of both information delivery services and encounters with health professionals (26,31). Hesse et al (2009) argue that just as consumers now expect twenty-four hour access to information through online applications, they increasingly expect 24-hour customer service capabilities, including expanded self-serve options online. Consumers want to be able to bypass traditional gatekeepers of system information (31), whether they are booking flights or conducting bank transactions, expecting timely, transparent access to information they want, in the form they want it in, and as they need it. Information-seekers adapted to today's media environment put great store in the wisdom of the crowd, relying on other users' reviews for purchasing decisions and other patients' experiences for health related decisions. Trends in consumer behaviours and expectations diverge significantly from norms of pre- scripted experiences and rigid one-way communications to conversations mediated by peers and online communities. Patients are frequently arriving at medical appointments having searched for health information online, blogged about their concerns, and posted questions to both peer-and expert-reviewed social networks. The consultation does not end once the health professional delivers opinions and/or advice, nor will unresolved concerns or issues wait for a follow up appointment. Health information consumers now have access to a broad array of experientially rich and customizable health information-sharing applications (13,22,29). These applications are used to seek out information and share health experiences (including rating and commenting on clinical encounters and individual health professionals): reading online posts on an issue can influence patients' attitudes toward health issues and can affect decision to comply with prescribed treatment or medical advice (6,13,20,22). "Social media experts speculate that there will be more change precipitated by advances in the new media environment within the next 5 years than there has been in overall communication environment over the previous 50."(31) 10 Public health communications in the era of social media must strike a difficult balance between understanding what is on the health agenda of specific populations and attempting to set the health agenda of targeted populations to improve health outcomes. b) New Communication Objectives: From "Push" to "Push/Pull" As described above, social media applications are an integral component of communications for a large portion of the Canadian public. Most public health organizations have already invested in Web 1.0 platforms, such as organization websites, which are intended to provide a one-stop shop for local public health services and a platform for health promotion, whether providing updates on food recalls, promoting clinics or educational seminars on breast feeding, or offering smoking cessation resources (e.g., http://www.peelregion.ca/health/ ). The rationale for implementing social media campaigns varies, but there are principles and components in common in campaigns deployed by major public health organizations (see Table 2). The US CDC's explicit rationale for using social media is to "...provide users with access to credible, science-based health information when, where, and how you want it. A variety of social media tools are used to reinforce and personalize messages, reach new audiences, and build a communication infrastructure based on open information exchange" (39). In an interview with Erik Augustson of the US National Cancer Institute (2010), he describes the drive to experiment with new media for the NIH/NCI's Smoke Free Women's campaign as a need to "take public health interventions to where the people are" or to "establish a presence in new media before people get there" (40). One feature of many strategies is a clear shift away from the sole objective of driving traffic to campaign websites. Most social media strategies emphasize reach, message reinforcement, tailoring messages, engagement and facilitating an open exchange of information with the public.

Agency Social Media Strategy

US CDC Provide access to credible, science-based health information when, where, and how the public wants it. Use tools and platforms to: Reach new audiences; Reinforce and personalize messages;

Build open information-exchange infrastructure

PHAC "Monitor the conversation, participate in the conversation, initiate the conversation, share content, include social media in all marketing initiatives." Create (Wikis, podcasts videos); Share (MSN, Google, Yahoo); Marketing (Flikr, YouTube, Facebook); Monitor and Participate (Google blog search, Technocrati,

Bloglines)

ONT MOHLTC Listen; Refine; Leverage word of mouth advertising; Customize / provide relevant messages; Invite user-generated content Table 2: A summary of the social media strategies of leading public health organizations 11 Hesse (2009) argues that social media provide public health communicators with tools to improve users' autonomy, health competency, and social connectedness (relatedness) (31). These in turn improve users' ability to respond to public health recommendations for health promotion and disease prevention (Table 3).

Autonomy Competency Relatedness / Social

Connectedness

Self-help management tools,

e.g., quit smoking applications for Facebook, mobile phones

Personalized health

information; development of patient-centered health records (Google Health, Microsoft

Health Vault)

Health Portals such as Web

MD, trusted sites for health

information Improve functional health literacy- through social network applications, interactive tutorials & medication reminders.

Information Prescriptions

Skills augmentation (similar to

spell-checker, online applications can augment users skills to help them find and process health information); collective wisdom- users ranking, commenting and rating of health interventions Patient and Health

Intervention networks, such as

online weight-loss social networks that provide individual and group incentives and monitoring

Health advocacy groups

(e.g., Breast cancer awareness)

Shared Communities of

Knowledge (e.g., Wiki Public

Health)

Table 3: Key ways health communication can improve healthy living in the new media environment Adapted

from (31). c) The Promise of Improving Reach: Maximizing receipt of message and change of awareness An increasingly large percentage of the population now participates in online forums as illustrated in Appendix 1. The potential audiences of both online and social media applications far exceeds that of traditional media, and the rate of penetration is accelerating for new media. It has been estimated that it would take 38 years for radio to disseminate a message to 50 million people, 13 years for television, 4 years for the internet, 3 years for the iPod, and less than 3 months for Facebook (41). Populations that are difficult to reach via traditional media (due to geographic remoteness or other social factors) can be targeted and effectively reached via social media. Seeman et al. (2008) note that the anonymity and accessibility of social media can help ease the participation of youth and people with stigmatizing illnesses (6). For example, they reported that men suffering from depression are more likely to participate in online support groups than face-to- face forums because depression is still a stigmatizing illness for many men. Similarly, Erik Augustson (2010) of the U.S. National Cancer Institute observed in an interview that mobile social media applications associated with the Smoke Free Women campaign are being designed 12 to reach inner city youth, who use cell phones extensively and are difficult to reach via other channels (40). Social media platforms allow organizations to freely take advantage of existing social networks and virally spread their messages. While creative costs to develop a public health campaign for social media are likely similar to traditional media, the costs of amplifying transmission or modifying a campaign in response to audience reception are negligible. The only barrier to responding to changing conditions in real time lies in the limits of organizational capacity. One challenge public health agencies face once they engage with social media is getting the attention of the vast audience amid an onslaught of online content and chatter. Messages that run counter to public health goals have been widely disseminated, and public health organizations have only occasionally been able to successfully re-direct the conversation, challenge inaccuracies, and respond to the promotion of unsafe or unhealthy behaviours. Messages opposing vaccination or promoting tobacco and fast food products have been widely disseminated using social media (12,14,28,42). Such messaging demands a response from public health authorities via the same channels. Building elegant, useful, and engaging experiences online will have sub-optimal results if the organization does not understand what drives user traffic and take advantage of the ever evolving tools required to funnel users to the agency's applications. For example, when a mainstream public health media campaign alerts the public to a health issue and urges them to seek out further information from their organization's website or take a specific action, most people will typically perform a "Google search" for further information rather than google the agency or type in the advertised url (43). If the agencies' web interface does not appear in the first ten Google results, the campaign will inadvertently drive the public to sites that may contain contradictory information. In the past few years researchers have raised concerns that the front page search returns (the top ten search results) for public health topics frequently lead to poor quality information (12). Recently, however, public health organizations have been more successful in having their organizations rank higher in Google searches through the use of traffic-driving tools such as sponsored links, blog and news aggregators, and advertising options on YouTube, Facebook and Twitter. Leading health agencies have largely adopted these strategies and, unlike five years ago, a Google Canada search for "flu vaccine" (on August 9th, 2010) has federal agencies and reputable health blogs dominating the top ten search returns. 13 However, public health agencies still lag when it comes to adopting social media platforms. This is concerning, because there is some evidence that health information-seeking is migrating to social media sites like Facebook and YouTube, and there are an increasing number of health- related searches taking place on these platforms (44). In a keyword search of "flu vaccine" on YouTube on the same day (August 9th, 2010) all top ten results would be classified as vaccine critical (Appendix 5). This result confirms what Keelan et al (2007) found in their study of vaccine-related information on YouTube and confirms that public health organizations have yet to penetrate YouTube as they have Google search (Appendix 5). d) The Promise of Engagement: Potential for Improved Learning and Behaviour Change

Outcomes

Marketers often maintain that the "brands that break through are the ones that engage consumers, and that the internet has made it easier to engage consumers by allowing them to contribute directly to marketing campaigns and brand development" (28, p. 213). Studies of internet interventions have shown a high correlation between site usage (measured for example by user logins and time on site) and behaviour change (51). However, research involving internet interventions also show drop out rates often approaching 50 percent, leading Gunther Eysenbach to refer to a "law of attrition" governing participation in internet-based interventions. (22,45). Subsequent research has shown that improved participation and engagement correlate strongly with the degree of interactivity of the platform and the experiential richness of the interface (6,13,20). This effect has been most clearly demonstrated in studies documenting the social marketing activities of the tobacco and fast food industries (See section on the circumvention of advertising regulations (24,28,42). There is also the concern that having a broad reach or connecting with new audiences is limited by the "echo chamber" effect, a phenomenon where people only gravitate to online opinions and information that affirm preconceived ideology and beliefs. e) The Potential to Tailor Messages

Web 2.0 interventions offer numerous

advantages over traditional communication campaigns because they can provide fine-grained demographic information and continuous statistics on intervention-engagement, platform usage, sharing and feedback behaviours. "The Internet has made measurable what was previously immeasurable: The distribution of health information in a population, tracking (in real time) health information trends over time, and identifying gaps between information supply and demand."(46, p.4). 14 Messages can be tailored to specific groups and respond to changing attitudes and behaviours over time. While several review articles discussed the advantages of being able to profile target demographics and tailor messages to reach them, none of the social media campaigns detailed in the published literature described efforts to tailor messages in response to usage analytics. Theoretically, agencies should be able to take advantage of computer signatures and platforms' user profiles to extract the geographic, demographic, and social characteristics of viewers. Such tools can then be used to gauge community interest and further refine their messaging to meet specific audience's needs. While preliminary data suggest that social media campaigns are successful in improving both reach and user engagement, data supporting social media interventions for desired behaviour change remains largely anecdotal but bolstered by strong theoretical premises. Social media, unlike traditional media campaigns, provides novel opportunities to embed and interject public health messaging into the daily online conversations of Canadians. Using social media applications, it is possible to track an individual's health-related discourse and automatically tailor and deliver relevant health messages to them at the moment they are seeking information or chatting about a health issue. In the future, it will also allow public health communicators to deliver a range of health promotion messages and self-monitoring tools through mobile applications, an innovation that will potentially increase the penetration to users without computers, and will allow public health messaging to penetrate the day-to-day health conversations and activities of Canadians. These tools, in conjunction with the cultural shifts inquotesdbs_dbs12.pdfusesText_18

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