A New Dimension of Health Care

Introduction

There is an ongoing increase in the use of social media globally [1], including in health care contexts [2–9]. When focusing on social media for health communication, it is useful to first outline the general characteristics of social media. Kaplan and Haenlein [10] defined social media as “a group of Internet-based applications that build on the ideological and technological foundations of Web 2.0, and that allow the creation and exchange of user generated content”. They suggested that social media can be classified as two components: media-related and social dimension. The media-related component [11] involves how close to synchronous face-to-face communication different types of social media come and how well they reduce ambiguity and uncertainty. The social dimension is based on Goffman’s [12] notion of self-presentation, whereby individuals’ interactions have the purpose of trying to control others’ impressions of them.

Social media provides opportunities for users to generate, share, receive, and comment on social content among multiusers through multisensory communication [1,2,10,13,14]. Although the terms “social media” and “social networking” are often used interchangeably and have some overlaps, they are not really the same. Social media functions as a communication channel that delivers a message, which involves asking for something. Social networking is two-way and direct communication that includes sharing of information between several parties. Social media can be classified in a number of ways to reflect the diverse range of social media platforms, such as collaborative projects (eg, Wikipedia), content communities (eg, YouTube), social networking sites (eg, Facebook), and virtual game and social worlds (eg, World of Warcraft, Second Life) [10].

The relationship between personality traits and engagement with social media has been reported [15]. Gender is a factor in that extraverted women and men are equally likely to engage, but emotional instability increases usage only for men. Age is also a factor in that extraversion is particularly important in younger users, while openness to new experiences is particularly important in older users [15]. Lenhart and colleagues [16] explored various types of Internet usage among teens and young adults in the United States between 2006 and 2010. During this time, social networking sites experienced the biggest rise (an average of around 50%), and the key shift in use came at age 30 years with almost double the number of teens and 18-29 years old using them as those 30 years and over (73% compared with 39%).

Social media is changing the nature and speed of health care interaction between individuals and health organizations. The general public, patients, and health professionals are using social media to communicate about health issues [2–9]. In the United States, 61% of adults search online and 39% use social media such as Facebook for health information [7]. Social media adoption rates vary in Europe; for example, the percentage of German hospitals using social networks is in “single figures”, whereas approximately 45% of Norwegian and Swedish hospitals are using LinkedIn, and 22% of Norwegian hospitals use Facebook for health communication [8]. Recent UK statistics reported Facebook as the fourth most popular source of health information [9]. There have been many applications of social media within health contexts, ranging from the World Health Organization using Twitter during the influenza A (H1N1) pandemic, with more than 11,700 followers [4], to medical practices [3] and health professionals obtaining information to inform their clinical practice [5,6].

To explore the diversity in form and function of different social media platforms, Keitzmann and colleagues [17] presented the “social media ecology”, a honeycomb framework of seven building blocks that are configured by different social media platforms and have different implications for organizations such as health care providers. In developing their model, they have drawn on Butterfield [18], Morville [19], Webb [20], and Smith [21]. The building blocks are (1) identity: the extent to which users reveal themselves, (2) conversations: the extent to which users communicate with each other, (3) sharing: the extent to which users exchange, distribute, and receive content, (4) presence: the extent to which users know if others are available, (5) relationships: the extent to which users relate to each other, (6) reputation: the extent to which users know the social standing of others and content, and (7) groups: the extent to which users are ordered or form communities. Thus organizations, including health care providers, need to recognize and understand the social media landscape, where the conversations about them are already being held, and develop their own strategies where suitable [17]. Similarly, Mangold and Faulds [22] highlighted that social media is changing the relationship between producers and consumers of a message. This suggests that health care providers may need to take a certain degree of control over online health communication to maintain validity and reliability.

In this paper, social media for health communication refers to the general public, patients, and health professionals communicating about health issues using social media platforms such as Facebook and Twitter. Currently, there is a lack of information about the uses, benefits, and limitations of social media for health communication among the general public, patients, and health professionals from primary research. The objective of this paper was to review the current published literature to identify the uses, benefits, and limitations of social media for health communication among the general public, patients, and health professionals and to identify current gaps in the literature to provide recommendations for future health communication research. This is important in order to establish whether social media improves health communication practices.

Methods

This review paper followed the PRISMA guidelines [23] and used a systematic approach to retrieve the relevant research studies. The review included all study designs in order to identify the best evidence available to address the research objective. The literature search was conducted on February 7, 2012, using the following 10 electronic databases: CSA Illumina, Cochrane Library, Communication Abstracts, EBSCO Host CINAHL, ISI Web of Knowledge, Web of Science, OvidSP Embase, OvidSP MEDLINE, OVIDSP PsycINFO, and PubMeb Central. The searches were performed using the following defined search terms: “social media” OR “social network” OR “social networking” OR “Web 2.0” OR “Facebook” OR “Twitter” OR “MySpace” AND “Health”. From the above database searches, 9749 hits were identified. Manual searches were conducted in the Journal of Medical Internet Research (January 2002 to February 2012) where 24 papers were identified; thus, 9773 papers were identified in total. The papers’ titles and abstracts were screened for relevance, duplication, and the selection criteria. The inclusion criteria were (1) primary focus on all communication interactions within and between the general public and/or patients and/or health professionals about health issues using social media, (2) including the uses and/or benefits and/or limitations of social media for health communication, (3) original research studies, (4) published between January 2002 and February 2012, and (5) all study designs. The exclusion criteria were (1) studies not in English, (2) literature reviews, dissertation theses, review papers, reports, conference papers or abstracts, letters (to the editor), commentaries and feature articles, (3) studies only on Web 1.0 ( ie, traditional Internet use), and (4) studies with a primary marketing or advertising focus. In total, 98 original research studies that included the use, and/or benefits, and/or limitations of social media for health communication among the general public, patients, and health professionals were selected for this review [24–121] (see Figure 1). Excluded studies and the reasons for exclusion are listed in 

Multimedia Appendix 1. Two researchers (AM, LH) independently reviewed and evaluated the studies and reached consensus on the inclusion for the analysis. The interrater reliability between them was 0.90, indicating strong agreement [122]. Any discrepancies were discussed with reference to the research objective until consensus was reached.‎