Social Media and Health Education: What the Early Literature Says

Robyn Gorham, Lorraine Carter, Behdin Nowrouzi, Natalie McLean, and Melissa Guimond

VOL. 26, No. 2

Abstract

Social media allows for a wealth of social interactions. More recently, there is a growing use of social media for the purposes of health education. Using an adaptation of the Networked student model by Drexler (2010) as a conceptual model, this article conducts a literature review focusing on the use of social media for health education purposes. The review found evidence of the phenomenon, allowing for a discussion surrounding the implications of social media with a health education perspective. Major benefits and risks of social media from a health education perspective are also discussed.

Résumé

Les médias sociaux permettent la réalisation d'une multitude d'interactions sociales. Plus récemment, on constate une utilisation croissante des médias sociaux à des fins d'éducation à la santé. Le présent article passe en revue la littérature en mettant l'accent sur l'utilisation des médias sociaux à des fins d'éducation à la santé et emprunte, comme modèle conceptuel, une adaptation du modèle des étudiants en réseau (Networked students model) de Drexler (2010). La revue de littérature a démontré l'existence du phénomène et a ainsi donné lieu à une discussion des implications liées aux médias sociaux dans le contexte de l'éducation à la santé. On y discute également des avantages et risques majeurs liés aux médias sociaux dans le contexte de l'éducation à la santé.   

Introduction

While the arrival of Web 2.0 with its many opportunities for users to connect, exchange information, and socially engage has revolutionized our lives, it has also generated new challenges. One area in which the use of social media requires particular judiciousness is health decisions. As we know, poor health decisions based on misappropriate or wrong information put a person at risk for emotional, physical, and other harm. This noted, there is little doubt that social media is here to stay and that an increasing number of health consumers are using social media to make decisions about their health. This paper is an effort to understand this trend as well as explore the relationship between social media and the information we access through it to make choices related to personal health.

In this literature review, 12 articles published between 2008 and 2010 are examined. They include research studies, commentaries, and a theoretical paper about the use of social media in relation to health. A conceptual model called the Networked Student Model by Drexler (2010) was used as the basis of inclusion in the review.

Papers were analyzed for four general messages: who is using social media for health purposes, the impact of social media on health-oriented learning and in professional practice: how social media is being used informally for health education purposes, and how social media is being used formally for health education purposes. Findings are discussed in relation to the above messages. Benefits and implications for educators and learners are also presented. Last, in re-exploring key ideas from the articles that comprise this literature review and considering other ideas found in papers that likewise look at the social media phenomenon but do not fully meet the criteria of Drexler’s model (2010), the paper closes with some thoughts about landscape of social media, education, and health both today and in our immediate future.

Purpose of this Review

The purpose of this review was to conduct a limited literature review on the use of social media for health purposes. In particular, the researchers looked for evidence of the phenomenon as well as instances of informal and formal health-based learning supported by use of social media.

Conceptual Model

The conceptual model used to select papers for inclusion and review is an adaptation of the Networked Student Model (Drexler, 2010). Drexler suggests that the Networked Student participates in several activities: the act of making contacts with others, information management, synchronous communication, and really simple syndication. The first activity is what distinguishes Web 2.0 from its previous iteration—the capacity to connect with colleagues, friends, classmates, and others through programs such as My Space and Facebook for purposes of socializing and sharing. In the act of information management, the user engages actively with the content he or she is accessing, making decisions about its relative value and prioritizing it in relation to other content sources. This activity requires the user to use critical thinking since he or she is assessing and organizing information that may be used at a later occasion. Asynchronous communication refers to contributions made to virtual discussion boards, blogs, forums, wikis, and other web spaces. While asynchronous communication involves two-way engagement, it does not occur in real time. Various researchers have remarked on the benefits of asynchronous communication since it provides time to make thoughtful contributions in contrast with the pressures of immediate or real time communication (Dickieson, & Carter, 2010; Carter, Rukholm, & Kelloway, 2009). Really simple syndication is another form of communication where information comes to the user through regularly updated web feeds.

In this literature review, the user is a health student with the term “student” defined in the broadest sense. He or she uses social media in different settings including informal personal spaces such as home and the more structured setting of a classroom. The principal reasons this student uses social media are as follows: to access and structure information (information management, really simple syndication) and to connect with people (contacts made, synchronous communication) (Drexler, 2010).

While the Networked Student Model (Drexler, 2010) was used in order to determine which papers to include, the concept of access to health information and health education was central to the authors’ discussion of the findings. As LeNoue, Hall, and Eighmy (2011) have reported, social software can be used to create what they call open-ended learning environments. Such environments provide learners with tools and resources to support problem-solving and interacting with experts such as instructors and professionals any time, any where.

Review of the Literature

Search Strategy

The search for literature for this review was first conducted in Fall 2010 and again in Spring 2011. Computerized database searches of CINAHL, Proquest, and PubMed were performed using key terms (social media, health, and education). Reference chasing and searches of specific health education journals were also conducted.

While the first search focused exclusively on research studies, the authors broadened their strategy in Spring 2011 based on the scarcity of research papers uncovered during the first search.

Selecting the Articles

All potential papers were reviewed by two nursing researchers who, at that time, worked in the same School of Nursing in a university in Northern Ontario. All papers were read independently by the researchers who later met to discuss the articles they had each identified for possible inclusion in the study.

As publications written in English and published between January 2008 and February 2010 met the majority of the criteria of the Drexler (2010) model—two of three criteria—they were selected for study. In total, 12 articles were included for review: 6 research studies, 1 theoretical paper, and 5 commentaries/opinion papers.

Analysis

After agreeing that the 12 articles met the majority of criteria set out by Drexler (2010), the researchers examined the articles more closely for their descriptions of social media tools, kinds of information accessed, and contacts made. The articles were also assessed for messages pertaining to the following: who is using Web 2.0 for health education purposes; the impact of social media on health-oriented learning and in the practices of health professionals; how social media is being used for learning about health in informal settings; and how social media is being used for learning about health in more formal settings.

Findings

Descriptions of Tools, Information, and Contacts

While all papers described various social media tools; ten described the kinds of information being accessed and ten provided descriptions of contacts made. The two papers that did not address kinds of information accessed were published in 2008 and 2009. Table 1 summarizes these findings.
Table 1. Type, Tools, Information, and Contacts
 
Table 1. Type, Tools, Information, and Contacts

Who is Using Web 2.0 for Health Education Purposes?

As context to use of the web for health education reasons, Chou, Hunt, Beckjord, Moser, and Heese (2009) point out that, in 2007, 69% of American adults had access to the Internet while 23% reported using a social networking site. By comparison, in countries where access to the Internet is limited, there has been rapid growth in the use of mobile devices to access information (McNab, 2009).

More specifically, Greene and Kesselheim (2010), as well as Lane and Twaddell (2010), indicate that approximately 60% of Americans seek health information from the Internet before going elsewhere. Between 45%-57% of users share their health care knowledge via social media, a statistic that suggests the need to investigate the reliability and credibility of health resources on the public Internet. Other research points to the use of the Internet and social media as tools for gathering health information and promoting health strategies, particularly among adolescents (Weaver-Larisey, Reber, & Paek, 2010).

The Impact of Social Media on Health-Oriented Learning and in the Practices of Health Professionals

Rapid evolution of social technology has drastically affected all of us. As examples, we bank and plan our vacations on line; we also connect with old friends and make new ones through social media. While social media tools have found their way into the lives of virtually every demographic group in the Western world, young people at the prime of their learning lives have been particularly affected. With billions of new and increasingly sophisticated mobile phones produced every year, leading to approximately four billion mobile phone subscribers globally (McNab, 2009), the impact of social media on youth should come as no surprise. Mp3 players such as iPods and social networking tools including Facebook and Twitter continue to grow exponentially while more than 350 million users worldwide have been reported for the largest social media sites (Greene & Kesselheim, 2010). Taken together, the learning preferences and methods of young people have been dramatically influenced (Mitchell, 2008). In itself, this is neither inherently positive nor negative; however, when health information is gathered through social means, there is potential for risk.

Communication and educational technologies are also invading healthcare at an impressive rate. As examples, many health-related offices have gone paperless while email is increasingly being used to book appointments. Eytan et al. (2010) have noted that some physicians use social media to build trust, promote management of health and wellness, and disseminate information to their patients. These strategies represent only some of the ways by which health practice and education are being affected by technology in general and social media in particular.

Use of Social Media in Informal Learning Settings

While Green and Kesselheim (2010) have indicated that 60% of Americans turn first to the Internet when seeking health-related information, Weaver-Lariscy, Reber, and Paek (2010) report that middle school students do not tend to differentiate among advertising, entertainment, and news content when they evaluate information. In other words, while adolescents are likely to seek health information via the Internet, they are not likely to critically assess (assessing) this information or question sources. Additionally, the influence of advertising on social media sites has potentially negative consequences for younger students without access to teachers and/or responsible adults able to identify potential dangers and choose appropriate interventions. Currie (2009) has reported that social media have been used to share information about everything from disease outbreaks to weather emergencies. However, because there are few or no controls on who posts or distributes information, there is no way to identify potential hoaxes and misinformation.

Lo et al. (2010) observed that, in addition to housing misinformation, media platforms such as You Tube can be used to sustain the stigma associated with certain health conditions. As an example, people who suffer from mental health issues may be victimized by stereotypes perpetrated by the widespread dissemination of visuals and messages through social media.

Use of Social Media in Formal Learning Settings

The ubiquity of modern technologies has led to new thinking about the potential of social media for more formal approaches to education. According to McNabb (2009), some educators have described successful incorporation of technologies and social media into their courses and programs. Reported benefits include support for different learning styles, creation of flexible learning environments, and provision of portable and interactive means of global knowledge building (McNab, 2009).

Use of e-technologies and social media tools such as podcasts, webcasts, interactive modules, and networking technologies (Facebook, Twitter) in educational settings has also been identified by post-secondary students as preferred ways of learning (Mitchell, 2008). As a result, colleges and universities have incorporated e-technologies into a wide cross-section of teaching and learning settings; direct educational interventions including online modules; learning resources; discussion boards; web pages; desktop videoconferencing; instant messaging; and so forth are used to enable synchronous communication and personal learning. These same technologies benefit the institution in other ways as well. Most notable is their potential to provide information to potential students and their families and facilitate continuous engagement with peers and educators.

Discussion

Networked Students

All of us are learners who gather information in order to make decisions. Moreover, as Drexler (2010) suggests, the information gathering we can do through social media is literally endless: we can receive information passively through tools such as a news feed; share and/or co-create information with the contacts we make; and find and pass on information made available to us through asynchronous discussion forums and so forth.

However, the gift of information through social media comes with a price. Reflecting on the subject of this paper, we, as health learners, need to be especially vigilant in assessing the integrity of the information we find through social channels. At the other end of the continuum, educators who use social media in health classes and courses must also exercise due diligence. Not to do otherwise means personal risk.

Numbers

Although the numbers of users of social media reported in this review are already dated, they provide evidence of the uptake of social media even in its earliest days. Similarly, the undisputed growth of mobile devices is a kind of insurance that social media will continue to permeate all aspects of daily life including our health decisions and practices.

Other numbers worth our reflection relate to the breakdown among the article types considered in this review. The scarcity of research is particularly noteworthy given the obvious prevalence and power of social media in our lives. This situation may be due to the general newness of the Web 2.0 environment and social media tools. Although there will be increasingly higher levels of research as time passes, the challenges of conducting research in this web-defined social milieu are not insignificant. A similar observation is offered about the scarcity of theory-based papers; theory development requires understanding of the phenomenon and often takes time. Alternatively, the higher number of commentaries/opinion papers may be indicative of efforts by leading thinkers to achieve understanding of the phenomenon during its early days.

Learning, Social Media, and Different Settings Including Informal and Formal Spaces

As the reviewed papers suggest, social media can enable health-focused learning in formal and informal ways. Teachers may choose to motivate students by using tools and learning strategies that are distinctly social and web-based. Outside of settings that involve courses and curricula, students of all ages and life stages including high school students through to practising health professionals may also choose to gather information
through the social fabric of the web.

Gathering information from trustworthy sources, critiquing it adequately, and determining appropriate actions when the information gathering tools are principally social is no small order. Because of this, many are wary of using social media tools for anything more than socializing. Still, as the next few paragraphs point out, social learning made possible through the web is here to stay and its potential is both exciting and, at times, disconcerting. Its potential to support learners is an area of less contention.

Other Reflections on the Intersection of Social Media and Health: The Present and the Future

The thoughts offered in this section draw from the ideas of the 12 reviewed papers as well as those in a handful of other papers on the topic of health, education, and social media. These additional papers did not meet the Drexler (2010) criteria sufficiently to be analyzed in the review proper. Still, they provide helpful insights that enrich the general goal of this work.

There is little question that socialization through technology is an experience accomplished through specific applications including entertainment, communication, and information retrieval (Parente, Swinarski & Noce, 2009). While this kind of socialization can benefit all kinds of students, it holds particular value for nursing, medical, and allied health students when they are completing placements in rural and remote settings. In rural and remote settings, health students and novice practitioners often report feelings of isolation from their families, peers, and educational institutions (Killam & Carter, 2010). Social media, however, can connect them with other professionals, resources, and learning opportunities and thus minimize feelings of isolation and make important information available. An example of the use of social media in the support of nurses is a web site called Nursing Ideas (http://nursingideas.ca) constructed by a recent graduate of a Canadian School of Nursing. At this site, nursing students and nurses share ideas about research, innovation, and leadership with nurses. Fraser (2009), founder of Nursing Ideas, has commented that “[o]ne of the misconceptions in social media is that it is just about connecting to more people. However, just connecting to everyone doesn’t do anything. The value of social media is being able to have influence and relationships, and finding people based on shared values” (retrieved July 31, 2011 from http://www.reflectionsonnursingleadership.org/pages/vol36_1_fraser.aspx).

While distance education is firmly established in most colleges and universities in Canada and the United States and some might argue that access to information and relationships can be provided through formal distance education programs, social media can provide a connectedness to the broader professional world that online courses and programs may or may not. Additionally, many students have stated that social media aligns with their learning preferences (Mitchell, 2008). Social media may also facilitate access to education for those who are unable to engage in continuing education and professional development due to barriers such as geography, time, and money (Mayadas, Bourne, & Bacsich, 2009). In summary, based on evidence that social factors, rather than technical factors, are the principal determinants of success or failure in learning (Guan, Tregonning, & Keenan, 2008), social media may be an appropriate means of complementing formal education in addition to being a valuable means for delivering continuing education and professional development opportunities.

Although there is a strong case for the use of social media for educational purposes, there is an important caveat. It is clear that the persons who use social media in order to educate themselves about health topics cover a broad spectrum. They range from health providers to health consumers and from older persons to younger persons. While one might surmise that health providers will have valuable foundational knowledge and formal training in the evaluation of information to assist them in making decisions about how to use the information they are accessing, even among this group, there will be variation in critiquing and assessment skills. Ideally, the use of social media for learning by health professionals should be complemented by discussions with instructors and clinicians. This recommendation is particularly important when novice health professionals and health students working in rural and remote environments are involved.

As inferred, health consumers of all ages may use social media to retrieve information to diagnose and problem solve their personal health challenges. These individuals may or may not be able to discern accurate information and, thus, could experience harm if they do not seek further opinion from experts. While some health experts use social media to inform others, discerning who the experts are can be a daunting task. Additionally, social media is largely about shared or created knowledge; however, when the collective is composed of adolescents or others whose judgment skills are not fully realized, there is distinct risk. In short, there are many points of awareness to be kept in mind for both educators and students when social media is used for health purposes. The following sections discuss some of these ideas.

Final Implications for Educators

According to Mitchell (2008), many health education practices are still heavy on teaching and light on learning, and educators need to be encouraged to engage students by creating conditions that facilitate learning. They also need to take learning styles and emerging trends such as the use of social media and e-technologies into consideration (Mitchell, 2008). Used well, social media and technology in health education can lead to increased access of information networks, engaged students, improved communication among peers and educators, collaborative learning environments, and self-directed learner-centered approaches.

Social media in health education has also been reported to be a productive use of time and efficient allocation of resources, as well as a powerful and cost-effective communication tool (Hawn, 2009). For example, social media tools such as Twitter and Facebook enable health officials to deliver important information to the public on disease outbreaks, food recalls, weather emergencies, and so forth (Currie, 2009). Two-way health communication systems assist health administrators and practitioners in learning about issues in specific geographic regions (Currie 2009).

Interestingly, the health care sector, primarily public health, has demonstrated an overall low adoption rate for social media tools (Avery et al., 2010). Public health agencies in urban communities show higher adoption rates while rural communities show lower rates (Avery et al. 2010). A possible explanation for this is the lack of efficient home Internet access in rural areas (Currie, 2009).

While the Internet and social media provide many opportunities for health education and health promotion activities (Feldacker et al., 2010), there are some challenges. As mentioned, Internet access in rural, remote, and underdeveloped areas continues to be a barrier to the use of social media for educational purposes including the work of public health units (Avery et al., 2010; Currie, 2009). Concerns about standards of care, professionalism, the security and privacy of information, and the reliability and credibility of health education materials found online still require attention (Currie, 2009; Greene & Kesselheim, 2010; Hawn, 2009; Lane & Twaddell, 2010).

Returning to Mitchell’s viewpoint (2008) that health education can be heavy on the teaching and light on learning, the principles of adult education (Knowles, 1975, 1978) are generally operative in learning when it involves social media. Although this experience of learning is directed largely by the student, there is a need for the teacher to partner with the student. Through an interactive partnership in which the instructor is more of “a guide on the side” than “a sage on the stage,” there is some insurance that the student will develop and use the thinking skills required to make appropriate decisions about the information and contacts made through social media (Drexler, 2010).

Final Implications for Students

In a study by Cain et al. (2009) on students’ Facebook activity and their opinions on accountability and professionalism, it was reported that the students did not have a full understanding of private versus public information. More importantly, the students did not understand the possible consequences of making private information public. Additionally, some healthcare professionals have been criticized for inappropriate behaviours and comments on social media sites such as Facebook (Devi, 2011; Livingstone & Vogel, 2010). This noted, Facebook has also been used by school nurses who share accurate health information with high school students (Chilvers, 2011). In summary, the potential of social media for supporting the learning needs of students about health is significant. However, the use of social media for education needs to be accompanied by a heightened commitment to professionalism, ethical behaviour, and well developed critical thinking.

Ally (2009) has highlighted some of the advantages and disadvantages of mobile learning, a phenomenon that continues to escalate and is now a major way by which younger persons use social media. The idea of constant access to the Internet and other people has received mixed reviews. While many view this level of access as something positive, it can also be overwhelming. In order to benefit most fully from the access and opportunity of mobile technology, students should be encouraged to maintain a healthy balance of on and off time.

Regardless of the challenges of learning and social media, to ignore this combination would be short sighted. Students today are not only comfortable with technology; they also have an expectation that a certain level of technology will be embedded within the design of their courses and programs (Drexler, 2009; Folley, 2010). Thus, educators are encouraged to immerse themselves in the technological worlds of their students and to design learning that reflects the preferences of today’s youth (Mitchell, 2008).

Conclusion

There is little question about it: social media is here to stay, and, despite barriers and concerns, patients, students including those in professional health programs as well as adolescents, and individual citizens use social media to learn about health. Hence, it is not a question of whether or not we should use social media—formally and informally—for educational purposes. Instead, the heart of the issue is learning how to use these tools well so that we are effective managers of health information and skilled decision makers.

As we also know, health is a constantly changing field and innovation in health education is inevitable (Eytan et al., 2010). Since technology and social media are central to how we live our lives and also play a significant role in the management of personal health (Eytan et al.2010), not learning how manage and use social media to be better health consumers and health professionals is short sighted.

In light of the above realities, researchers are encouraged to work with health care professionals and educators in order to discover and assess educational strategies that use social media. Research is also required to better understand how social media can enable changes in traditional disease surveillance methods and o address barriers and challenges in the delivery of health education and information (Currie, 2009).

Perhaps most importantly, social media has made a significant contribution to a levelling of the health playing field through its removal of geographical boundaries and opportunities for support and connectedness. As Hawn (2009) has reported, patients using social media report higher satisfaction than others; this finding is not hard to understand since social support networks have also been listed as a determinant of health by the World Health Organization (http://www.who.int/hia/evidence/doh/en/). Educators and students from all backgrounds and of all ages have been presented with an important opportunity; through technology grounded in the social experience, we have the opportunity to make appropriate evidence-informed decisions so long as our use of social media is supported by the principles and practices outlined in the emerging literature.

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Robyn Gorham is a Nurse Practitioner, Assistant Professor, School of Nursing at Laurentian University. E-mail: rgorham@laurentian.ca

Lorraine Carter is the Academic Director, Centre for Flexible Teaching and Learning at Nipissing University. E-mail: rgorham@laurentian.ca

Behdin Nowrouzi works at Laurentian University. E-mail: bx_nowrouzi@laurentian.ca

Natalie McLean is a recent graduate of the BScN program at Laurentian University. E-mail: NY_McLean@laurentian.ca

Melissa Guimond is a recent graduate of the BScN program at Laurentian University. E-mail: NMK_Guimond@laurentian.ca

The authors wish to recognize the contributions of Alanna Carter for her superior language and editing expertise in the preparation of this paper.