Leapfrogging: What Social Media Is Doing for Communicative Competence

Plain Talk in Complex TimesChristina Zarcadoolas, PhD

CUNY SPH at Hunter CollegeSept. 23 2011

Falling Through the Net…the Coming Digital Divide - 1990’s

• On July 28, 1998, NTIA – report on telephone and computer penetration rates.

• Finds, there is still a significant "digital divide" based on race, income, and other demographic characteristics in computers in homes.

• http://www.ntia.doc.gov/ntiahome/net2 National Telecommunications and Information Administration

Who had computers at home?

Who was online?

Divide – dis-equity

What a difference a new century makes.

Narrowing Digital Divide

National Center for Educational Statistics http://nces.ed.gov/

Household Broadband Use by Race/Ethnicity

Asian, NH White, NH Black, NH AI or AN, NH Hispanic0

10

20

30

40

50

60

70

80

9077.3%

68%

49.4% 48.3% 47.9%

Dept of Commerce 2010 Report(Slide courtesy of Vish Viswanath)

Technology is ever more powerful

• It’s growing EXPONENTIALLY – iPhone 1,2,3….• Technology is crowd- sourced• It gets cheaper - Hard drive was $3400 - now

$100 ( 10 megabyte)• It gets more personally “relevant” – we can

“quantify ourselves” : Fit Bit ; deCode Me • It’s in the common discourse and media –

People Talk About it - IBMs WATSON beats humans on Jeopardy

Technology growth

• Exponential - iPhone 1, 2, 3,4• 20,000 different apps for the iPhone today• You can pee on an S chip or check blood

glucose via mobile device• Yes – there’s an app for that. (See - TED talk - David Kraft, June 2011)

Web 2.0 Crowd Sourcing

Texting• 75% of teens have cell phones(up

45%/2004)• They send 50 - 100 text messages

a day • Nearly three quarters (73%) of

online teens and an equal number (72%) of young adults use social network sites.

Youth Media Diet – 12 hours

Source: 2009 Alloy College Explorer

Broad Band Use (2010)

• 69% of African Americans and 58 % of Hispanics now regularly use the Internet, compared with 79% of whites.

• Rate of broadband adoption in African American homes has risen to 59% from the 46 percent.

(Joint Commission for Political and Economic Studies, 2/25/10 National Minority Broadband Adoption: Comparative Trends in Adoption, Acceptance and Use, Joint Center's website at (www.jointcenter.org)

African-Americans and Hispanics leading the charge in growth of mobile.

• 46 % of non-Hispanic blacks and 51% of English-speaking Hispanics use their phones for internet access, compared with 33% of non-Hispanic white Americans. (poll not in Spanish language)

• “This is my laptop”

http://www.pewinternet.org/Reports/2010/Mobile-Access-2010.aspx

http://techcrunch.com/2008/07/11/nielsen-iphone-in-fourth-place-among-smartphones-first-in-customer-satisfaction-not-for-long/

Minorities have equal or greater usage on most major social media platforms

Social networking sites

Online video Twitter0

102030405060708090

Social media usage by race/ethnicity(% of Internet users)

WhiteBlackLatino

PEW Internet and American Life Project 2010 data

The communication technology revolution: rethinking health literacy

Web 2.0Informatics

eHealth

eHealth

• An emerging concept known as "eHealth" seeks to capitalize on the promise of new media technologies to facilitate equal access to timely and credible health information.

Web 2.0 communication: key measures

• Internet penetration (~69-75% adults1, 2) • Broadband adoption (~66%2) • Mobile technologies (~82% 2) • Social networking participation (23% of Internet

users1)• Health information seeking online (80% of Internet

users2)• Health-related Internet use3

1 Chou, WS et al. 2009. Social Media Use in the US: Implications for health communication, JMIR, 1(4): e48.2 Pew Internet and American Life Project3 Chou, WS et al. 2011. Health-related Internet Use among Cancer Survivors: Data from Health Information National Trends Survey, 2003-2008. J Cancer Survivorship.

Lower Use with Less Education

2338

14611461

391

0%

10%

20%

30%

40%

50%

60%

70%

80% Requested password

Logged on

College Grad/Post Grad

Some College High School/

GED

No High School Degree

0%

10%

20%

30%

40%

50%

60%

70%

80%

College Grad/Post Grad

Some College High School/GED No High School Degree

N=14,102

N=5671

Internet for health purposes

0

10

20

30

40

50

60HINTS 2008, N=998 Internet Users

16.423.3

8.1

52.0

Emailing Providers

Online Rx purchase

Support group participation

Internet as 1st source of health information

Chou, WS et al. 2011. Health-related Internet Use among Cancer Survivors: Data from Health Information National Trends Survey, 2003-2008. J Cancer Survivorship.

National Research Corp. survey: 1 in 5 Americans use social media websites as a source of health care information; 94% respondents reported having using social media to gather health information.

Facebook as 1st choice (94%) and YouTube second (32%).

Use of social media for health information

http://hcmg.nationalresearch.com/public/News.aspx?ID=9

% of Internet users

Reported having: Sample

22.97% Participated in a social networking site

N=1159

4.59% Participated in an online support group

N=232

7.06% Written in a blog N=356

Social media use among Internet users in 2008 (69% of US adult population)

• 250 million > users on facebook worldwide

There’s an app for that!

Users are driving the need for us to develop more usable (

readable/navigable/efficient/entertaining) health communication tools

What app?

Exercise, Nutrition, Smoking Cessation

Online blogging

Find my iPhone

Empowering Communities with Direct Access to Health Data: Patient use of Electronic

Medical Records

Christina Zarcadoolas, PhD, Wendy Vaughon, MPHWith Sara J. Czaja, PhD,

Maxine L. Rockoff, PhD, Joslyn Levy MPANIH R21 1 R21 CA133487-01A2

Common Themes Across Groups (a) • Consumers unanimously very interested in patient

accessible EMRs although most didn’t have access to one.

• Physical access to technology not a primary barrier. • Many participants accessed the internet wirelessly using

mobile technology.

“This is my laptop.” • High interest in lab/test results, but reviewing results,

posed unusually high reading and numeracy demands– “If I could read it and understand it [I would use it] … I

can’t understand it.”

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Common Themes Across Groups (b)

• Want health education specific to their condition in their records

• Want ‘just-in-time’ links to sources that use understandable language.– “Web MD … that thing is so hard … it

doesn’t really break it down where the average person can understand … some of the translation is in doctor terms … the average person that’s looking at it gets lost.”

34

Access empowers

“Information is power.”

“It all boils down to the same thing … a lot of people don’t take charge of their health because they don’t … remember to take care of themselves and a lot of times they don’t even know at what age they should be checking for what things.”

Common Themes Across Groups (c)

Categories of Barriers

User Characteristics:• Linguistic/reading• Confidence• Navigation• Active reasoning -

cognitive demands

Patient Portal:• Readability• Strategic repetition • Design • Navigability

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Portal Example - Symbols

Patient Portal - Numeracy

Categories of Opportunities

• Target audience likes and uses social media tools – – Usable layouts– Easy navigation tools – Short, sound byte language – Mouseovers – the define and explain content– Wikis– Google searches – Voice overs– Streaming video – Etc.

Using social media – what is it teaching people?

• Immediacy • Crowdsourcing• Community • Empowerment• Leapfrogging over cumbersome vocabulary

and syntax

Approach to Communication

1. Use health literacy principles to develop content.

2. Use human factors engineering and user-centered design.

3. Use communication modalities and tools people are using in their daily lives.

4. Strive for shared decision making & empowerment

A Paradigm Shift

Past 20 years we’ve focused on identifying what people CAN’T DO

It’s time to focus on identifying what people CAN and ARE doing;

To Achieve -• Virtuous • Honest

• Inclusive Health Literacy