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Social Media / Promoting Health through Digital Media

Stefan Ludwigs, Guido Nöcker

(last update 28 December 2015)


Digital media and communication channels are no longer an add-on in our modern information and knowledge-based society. They are a fundamental constituent of many areas of life, from entertainment to learning and working as well as health. They influence, structure and shape our perception, create new spaces of experience and interaction and are becoming an important factor in socialization.

Since the introduction of internet technologies in the 1990s, a rapid digital development (the ‘digital revolution’) has taken place. Its consequences can be felt, far beyond altered knowledge and information processes, as a societal structural change in almost every area of life. Such a change is currently making itself felt in healthcare, too, such as through the Digital Agenda 2020 and the European Commission’s action plan on eHealth (Innovative healthcare for the 21st century).

The starting point of the political initiative is the insight that there is huge developmental potential for the healthcare sector in this area, while the implementation of IT solutions in healthcare is lagging more than ten years behind their introduction in other areas. One area highlighted as worthy of support was the support of digital medical procedures and practices, the (mobile) mHealth services (see the printed paper (Drucksache) 167/14 of the Bundesrat). The EU Commission funded its testing and development in the context of the research programme ‘Horizon 2020’ to the tune of almost 60 million euros in 2014 alone. The political expectations are not just focused on removing economic barriers in the healthcare market, but also on increased density of provision, improved treatment quality and early detection and prevention.

With regard to the practice of disease prevention and health promotion, it is therefore likely that the use of digital media will play a central role in healthcare communication in the future.

The introduction and application of new digital media do not enjoy universal support, however. Bestselling publications criticizing this culture and basing themselves on neuroscience bluntly talk about ‘digital dementia’ (Spitzer 2011), thereby highlighting the potential negative effects on health of intensive digital media use.

Despite this criticism, concrete services and applications as well as user numbers, especially of online applications (apps), are developing very rapidly. According to an EU estimate, there were 97,000 mHealth apps available in June 2014. The high distribution and acceptance of these new media can be attributed to the expanded ability to share, co-operate and create that they provide -features considered specific characteristics of social media.
The term ‘social media’ encompasses a group of internet applications ‘that are based on the technological and ideological foundations of the web 2.0 and allow the creation and exchange of user generated content (see box)’ (Kapland and Haenlein 2010). Exchange, creation and distribution take place with the help of social media technologies, which include social networking services (SNS), forums, blogs, wikis, mobile apps, podcasts, bookmarking and social news services.

In brief

Daphne

A co-operation between business and healthcare research to create a ICT platform to monitor the sedentary lifestyles and eating habits of individuals to regulate their weight: www.daphne-fp7.eu.

Digital Agenda 2020

The EU strategy with which digital technologies, including the internet, are to be used to stimulate the European economy. Public and business alike will, it is hoped, achieve maximum use from the application. The agenda is the first of a total of seven initiatives within the ‘Europe 2020’ strategy to promote intelligent, sustainable and inclusive growth.

eHealth

Refers to the use of electronic, digital information and communication technologies (ICT) and services for health. It includes the interaction between patients and healthcare institutions, data exchange between institutions, and the exchange between patients and between healthcare experts. eHealth encompasses a broad spectrum of ICT-supported applications, e.g. telemedicine and mHealth services.

e-Health Literacy

Refers to the ability to use eHealth services in an optimum manner. Computer literacy is understood as one of six necessary constituent skills.

Social Web

According to Ebersbach et al. (2008), consists of web-based applications that support people in their efforts to exchange information, build and nurture relationships, communicate and work together collaboratively in a social or common context, as well as of the data generated as a result, and of the relationships between the people using these applications.

Horizon 2020

The EU’s framework research programme. One focal point is PHC (personalized health and care) with mHealth applications in particular. These are understood as a contribution to help citizens manage aspects of health, disease, health promotion and disease prevention themselves. A budget of 549.3 million euros was made available for PHC in 2014.

mHealth

One component of eHealth. This term encompasses various mobile devices such as smartphones, tablets and patient-monitoring devices. These includes lifestyle and health apps, which transmit a large number of vital counts (such as pulse, temperature, blood pressure) and data (information).

Telemedicine

Refers to diagnosis and treatment while bridging a spatial or temporal gap between doctors, therapists, pharmacists and patients or between two doctors consulting each other using telecommunication. It encompasses secure information transfer by text, sound, image or other formats necessary for prevention, diagnosis, treatment and follow-up care.

User Generated Content (UGC)

Refers to content and formats not generated by website operators but by the website users. Comments, blog entries, video clips, audio podcasts and photos as well as written contributions in wikis are the most widespread formats.

Table 1. Key terms and concepts in social media and health promotion.

This is a very broad spectrum of digital applications with different functionalities. Kietzmann (2011) distinguishes seven different elements (identity, conversation, exchange, presence, relationships, groups and reputation) that are to be taken into account when creating social media services and can be tailored to the users’ needs. This system is determined by a commercial outlook on use. However, the use of social media and the sharing, networking and expressive opportunities thus made accessible to the recipients, open up, from a perspective based on the main idea of promoting heath, hitherto unavailable opportunities of achieving ‘more control of our own health’ (Promoting Health I).

The American health authority, the Centers for Disease Control and Prevention (CDC), has played a pioneering role in testing social media in the healthcare field. The CDC emphasize the advantages of social-media applications for communicating about health issues (Centers for Disease Control and Prevention 2011). Advantages include personalized information, meaning that content is tailored to an individual’s needs, the rapid presentation of relevant content in various formats, and the direct participation of the target group when choosing and compiling content.

On the part of the healthcare industry, the development is shaped by large firms, which, through their products and initiatives, advance the use of these technologies beyond considerations of public health care (health sciences/public health). One pharmaceutical company (Pfizer) for example turns to patient organizations with a hand-out on the use of social media, while in September 2014 Apple for the first time integrated a health app as standard in its operating system iOS 8.0, with the goal of allowing fitness and health tracking (see Mobile Applications).

With regard to the technical requirements, access and the actual use behaviour of the digital technologies, it is almost impossible to depict the valid, current status quo because development in this field is incredibly rapid. Nevertheless, the figures of the Statistisches Jahrbuch 2014 provide reference points to assess the development. According to this source, 83% of all households had a computer in 2013, while 82% had internet access. In households with at least one child, the computer-ownership figure rose to 97%. While the older generations (65+) still make little use of social networks, forums etc. (19%), 91% of 16-24-year-olds were already active in this field. As a result we can assume that many target groups can be reached easily. However, differences with regard to age and, particularly towards the older end of the spectrum, with regard to gender as well as socioeconomic status must be taken into account. This is likely to be even truer for the distribution and use of mobile devices.

The use of social-media technologies for the tasks of communicating about and promoting health requires much more than the mere selection of the appropriate technologies to reach the relevant target audiences. In particular, it requires an in-depth understanding of the communicative processes and the associated changes in the relationship between recipients and providers.

The communication-studies perspective. From a communication-studies perspective, the trend towards the use of social media heralds a paradigm shift from the classical sender-recipient model to network theories shaped by systems theory. Figure 1 clarifies this.

Figure 1. Levels of information in health matters.

Figure 1. Levels of information in health matters.

The first tier (Information) depicts the level of static information transfer, for example in the guise of print, pictorial and film materials or corresponding websites. It corresponds to the established understanding of the sender-recipient logic shaped by mass media, where communication flows one way only. Here the internet is at best understood as a permanently accessible library in which a large amount of information (pertaining to health) is deposited and kept at hand in virtual drawers and shelves for various target groups. The claim of initiating behaviour conducive to health and modifying behaviour that endangers health is focused on imparting information and delivering imperative messages (e.g. ‘Keine Macht den Drogen’ (‘no power to drugs’), ‘(Krebs-)Vorsorge schützt!’ (‘(cancer) screening protects!’)). The senders generate a communicative service that is to be accepted and interpreted by the recipients as was intended (persuasion model).

On the second tier (Interaction) healthcare providers exploit the opportunities for interaction and dialogue that the internet offers. For example, they offer calorie calculators or self-evaluation tests, and introduce target-group representatives and their opinions. From the perspective of the healthcare providers, the goal is to reach and involve an increasingly fragmenting audience and to generate personal motivation by increasing the benefit and experience of the service. The potential for two-way communication is only used sporadically. Finally, the notion of communication as a largely sender-dominated transaction information process is also associated with this second tier. However, this form of two-way communication with its recursive response options allows for better tailoring and therefore for a better fit of the services. This in turn can increase the acceptance of the content provided, thereby improving the chances of triggering the desired behaviour.

The third tier is Networking, where people communicate with each other independently of senders such as businesses or institutions. The traditional sender-recipient formula has been dissolved; everyone can occupy both positions at once and communication is perceived by the participants as reciprocal (e.g. Facebook, question-and-answer forums, communities). The target groups previously perceived as users now have the ability to produce information themselves, comment on items and evaluate them. This happens on every qualitative level, from simple forum entries to demanding expert articles and blog entries. As a result additional communication effects have been created. The term ‘viral communication’ refers to information that spreads rapidly (e.g. via a video clip) in networks, where users share information, refer to it or even recommend it. In this way the recommendation can be boosted in its significance and relevance.

A further effect is the indirect communication that occurs with observers that follow a debate online, in a blog for example, which makes them relevant as an expanded audience. This changes the traditional information paths and, consequently, also the ‘gravitational field’ of information providers (about health), whose knowledge becomes part of a global, continuously changing information market.

The concrete options for health communication that result from the use of social media are dependent on the technologies used, which, when looking at the large number of functionalities and constant technological advances, are subject to changes in user preferences. The following descriptions of current applications should therefore be seen, by way of example as a detail (of content) and snapshot (in time).

Social Networking Sites (SNS). Social networking sites like Facebook and Google+ offer users the opportunity to share content with each other and to ‘like’ it, thereby creating a link to that content. All Facebook users have a profile page where they introduce themselves and can upload pictures and videos. Visitors to a profile can leave publicly visible news on the user’s wall or comment on content shared by the user. The most important tool is the ‘like’ button, which allows users with a single click to express approval or support. In addition to communication that is visible to all users, there is also a private messaging function and specific friends can be invited. This creates an interactive space with a high personal relevance to its users.

Brands and institutions can also achieve ‘friend status’, thereby gaining access to the circle of a personal network. This happens for example with ‘love brands’ - brands with a high level of identification and emotional customer loyalty (such as Apple or Nike), where users choose to click on the ‘like’ button to express interest (for new product information) or a certain disposition (being a fan). Clicking on the ‘like’ button can also be seen as social marking through which users can express their own attitudes, which also aims at producing social resonance within their circle of friends.

Providers of healthcare information can set up their own profiles on social networking sites, thereby initiating direct access to their target groups. The defined profile does not usually go beyond the function of a business card, since the main content has to be presented on the provider’s website. The transfer to that website (‘landing page’), and the desired increase in reach through viral communication associated with that transfer, can only be achieved if the information provided is particularly significant, topical or highly entertaining to visitors. The potential for dialogue associated with social networking sites, which is to bring organizations closer to their target groups, does not exist in the case of the ‘like’ button. ‘Fans’ are, however, interested in additional information and can legitimately be reached via the link. Two-way communication is more likely to be generated via the media described below.

Mobile applications (apps). Smartphones are increasingly taking on the role of ‘life companion’, which, as a communicative interface, connects the real and virtual worlds. They are almost always with us and keep young people connected all the time, when they check their friends’ status updates on social networking sites by the minute, seek distraction and entertainment with small games and funny videos or search for area-specific information relating to events, shopping and more. The technical requirements for this are provided by apps installed on the device. Apps are small software programs that organize specific tasks. They range from very simple tools with just one function (e.g. an alarm clock) to a whole package with extensive functionalities (e.g. a jogging app) and social exchange functions. The suitability of mobile apps for healthcare communication is based on several factors.

  • They can provide supplementary, interesting non-location-specific background information about the way the body works, and the effect of substances for example.
  • They provide individually configurable calculators, which make the experience of taking on information a personal one (BMI, alcohol units and calorie counters etc.), thereby creating a special relevance.
  • Through their hardware, smartphones also allow the use of Augmented Reality (AR) apps, which are the next level of digital networking. Such AR apps refer to computer-supported expansion of our perception of reality, as is made possible by screens integrated in glasses for example (‘Google Glass’). The augmented reality aspect is the visual depiction of information via images or videos with computer-generated additional information or virtual objects superimposed on the real world. Additional information or alternative actions could be depicted while viewing objects for example.
  • A current development in this context is the trend of ‘self-tracking’ (ST), where other mobile devices such as watches and bracelets are used alongside smartphones. These apps collect person-specific data with regard to health, fitness and the everyday organization of life (heart rate monitors, pedometers, calorie counters etc.). This makes the user’s behaviour quantifiable, transparent and available for comparison. The aim of this information is to increase the user’s motivation to change his or her behaviours and facilitate the adoption of new routines. The apps take on the interpretation of the data and offer individually tailored recommended actions - all of this is scientifically informed. These apps are often about more than monitoring one’s behaviour. It is only the social comparison with others that creates the feeling of being a member of a group of like-minded individuals who have meaningful goals. This can have a positive impact on an individual’s motivation.

Both AR apps and ST apps are innovative developments that have already achieved market readiness and target a broad spectrum of consumers (e.g. nutrition, fitness/sports). The speed of their distribution is strongly supported by the EU Commission’s abovementioned mHealth strategy. Innovative co-operative projects such as DAPHNE (www.daphne-fp7.eu), an online platform to monitor individual exercise and dietary habits for weight management, are already determining the direction.

Video and photo-sharing websites. Video and photo-sharing websites such as YouTube, Vimeo, Flickr and Instagram allow users to upload videos and pictures and, if they are registered, to comment on them, evaluate them, add them to favourites and embed them into their own websites. These websites do not just have a vast and constantly growing number of users, they are also developing more and more into search engines and networking tools. YouTube has become the second-largest search engine in the world after Google. More than a billion people used the website in 2013, watching six billion hours of videos every month. The search for distraction and instruction dominated.

These websites give providers of healthcare information additional ways of inexpensively presenting their material and content to a wide audience via short clips or films. Furthermore, by making use of the linking and commenting elements, a direct exchange with those target groups is possible, something that would not be reached via the providers’ websites. The commenting and linking functions are also a way for content providers to check the acceptance and the comprehensibility of their medial services (clips) among their target groups and to determine the level of distribution achieved. This is a new option in the interest of a quality-assured media development. At the same time this development is causing old formats (CDs, DVDs) and distributors (film services etc.) to become less and less significant.

Blogs and microblogging. A weblog (blog) is a kind of diary (logbook) maintained online by one or more authors. Periodical entries that are arranged by date, from newest to oldest, are typical of this format. Further important features are that the entries are categorized using subjects and tags and that there is a commenting function. There are now blogs of very different sizes. They range from blogs that basically have trade-magazine status (www.automobilblog.de), to highly niche-oriented blogs (www.socialmediablog.de). As a result of this large and constantly growing number of blogs, there are now special blog search engines that can be used to scan blogs for content. There are also an indeterminate number of online rankings that provide blog ‘charts’ sorted by subject (e.g. health) based on user numbers. It is not possible to say anything here about the quantity and quality of blogs focusing on health. The keyword ‘Gesundheitsförderung’ (health promotion) generated 57,000 hits (17 July 2014) through Google’s blog-search function. Blogs targeting other experts are particularly suitable for anyone working in promoting health. Like a social news service, relevant contributions from various media could be compiled (alert function) and made available for debate for users with a professional interest (e.g. http://scienceblogs.de/gesundheits-check// http://medizin-und-neue-medien.de/). In this way experts and interested parties can exchange opinions outside of existing organizational boundaries and modes of working. Maintaining an expert blog requires a large amount of time and presupposes regular and on-going publication activities.

Forums, communities, question and answer pages. While social networking sites digitally organize a user’s circle of friends, forums, communities and question and answer pages are subject-focused. The spectrum ranges from websites about health (www.onmeda.de, www.gesundheit.de) and addiction meet-ups (Forum Alkoholiker) to gender-specific communities (www.gofeminin.de) to pure question and answer pages (e.g. www.gutefrage.net). While the communities tend to have a very strong editorial basis, the forums and Q&A sites generate their content exclusively through user contributions and discussions. The quality of the answers can be evaluated by the person asking the question, so that over time answer experts emerge whose statements gain more and more significance.

In April 2014 the largest German Q&A website, gutefrage.net, had around 17.5 million unique users (i.e. users that are only registered once), thereby reaching almost a third of all German internet users (AGOF internet facts 2014-4). 50 million answers were given to 13 million questions that were posed there by July 2014. At that time there were more than 100,000 questions about drugs. One reason for the popularity of this avenue is that concerns are often not just answered in general terms but by taking into account personal circumstances and by focusing on the specific situation, while remaining sympathetic (‘I know what you mean, in my case it’s like this…’). An initially topic-related exchange (forum) can create emotional bonds and therefore develop into a system of like-minded individuals with community character. Nevertheless the quality of the responses is often highly variable and at times even problematic. Therefore it is a sensible approach for those working in health education to actively contribute to such forums - and this approach is also accepted by those affected. Since the forum posts remain there for years, they endure in a special way because later search queries automatically refer to the old answers. Contributing to the discussion, especially about sensitive subjects, can be used as a new form of virtual streetwork. It is a must that users have clear IDs.

Games / Serious Games / Social Games / Gamification.
As ‘serious games’ and ‘social games’, computer games have in the past few years found new fields of application in healthcare provision and health education. (see also international conference www.gamesforhealth.com). They are linked with a whole variety of expectations regarding the influencing of behaviour. Studies have now provided evidence of the motivating effects of ‘serious games’ on self-management. Thus one game (ReMission), in which children fight virtual cancer cells (www.re-mission2.org), showed positive effects on compliance. The same effect was demonstrated with other games with child diabetics. The announcement by researchers in New Zealand that a computer game could help to mitigate the effects of depression in young people provided for particular excitement in specialist circles (https://www.sparx.org.nz).

A characteristic of these games is that they stage an educational or behavioural topic as an authentic, credible game experience. In this way they exploit the activating, motivating effect of games in order to create a ‘flow’. In the process, clear task assignments, steady progress and immediate rewards generate self-empowerment experiences which, or so it is presumed, can lead, alongside general motivational effects, to cognitive, affective and behavioural transfers (Fritz 2011). In this way, in addition to motor skills, studies have demonstrated, time and again, that involvement in games is followed by positive moods, social behaviours, and general problem-solving skills (Granic et al. 2014).

This potential is, in turn, the foundation for the general trend towards gamification  in many areas of life. The term means the use of game-typical elements in non-game contexts. Work and above all learning activities are combined with experience points (XPs), high scores, progress reports, ranking lists or distinctions. In this way, even small successes can be seen, and these help to maintain motivation to, for example, train a new behaviour.

It is apparent that playful engagement is increasingly becoming embedded in social media such as Facebook. Social gaming often involves mini-simulations (www.farmville.com) or co-operative guessing games (https://apps.facebook.com/candycrush), in which the payers’ activities are visible to their ‘friends’ and mutually networked. In this way, the feeling of self-empowerment is joined by that of social integration and is reinforced by the player’s peers.

For this reason, social games are also produced for the healthcare sector. They are increasingly being used in disease prevention (e.g. healthy eating: www.spaplay.com), therapy (ayogo.com/blog/case-study-healthseeker) and rehabilitation, as well as in patient training and the training of healthcare workers. (e.g. young doctors www.g4appliedgames.com/portfolio/geriatrix/).

Relevance for promoting heath. It is currently unclear whether, to what extent and with what success the technologies described here can be used in the context of communicating about health, which is why the issue should be the subject of future research. So far there are few definite insights into how institutions and people working in health promotion use digital media and channels in the social web. Overall, their distribution and the use of these media are still comparatively low. This is contrasted with the positive estimation regarding their potential to improve communication with the target groups, which is considered definite. It is striking that all this potential, such as allowing active participation, networking and the experience of social support, the promotion of self-efficacy experiences (social cognitive theory), the recipient-appropriate information (personalization) and the use of viral effects (mobilization) are well reconcilable with the strategies and areas of work of the Ottawa Charter.

The demand for healthy living environments (setting approach/living environments approach) is also hugely relevant for the virtual living environments. The term ‘setting’, which is considered a central starting point for measures in health promotion in the living environment, has to be supplemented or expanded by a virtual component. Working, learning and shaping our leisure time and social relationships are increasingly taking place online. Therefore the demand for health-promoting living environments also has to include our digital environment. This is because the pioneers and developers of expanding digital environments are mostly commercial providers who care first and foremost about customer loyalty, sales volume and product placement, and rarely take health considerations into account. It would seem, however, that producers of commercial services are better able to adapt to the new forms of communication and therefore to the altered participation requirements of the recipients. The rapidly rising number of digital apps in the fitness area is a good case in point.

The social web also seems to be particularly suitable for the area of action ‘strengthening health-related community activities’ (community orientation). This is because in accordance with the concept of ‘social capital’ (Bourdieu), the social media can help organize social connections such as friendships and neighbourhoods to benefit people’s health. Networks that aim at mutual support provably have a central position in promoting health. The opportunity to contribute to the mutual networking of target groups, by, for example, providing subject-specific forums and websites on which knowledge, experiences and tips can be exchanged, and the associated publicly visible communication can confront the providers of such services with new challenges. This is equally true for public bodies as well as non-governmental organizations. Insecurities arising with regard to handling these demands can be lessened by developing instructions for employees about how to communicate in social media (social media policy). The development of such a policy leads to central conceptual and strategic questions for the provider, and requires testing the mission (goals) and one’s attitude (equal terms) on the recipients. In light of the central goal of health promotion to give people a greater degree of self-determination (control) over their health, these opportunities should be used courageously, even though this communication can be associated with unforeseen difficulties. Persistent, destructive visitors (trolls) or a massive negative response (shitstorm) are occurrences one should be prepared for.

Furthermore, the abovementioned media can be used to trigger new impulses in the action sphere of ‘strengthening personal competencies’, e.g. by developing targeted, individually tailored learning and training services.

Starting with the insight that nothing promotes health in such a lastingly positive way as the ability to lead a self-determined life, health-psychological concepts point to the significance of self-efficacy experiences that people go through during their biographical development. According to this idea, a high degree of self-efficacy conviction (internal behavioural control) is of great significance to how people act with regard to their health. The notion of personal self-efficacy is then largely based on previous affirmative experiences of success.

The tools of self-tracking provide effective ways of making health-related experiences of competence, thereby strengthening the experience of self-efficacy. Two factors are crucial here: firstly, goals and requirements can be set highly individually so that demoralization as a result of being over or under-challenged can be avoided. Secondly, the programs can often be incorporated into the social resonance sphere of a community, which largely produces positive attention and motivational encouragement. This social encouragement is an important reinforcing variable in the development of an experience of self-efficacy.

Currently, personal competencies are given a different, somewhat limited meaning with the term ‘health literacy’. At the heart of this ‘health literacy’ concept is the ability to acquire, understand and critically evaluate health information. The term ‘health literacy’ is applied both to people (e.g. patients) and providers of health information (e.g. doctors, health-promotion experts) and therefore ascribes responsibility to both sides. Low or insufficient levels of health literacy are thus also an expression of communication that is not working. Social media seem well suited here to create a bridge between users (laypeople, patients) and providers (experts, clinicians). They can provide valuable support for all three functions (seeking, understanding, evaluating) as well as for other things. In the ePatient handbook (Belliger and Krieger 2014) de Bronkhardt strikingly illustrated the benefit of communicating via social media for medical-treatment purposes. It is a plea for a (systematically) expanded understanding of health and disease, where the normative distinction between laypeople and experts (patients - doctors) is abandoned or expanded in favour of a complex network of different actors. This is also demonstrated by the example of the pharmaceutical company Pfizer, which, together with two patient self-help organizations (AMSEL, Leukämie), developed a practical manual in 2014 that aims to prepare patient organizations for handling and using social media. The term ‘participatory medicine’ is increasingly being used in this context. The ‘Salzburg Statement on Shared Decision Making’ (http://e-patients.net/u/2011/03/Salzburg-Statement.pdf) proclaims the (technologically supported) vision of health as a joint achievement by patients and clinicians. Clinical or epidemiological evidence as well as resilient and transferable study results are not yet available in this area, however.

This consideration touches directly on the fifth area of action of the Ottawa Charter, which demands that ‘health services [be] re-oriented’. Here, hardly any structural changes towards a healthcare system that focuses more strongly on prevention and empowerment have taken place in Germany in the last thirty years. The omnipresent internet has, however, started to change life much more profoundly than any other technology. This is creating new framework conditions for the future actions of the protagonists and institutions in the healthcare sector and, hand-in-hand with that, significant changes in their interaction, as the report by the EU Task Force on eHealth (Redesigning health in Europe 2020) emphatically confirms.

The need for change and possible consequences for the field of prevention and health promotion are here summarized below.

  • The dissolution of the sender-recipient principle requires thinking and action that take systematic theories and network structures into account.
  • With the end of a clear dominance of mass communication, educational institutions have to adapt their actions from the sender-driven ‘one to many’ approach to a ‘one to one’ approach, such as personalized newsletters and individual reactions in online forums. The ultimate goal is to transfer the existing communication competence on to the thematic and dramaturgical conditions of a world networked via many different media. This involves being aware of the different media formats and being able to assess and create their specific efficacies as well as to oversee the dramaturgically expedient networking of the formats.
  • This competence has to include the aspect of the technical-functional relationships between the media. Only a deep understanding of the technical possibilities of use, and user analysis to promote a behaviour and interest-based placement of messages, will secure effective and efficient action in the new media.
  • Information providers’ areas of action will expand by the components ‘listening’ and ‘empowering’. One central task will be participation in public debates, initiating websites for exchange and the support of existing structures and initiatives (bloggers, local websites), instead of producing and publishing information about health. To do this authentically, these institutions’ representatives have to appear as real people and engage with others as equals.
  • Significant aspects of communication will be conducted with the help of active agents (bloggers) and social structures (communities). One important task for the future will be to empower important opinion formers and initiatives that support the promotion of healthy ways of life.
  • The significance of information as an impulse to alter behaviour seems relativized. The goal of health communication via social media is to play at least a sporadic role in the ‘individual, digital flow of life’ (Gelernter) and to trigger interaction (in the sense of expressing an interest, expressing opinions and expressing an attitude). The goal is less to create a persuasive impulse than to stimulate critical reflection by subtly participating in conversations.

The changing world of media with its new communication mechanisms poses technical and strategic questions as well as ethical ones. Addressing individuals via a social network could be perceived as violating their privacy. On the other hand, the imprudent publication of supposedly private content from one’s professional or private life (e.g. with photographs) could easily violate personal and institutional boundaries. When participating in communal activities, there should be careful investigation to see who is participating with what interests (e.g. industry). Here the protagonists need to develop a clear position and take it into account while communicating.

References:
Belliger A/Krieger DJ (eds), Gesundheit 2.0. Das ePatienten-Handbuch, Bielefeld 2014.
Bundesrat Drucksache 167/14: Grünbuch über Mobile-Health-Dienste 2014, download from:
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Centers for Disease Control and Prevention (CDC): Social media toolkit 2011   Accessed on 28 Nov. 2014
Granic I/Lobel, A/Engels RCME, The Benefits of Playing Video Games, in: American Psychologist 2014, 69 (1), pp. 66-78, download from
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http://europa.eu/rapid/press-release_MEMO-12-959_en.htm
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Statistisches Bundesamt , Fachserie 15, Reihe 4, IKT 2013, Wiesbaden 2014  

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