{"id":2189,"date":"2011-10-31T19:50:40","date_gmt":"2011-10-31T23:50:40","guid":{"rendered":"http:\/\/pmedicine.org\/journal\/?p=2189"},"modified":"2023-02-20T11:03:32","modified_gmt":"2023-02-20T16:03:32","slug":"promoting-participatory-medicine-with-social-media-new-media-applications-on-hospital-websites-that-enhance-health-education-and-e-patients-voices","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/journal\/evidence\/research\/2011\/10\/31\/promoting-participatory-medicine-with-social-media-new-media-applications-on-hospital-websites-that-enhance-health-education-and-e-patients-voices\/","title":{"rendered":"Promoting Participatory Medicine with Social Media: New Media Applications on Hospital Websites that Enhance Health Education and e-Patients’ Voices"},"content":{"rendered":"

Abstract<\/h3>\n

Summary<\/em><\/strong>:
\nBackground and Objective:<\/em> The nature of health communication is changing as people increasingly seek health information on the internet. The objective of this study was to investigate how hospital websites utilize a variety of e-health tools; online communication technologies such as social media, video, podcasts, and interactive formats.
\nMethods:<\/em> An inductive content analysis was performed on the websites of 14 top-ranked US hospitals from January 5, 2011 to February 28, 2011. A total of 1,330 web pages were analyzed to identify the types of online communication technologies utilized by hospitals to provide e-patients with health information.
\nFindings:<\/em> The findings provided an exploratory look at how hospitals provide web-based health information to patients. All hospitals used social media platforms such as Facebook, Twitter, or YouTube. Most hospitals offered web-based broadcasting of health information. Online health tools such as body mass index (BMI) calculators and health dictionaries were also a common website feature. Less frequently employed were mobile applications, hospital-patient interaction tools and health blogs.
\nImplications:<\/em> The convergence of interactive media formats with web-based communication tools will likely enhance e-patient education and promote patient involvement in ways that alter traditional health care interactions, and may lead to enhanced levels of participatory medicine.
\nKeywords<\/em><\/strong>: Hospital websites, social media, podcasts, online tools, mobile applications, blogs, Facebook, Twitter, YouTube, e-health, health information.
\nCitation<\/em><\/strong>: Gallant LM, Irizarry C, Boone G, Kreps G. Promoting participatory medicine with social media: new media applications on hospital websites that enhance health education and e-patients’ voice . J Participat Med. 2011 Oct 31; 3:e49.
\nPublished<\/em><\/strong>: October 31, 2011.
\nCompeting Interests<\/em><\/strong>: The authors have declared that no competing interests exist.<\/p>\n

Introduction<\/h3>\n

The nature of health communication is changing as people increasingly rely on the internet for health information.<\/a>[1<\/a>] Frydman<\/a>[2<\/a>] asserted that patients have used the internet since its early inception “to share experiences, learn about diseases and treatments, and become advocates” for their own health care. A recent Pew Research Center study found that 80% of internet users look online for health information, making it the third most popular activity behind email and search.<\/a>[3<\/a>] More than half of online health searches have had an impact on health decisions by e-patients.<\/a>[4<\/a>] E-patients are internet-savvy users who seek online health information for education and decision making. Understanding web-based communication tool development that engages e-patients can better guide effective healthcare strategies and interventions<\/a>[5<\/a>] and enhance participatory medicine.<\/p>\n

While hospitals are cornerstones of public health information and health education,<\/a>[6<\/a>]<\/a>[7<\/a>]<\/a>[8<\/a>] it is not known to what extent hospital websites are helping to achieve these important health goals. Past research has indicated that hospitals are just starting to use web 2.0 technologies to communicate and interact with e-patients.<\/a>[9<\/a>] Thus, it is important to examine how hospitals use their websites to carry out their critical health care mission with various media and content delivery formats. <\/p>\n

The current study examines how 14 top-ranked US hospitals serve the information needs of e-patients through online interactive media formats on their websites. Health organizations and professionals need to use social media channels to promote reliable and accurate health information to e-patients.<\/a>[10<\/a>] Yet, there is little research regarding the nature of presentation of health information on hospital websites to guide this process. Knowledge about the use of new media by top-ranked US hospital websites may help health care administrators and other professionals assess and improve web-based health communication. The importance of web-based communication media formats for e-health leads to the following research question: How is health information represented in online media formats for e-patients on hospital websites?<\/p>\n

Methods<\/h3>\n

This research employed an inductive content analysis to examine the websites of 14 top-ranked US hospitals, based on a national report published in 2010 by US News and World Report<\/em>.<\/a>[11<\/a>] Inductive content analysis is increasingly being used to study internet content.<\/a>[12<\/a>] Since there is limited empirical work on hospital website content and virtually no research on hospital websites and online multimedia formats, an inductive analysis was appropriate to utilize for this study. <\/p>\n

The 14 hospitals, ranked in order, include: (1) Johns Hopkins Hospital, Baltimore; (2) Mayo Clinic; Minnesota; (3) Massachusetts General Hospital, Boston; (4) Cleveland Clinic; (5) Ronald Reagan UCLA Medical Center, Los Angeles; (6) New York-Presbyterian University Hospital of Columbia and Cornell; (7) University of California, San Francisco Medical Center; (8) Barnes-Jewish Hospital\/Washington University, St. Louis; (9) Hospital of the University of Pennsylvania; Philadelphia; (10) Duke University Medical Center, Durham, N.C.; (11) Brigham and Women’s Hospital, Boston; (12) University of Washington Medical Center, Seattle; (13) UPMC-University of Pittsburgh Medical Center; and (14) University of Michigan Hospitals and Health Centers, Ann Arbor.<\/a>[13<\/a>]<\/p>\n

As units of analysis, the authors first identified different types of online media formats utilized by each hospital (eg, blogs, instant-messaging, audio clips, and video clips etc.). After identifying media formats, patient health information content (eg, disease information, symptom checkers, and health education) was identified within each media format.
\nThe total number of pages analyzed was 1,330, an average of 95 web pages per hospital website. The time frame for the content analysis of the 14 websites was January 5, 2011 to February 28, 2011. The first author identified six major content categories in the presentation of health information using hospital online media formats. These content categories include: social media; blogs; web-based broadcasting; web-enabled e-patient communication tools; mobile applications; and online health tools. These content categories and relevant sub-categories were corroborated by the second and third author. The analysis continued until saturation was reached.
<\/a>[14<\/a>]<\/p>\n

Results<\/h3>\n

This exploratory look into how hospitals provide web-based health information to e-patients provides details on the presence of various online media formats such as social media platforms, text-based, video, and webinars. Six content categories emerged in the analysis: social media, blogs, web-based broadcasting, web-enabled e-patient communication tools, mobile applications, and online health tools. The categories are defined below. Because of the developing nature of online technologies, some areas are more mature than others. For example, mobile applications, as a newer technology, presented less content compared to other categories. However, this category represents an important type of online communication which will grow in the future and so we included it in this analysis.<\/p>\n

Two levels of content analysis are reported for each category, as depicted in Tables 1-6. The left column reports how many websites have a particular format, whereas the right column provides the number of these online media formats that contain patient health information. <\/p>\n

Category 1: Social Media Applications<\/h4>\n

Social media applications connect one group of people to another. More importantly, social media applications enable hospitals to target e-patients with health communication messages. Table 1 illustrates that the vast majority of top-ranked hospitals use Facebook, hospital sponsored YouTube videos, and Twitter to communicate with e-patients. <\/p>\n

Table 1:<\/strong> Social media.
\n
\"\"<\/a>\t<\/p>\n

This study found that typical health information content on social media sites included a mixture of patients’ stories, expert opinions by medical professionals, and details about what to expect from a particular test or procedure. Some content provided health tips, eg, diet, pediatric care, and cancer prevention.<\/p>\n

Johns Hopkins offered a comprehensive and interactive approach, using social media to provide health information and refer e-patients to needed online or offline resources. Johns Hopkins used Twitter to refer to its Facebook page, its clinical web pages and other hospital resources. Most hospitals, however, did not sync their social media platforms to each other. This means that a hospital employee must enter messages individually on each social media platform hosted by the hospital. <\/p>\n

The degree to which social media platforms promoted interactivity varied. For example, of the 13 hospitals that included Facebook pages, nine featured a Facebook link on the landing page making it easily accessible to e-patients. Six of the 13 hospitals with Facebook pages offered a dedicated health discussion forum on the site to promote interaction between health care providers and e-patients. While inconclusive, review of each hospital’s Facebook wall revealed some degree of interaction between hospital staff and e-patient inquiries. Hospital staff normally referred patient health inquires to the appropriate clinical care website. Facebook wall posts appeared to promote interaction among e-patient Facebook users on matters regarding their health inquiries, hospital services and hospital events. Further, the Facebook wall also became a forum for e-patients to voice their concerns or complaints regarding hospital services.<\/p>\n

Most of the hospitals reviewed also offered a YouTube channel featuring a comments function. However, the interactivity potential of such videos was minimal, with little to no e-patient comments noted. Duke disabled the commenting function. Eleven of the 14 hospitals reviewed offered a “share” function which allowed e-patients to exchange information from hospital websites with other e-patients. Share functions included sending content to another person via email or posting information on an individual’s social media account such as Facebook or Twitter. Twitter postings were used most often by hospitals to promote community health events and news. This function provided easy one click linkages for visitors to repost hospital tweets to their individual Twitter feeds. <\/p>\n

Category 2: Blogs<\/h4>\n

Blogs are a web-based, text-heavy format. Typical blog content on the websites studied contained health communication messages from medical experts and personal stories from patients (see Table 2). Physicians provided specialty medical information and advice through blogging in five of the hospital websites reviewed. Allied health professionals, such as nutritionists, wrote blogs about health information for hospital audiences. In both physician and allied health professional blogs, comment functions were available for e-patients. Depending on the topic, e-patients would engage each other through the blog. Very little additional engagement was noted between e-patients and blogging health providers.<\/p>\n

Table 2:<\/strong> Blogs.
\n
\"\"<\/a>\t<\/p>\n

However, there were a number of hospitals hosting e-patient blogs on their websites. In general, e-patients wrote about their medical conditions and hospital experiences on the blogs. Moreover, specialized online social media platforms such as CaringBridge or CarePages were utilized by more than half of the hospitals to provide patients with a way to report their progress and well-being. It also allowed a patient’s friends and family members to view entries and to make comments on patient posts. Such patient-driven social media combined blogging and online community building around an individual patient’s medical journey. <\/p>\n

Category 3: Web-Based Broadcasting<\/h4>\n

Web-based broadcasting uses the typical broadcast media formats in an online environment. As reported in Table 3, these formats included: online videos, podcasts, and webinars. All of these media were hosted directly on the hospital websites, rather than using YouTube and Facebook. The online videos reviewed presented a variety of health information from hospital physicians and allied health professionals. Similarly, podcasts (audio productions) were also produced to provide health information for e-patients. Webinars are slightly different in that the initial webinar can be live and allow audience members to interact online with other guests. After the live webinar, the productions may be posted for future viewing. In this study, eight webinars were identified, in which half were devoted to medical and support staff training and half provided health information to e-patients. <\/p>\n

Table 3:<\/strong> Web-based broadcasting.
\n
\"\"<\/a>\t<\/p>\n

Category 4: Web-Enabled e-Patient Communication Tools<\/h4>\n

Web-enabled communication tools allow two-way communication between hospital health care providers and e-patients. E-patient web-enabled communication tools identified in this study included email, online chat, and text messaging, and online support groups. The occurrences are reported in Table 4. A standard email link to contact the hospital was available on the majority of hospital websites. Only the University of Washington Medical Center-Seattle website required that contact with the hospital occur via phone. More innovative web-enabled communication tools were found in online chat forums. For example, the Cleveland Clinic’s online health library offered e-patients an opportunity to chat with a health care provider to aid their search. The hospital also offered the ability to submit a question online throughout their site. <\/p>\n

Table 4:<\/strong> Web-enabled e-patient communication tools.
\n
\"\"<\/a><\/p>\n

\tWhile most hospitals reviewed offered support group lists on their websites, only five hospitals provided web enabled links to online support groups. In most cases, hospitals simply listed the telephone number of local support groups.<\/p>\n

Category 5: Mobile Applications<\/h4>\n

Mobile applications support health information and messages in a wireless format available through mobile devices like smartphones and web-based tablets such as the iPad. These applications included walking exercises, symptom checkers, and meditation exercises. Only Ronald Reagan UCLA Medical Center, offered the entire website in a mobile format. As indicated in Table 5, only five of the 14 hospitals had mobile applications available. However, all of the mobile applications reviewed offered patient health information content. <\/p>\n

Table 5:<\/strong> Mobile applications.
\n
\"\"<\/a><\/p>\n

Category 6: Online Health Tools<\/h4>\n

Online health tools were provided for e-patients to learn more about their personal health needs. These tools ranged from static information such as health dictionaries, health topic guides, and event calendars, to more interactive information such as BMI calculators and an option to request a second opinion online (see Table 6). <\/p>\n

The most interactive and personalized online tool available on hospital websites was the patient portal to access information from a hospital’s electronic health records. Patient portals are individualized, password protected accounts for which a patient must register. Unlike general health tools on hospital websites, a patient portal contains personal health information, which must be protected under healthcare privacy laws. Since privacy prevents direct examination of a patient’s portal web content, this research relied on hospital descriptions of their patient portal functions. <\/p>\n

Of the 14 hospitals reviewed, 11 hospital websites provided patient portals through personalized accounts. Three types of online functions involved administrative tasks, accessing personalized medical information, and interacting with health professionals. Common tasks included:<\/p>\n