PUBLIC HEALTH, PUBLIC PERSPECTIVE, PUBLIC POLICY: THE INFLUENCE OF SOCIAL PROOF

Transcription

1 PUBLIC HEALTH, PUBLIC PERSPECTIVE, PUBLIC POLICY: THE INFLUENCE OF SOCIAL PROOF University of California, San Francisco Dental Public Health Seminar, April 12, 2016 Brittany Seymour, DDS, MPH Assistant Professor Harvard School of Dental Medicine Department of Oral Health Policy and Epidemiology Fellow Berkman Center for Internet and Society at Harvard

2 Today: Visual tour of cyberspace Why do I do this research? Case studies Fluoridation Ebola Vaccines So what? Insights gained, Key theories Take home messages for digital communication strategies

3 Fast facts: 74% of internet users in the US utilize social networking sites (Pew Research Internet Project) Facebook has 1 billion users worldwide (Burke-Garcia et al, 2014), 166 million in the US (Mertz et al, 2014), and is one of the most trustworthy sources of information in the US (Higgins, 2013), with >680,000 pieces of content shared every minute (Cortesi 2014) Twitter has 140million US users (Mertz 2014), ~5700 tweets/second (Twitter) YouTube is the second most used search engine globally (Higgins 2013), with 100 hours of video added each minute (YouTube 2015)

4 Fast fact: 8 out of 10 internet users search for health information online Fox 2009 Key Question: If today s technology ensures unprecedented access to information, why don t we see a stronger corresponding improvement in health policies and behaviors by individuals who are engaging with this information?

5 Top 10 Public Health Achievements of the 20 th Century 1. Vaccines 2. Motor vehicle safety 3. Safer workplaces 4. Control of infectious diseases 5. Decline in deaths for coronary heart disease and stroke 6. Safer and healthier foods 7. Healthier mothers and babies 8. Family planning 9. Fluoridation of drinking water Source: Centers for Disease Control and Prevention Graphic: courtesy of ASPH What is Public Health? 10. Recognition of tobacco use as a health hazard Source: Centers for Disease Control and Prevention

6 The tipping point.

7 A digital pandemic? CNN, Forbes, Time, USA Today 54,000 Views And Shares Across Social Media 100 Friday, 2/14/14 Monday, 2/16/14

8 The Story of Fluoride

9 At the interface of social media and fluoridation Pro F- Anti F- The Way Forward Mertz, Allukian, JMDS 2014

10 Initial Approach: PIFIE Global Health and Social Media Fellowship with Workshops, South Africa, Uganda, Rwanda, June 2014 New knowledge at the interface of global health and social media HGHI May 1, 2014 Anti-fluoride viability study

11 Hypothesis: Engaging with health information on social networking platforms is less about the information content and more about connecting/making a social statement

12 Anti fluoride viability study I. Social networks and influence II. Social diffusion of information III. Sentiment and engagement Seymour et al, AJPH 2015

13 Network influence 9 out of 10 group members have friend connections within the group Our sample groups were Significantly more connected (p<0.001) that Facebook overall High betweenness centrality was present

14 Social Diffusion 60% of reference posts were 2-3 degrees from the original source 12% of reference posts were dead ends

15 Engagement and Sentiment 39.58% Comments by Type 7.64% 9.03% 20.14% Ad Hominem: Autonomy: Conspiracy Theory: Disputed Evidence: Null: 2324 Likes by Type of Comment Ad Hominem: Autonomy: 442 Conspiracy Theory: Disputed Evidence: 181 Null: Science based most frequent, most engaged single category, with a positive sentiment score Selected/Anecdotal: Science Based: 7.64% 9.03% 6.94% Engagement Score by Type of Comment Selected/Anecdotal: 387 Science Based: 414 Sen ment Score by Type of Comment 36 Majority of comments were non-science based, all with a negative sentiment score Ad Hominem: Autonomy: Conspiracy Theory: Disputed Evidence: Null: Selected/Anecdotal: Science Based: Ad Hominem: Autonomy: Conspiracy Theory: Disputed Evidence: -5-9 Null: Selected/Anecdotal: Science Based: Users have a 1 in 2 chance of encountering negative, nonscience based content

16 The Story of Ebola

17 The Story of Ebola

18 The Story of Ebola

19 The Story of Ebola Roberts et al, Report for the WHO, 2014

20 Top 10 Public Health Achievements of the 20 th Century 1. Vaccines 2. Motor vehicle safety 3. Safer workplaces 4. Control of infectious diseases 5. Decline in deaths for coronary heart disease and stroke 6. Safer and healthier foods 7. Healthier mothers and babies 8. Family planning Source: Centers for Disease Control and Prevention Graphic: courtesy of ASPH What is Public Health? 9. Fluoridation of drinking water 10. Recognition of tobacco use as a health hazard Source: Centers for Disease Control and Prevention

21 The Story of Vaccines

22 The Story of Vaccines Below optimal herd immunity!

23 The Story of Vaccines *Most were unvaccinated, and several hospitalizations were infants too young to be vaccinated

24 The Story of Vaccines

25 The Story of Vaccines

26 The Story of Vaccines Expert? Social influencer? Both/Neither?

27 The Story of Vaccines

28 The Story of Vaccines

29 The Story of Vaccines

30 Today s Vaccination Challenger Networks: Image source: Strategic Advisory Group of Experts on vaccine hesitancy

31 Our Study Target Network: Image source: Strategic Advisory Group of Experts on vaccine hesitancy

32 Autonomous, thoughtful and uncertain Engaged in the vaccination issue More likely to turn to the internet for information Long, balanced decision-making process Less likely to respond to policy mandates Communication becomes key

33 This study is the first of its kind and aims to achieve the following: 1) Map and describe the behavior of the Confidence network online 2) Map and describe the most influential informational sources online

34 Influencers -Betweenness centrality -Degree centrality -Degree of freedom of speech -Sentiment

35 Results: Social Clustering

36 Social clustering Roberts et al, Report for the WHO, 2014

37 Results: Variable outcomes Variable N(%age) Sentiment Pro-Vaccine 302(75.0) Vaccine Hesitant 98(25.0) Hyperlink degree Centrality High 198 (49.0) Low 202(51.0) Betweenness Centrality High 326(81.0) Low 74(19.0) Freedom of Speech* High 179(46.0) Low 213(54.0)

38 Results: Top sites

39 Results: Significant associations 4187 sources met inclusion criteria. Clustered social communities formed based on shared hyperlinks Pro vaccine sources were directly linked to most frequently (OR=1.68, 95%CI [1.06, 2.67], p=0.027). Sources with a high degree of freedom of speech were more likely to demonstrate vaccine hesitancy (OR=0.003, 95% CI [ ], p<0.001) and Sources with a high degree of freedom of speech were more influential in spreading information further among and between communities (OR=0.48, 95% CI [ ], p=0.033).

40 Preliminary Patterns 1 Online information: pretty good 2 Social use of that information: not so good 3 Disconnect between what people link to and what they share and talk about How does this difference in Internet behavior impact health beliefs and behaviors, if at all?

41 So what? Broadcast vs. Social Diffusion Image source: Goel, et al. The structural virality of online diffusion. 2013

42 Today s Internet Practices: Consumption Creation Curation Conversation

43 Social Proof: Lots of people share this People you like share this Your friends share this You share this Quarantine them! Travel ban! Vaccines cause autism! Fluoride is a neurotoxin!

44 Today s Internet Practices:

45 Now what?! Social Health Communication Strategies Key theories: Peers over authority/expert Content creation versus consumption Social first, information second Advocacy versus accuracy

46 Empirical Social Communication Strategies Measure and Model Network Behaviors: Sentiment (positive, negative, accurate, emotional) Betweenness centrality (influence) Source type/freedom of speech (gov t, blog, grass roots, MSM) Social diffusion/cascades Engagement *If we re going to use the Internet to communicate, we must have a better understanding of how networks translate and transfer our messages or why they don t

47 Please stay in touch: Follow me on 2016 by Harvard School of Dental Medicine. All rights reserved. This material contains unpublished information-not for distribution.