Facebook as a conduit for population health messaging
evidence and practice    

Open Access Facebook as a conduit for population health messaging

Ruth Chambers Professor of Health Care, NHS Stoke on Trent CCG, Keele University and Staffordshire University, Hanley, England
Yazdan Zargham Foundation Doctor, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, England
Gina Newman Health Improvement Practitioner, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, England
Anna Buckle Digital Health Adviser, Redmoor Health, Preston, England
Gemma Hall Commissioning Support Manager, northern locality, NHS Stoke on Trent and North Staffordshire CCGs, Hanley, England

Why you should read this article:
  • To learn about the role of Facebook as a platform for population health messaging in primary care

  • To understand how Facebook is used by general practices

  • To develop ideas for implementing your own official Facebook page

Facebook is the most common social media site on which adults in the UK have a profile. It is therefore a potentially useful platform for general practices to promote their services and update their patients. However, the value of social media platforms is not always appreciated by frontline general practice teams. This article describes a project that assisted general practices in the Staffordshire area to develop their own official Facebook pages. It offers advice and suggestions about how to develop and best use Facebook in practice areas.

Primary Health Care. doi: 10.7748/phc.2020.e1672

Peer review

This article has been subject to external double-blind peer review and has been checked for plagiarism using automated software

Correspondence

ruth.chambers@stoke.nhs.uk

Conflict of interest

None declared

Chambers R, Zargham Y, Newman G et al (2020) Facebook as a conduit for population health messaging. Primary Health Care. doi: 10.7748/phc.2020.e1672

Open access

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (see https://creativecommons.org/licenses/by-nc/4.0/) which permits others to copy and redistribute in any medium or format, remix, transform and build on this work non-commercially, provided appropriate credit is given and any changes made indicated.

Published online: 02 September 2020

Introduction

A survey of adult media use found that 90% of adults in the UK have access to the internet, with 64% saying that it is essential to their daily lives (Ofcom 2018a). The increased connectivity means people are becoming more reliant on social media platforms as a source of news and information (Ofcom 2018b). In terms of users, Facebook remains the most dominant social media platform, with 62% of adults reporting that they have a profile on the site (Ofcom 2018b). It is therefore a useful tool for general practices to use to update and engage their registered patients.

As well as individual profiles of people, Facebook enables groups, organisations or companies to develop their own official pages. Official Facebook pages for general practices enable them to share updates about their services and similar health promotion messages with their patients, for example, to increase the uptake of breast cancer screening or promote flu vaccinations.

Such public access to information and services through technology-enabled care is a priority for NHSX, the joint unit that brings together teams from the Department of Health and Social Care, NHS England and NHS Improvement to drive digital transformation of care across England (Department of Health and Social Care 2019). Currently, there is an urgent need to engage with patients to update them about coronavirus symptoms and support those with long-term health conditions while their usual face-to-face review service is unavailable. However, the value of social media platforms such as Facebook in engaging with patients is not necessarily appreciated by frontline general practice teams, with practice engagement with the platform variable (Moore et al 2018). Intelligent use of Facebook could potentially improve public awareness of primary care services and enable promotion of self-care.

This article examines the results of a digital transformation project in northern Staffordshire, England, that assisted general practices to set up official Facebook pages for population health messaging.

Key points

  • In terms of user base, Facebook is the most dominant social media platform, and is therefore a potentially useful platform for general practices to update and engage their patients

  • Evidence suggests that Facebook is not necessarily appreciated by general practices as a method for disseminating information

  • Using digital expert companies can encourage practices to develop their own official Facebook pages

  • Using Facebook can potentially improve patient uptake of health screening measures, such as those for breast cancer

Background to the project

In 2016, a digital transformation lead in northern Staffordshire commissioned a digital expert company, Redmoor Health, to assist general practices in the entire Staffordshire region setting up their own official Facebook pages (Redmoor Health 2019a). At that time, data on practices based in the northern Staffordshire area found that 37% (n=31) of the then 83 practices had official public Facebook pages (Moore et al 2018), that is, a page created by the practice team. A further 48% (n=40) had unofficial pages set up by patients without the practice managers’ permission or knowledge, while 14% (n=12) had no Facebook page at all (Moore et al 2018).

The company provided expertise about adopting social media for health purposes for a sceptical primary care workforce plus support and guidance about developing Facebook content (Chambers et al 2018, Redmoor Health 2019b).

This arrangement between the practices, the company and Staffordshire commissioners meant that public Facebook pages could be set up for practices to provide their patients individualised information about services and relay national health messages related to the time of year or particular health conditions. The pages could also be used to gather the public’s views on current and future services.

Breast cancer screening

One example of an official Facebook page from a health provider in the region is the North Midlands Breast Screening Service. Its Facebook page relays information about breast screening dates, eligibility and access to the service for local people. It also attempts to alleviate women’s concerns before appointments and advises them to contact the service. The page has 1,682 followers and has attracted national interest as a useful communication tool for population messaging (Newman and Johnson 2018, Public Health England 2019).

In 2018, new data was published that demonstrated that, over the previous ten years, there had been a decline locally and nationally in attendance for breast cancer screening (NHS Digital 2018). This prompted the North Midlands Breast Screening Service to approach the digital transformation team in 2018 to ask if it could promote the service on the Facebook pages of GP practices in the area, to reach eligible cohorts in Staffordshire; this would complement its traditional promotional methods, such as advertising in local newspapers or community magazines and on Facebook community group pages (Newman and Johnson 2018).

Assessing outcomes from the project

After its initial work in 2016, the digital company continued to oversee the rollout of official Facebook pages across Staffordshire GP practices as the clinical commissioning groups in the region started to work more closely together. It monitored the numbers official Facebook practice pages being developed, as well as unofficial pages, and reported these figures to the North Staffordshire Technology Enabled Care Services steering group.

As a result of the project increasing GP practice engagement with Facebook, several closed Facebook groups were developed by clinicians – usually practice nurses – to provide ongoing remote support. Closed Facebook groups were set up for specific health conditions, such as type 2 diabetes, and allowed practice nurses to provide support to those who posted messages in the group. Closed Facebook groups are groups that are only visible to members, who must request access via an administrator.

This approach was replicated by local secondary care nurse specialists, who have set up similar groups for patients experiencing cardiac rehabilitation, multiple sclerosis and atrial fibrillation (Table 1).

Table 1.

Closed Facebook group membership numbers

Facebook groupNumber of patients who are members
Multiple sclerosis support network383
Cardiac rehabilitation support network196
Atrial fibrillation support network201
NHS Health Check study267

Redmoor Health assisted with content development, and loaded animations and infographics onto official practice Facebook pages as part of population health promotion messaging and reported on numbers of likes received by posts. Some of its latest findings, including the number of official Facebook pages, unofficial pages, breast cancer screening promotion, and details on the closed Facebook groups, are presented in this article.

Project outcomes

Official Facebook pages

In June 2020, the digital company used Facebook’s search function to identify unofficial and official Facebook pages across all 151 practices in Staffordshire (Table 2). It found 75% (n=113) had official pages, 30% (n=45) had unofficial pages and only 10% (n=15) did not have a page, with 25 practices having both official and unofficial pages.

Table 2.

Facebook presence of practices in Staffordshire in June 2020

AreaClinical commissioning group (CCG)Official pagesUnofficial pagesNo pages
Northern StaffordshireNorth Staffordshire CCG2822
Stoke CCG3832
Subtotal6654
Other areasStafford and Surrounds CCG782
Cannock Chase CCG13133
South East Staffordshire and Seisdon Peninsula CCG12154
East Staffordshire CCG1542
Subtotal474011
All areas total1134515

Data for northern Staffordshire practices were isolated to enable comparisons to be drawn with previous research. Of the now 70 practices in the area, 94% (n=66) had official pages and the number of practices with unofficial pages had decreased to 7% (n=5). Only four practices did not have an official or unofficial presence on Facebook.

Breast cancer screening

The growth in official practice Facebook pages enabled the North Midlands Breast Screening Service to promote its service and provide dates of mobile breast screening van visits on local GP practice pages. Uptake of breast screening improved by 13% in the areas where the service’s mobile breast screening van visited, locally reported data in September 2019 showed. Areas of Staffordshire not covered by the breast cancer screening service did not have a similar rise in uptake.

Closed Facebook groups

Table 1 provides information on the number of members of closed Facebook groups developed by local secondary care nurse specialists, which was gathered from the individuals who developed each group. These share best practice, such as emphasising the importance of taking regular medicines, encouraging exercise specific to the condition and reducing social isolation.

Learning from this success, researchers at Staffordshire University set up a closed Facebook group for patients participating in their study investigating the outcomes of the NHS Health Check. They have gathered ongoing perspectives from 267 subjects, in response to questions they posted to the group on Facebook (Table 1).

Discussion

This project has demonstrated that there is potential for GP practices to use Facebook to develop effective population health messaging.

Official Facebook pages

An official Facebook page provides a trustworthy site to for a practice to promote messages to its patients; it can emphasise the importance of trustworthy sources of information by providing links to NHS and government sites for the latest updates of health advice, for example. Animations can also portray health messages in an engaging way. However, the page should also feature a disclaimer, reminding readers that the content is generic and not a substitute for clinical advice. Box 1 provides some example disclaimers that can be used on these pages, and on closed Facebook groups.

Information constantly evolves and patients must weigh up the information and guidance on the page with regards to their own circumstances. The disclaimer should also tell patients not to post any questions or information relating to their clinical condition or to expect a personal answer shared with the public. In addition, practice managers must make their teams aware of best practice and national requirements relating to IT security, clinical safety, data quality, the use of patient data, data protection and privacy, and information standards (Chambers et al 2018).

Unofficial pages

Due to the potential for misinformation to be spread via social media, practices should create their own official pages. Practices have no control over the content of unofficial pages, which patients often create and use to criticise the practices’ services. However, unofficial pages can be useful for obtaining feedback on services (Liddy et al 2017). Practices will need to have administrative teams to respond to posts on these pages, especially if they are unfair or target a clinician unduly.

Concerns about Facebook

Facebook appears to be a positive platform for general practice teams in Staffordshire to access and interact with their registered patients. The implementation of individual practice groups has shown that a small amount of time invested each week by an administrator can produce positive benefits. However, there is undoubtedly some hesitation among practices implementing their own pages.

There are concerns that Facebook’s primary source of revenue is advertisement sales with some adverts targeted at people based on certain characteristics and user data such as age, gender, and interests (Gunnars 2020). The company generates value from user data, for example through personalised advertising. ‘Surveillance capitalism’ – commodifying personal data to make a profit – therefore needs to be considered when weighing potential risks to patients from using Facebook against the health benefits. The sensitive nature of patient data needs to be considered further, but disclaimers in closed Facebook groups should alert patients not to share personal information.

Future research

Future research should consider the type of knowledge patients gain from interactions with practice teams and clinicians on Facebook pages, such as how it is different from face-to-face patient interactions and what extra support, if any, it provides to trigger and sustain behavioural change.

Conclusion

The changing nature of general practices, with collaboration across primary care networks, means there is a need to keep patients updated as to what services are available. General practice teams are currently consolidating what they have learned from their urgent switch to digital delivery of care during the COVID-19 pandemic with new ways of accessing services and supporting people to manage their own conditions, to sustain future care. It is important that practices make the most of the opportunity for population health messaging that Facebook provides.

Box 1.

Example disclaimers for practice Facebook usage

Closed Facebook group

The purpose of the closed Facebook group is to provide patients and families who live with [insert condition] with a closed forum where they can share their experiences and learn more about their condition. Doctors or nursing staff will not be able to diagnose any conditions for patients or give personal advice on their treatment via this forum. If you require any one-to-one support, please arrange to discuss this with the doctor or nursing team by contacting them directly. This not a replacement for face-to-face services and if any patient is unsure about something, they should contact a member of our team through the normal channels. This group is not monitored 24/7. We will visit the group occasionally during the week but please respect that we can only do this when we have time between clinics. We retain the right to delete any inappropriate or offensive posts. We hope that you find the group helpful and would encourage you to tell other people you know who live with [insert condition] about our Facebook group. Please note, the practice cannot be held responsible for patients or others sharing information received via this group.

Practice official Facebook page

This is a page managed by the practice so please be respectful as to what you contribute. This is not a channel for discussing personal medical issues or asking to book or cancel appointments. For appointments or general queries, we still advise you contact us via telephone or our website. We retain the right to delete any inappropriate or offensive posts. We hope you find the page helpful and would encourage you to tell other people you know who are registered with our practice about our page. Please note, the practice cannot be held responsible for patients or others sharing information received via this page and please note that we aren’t able to monitor the page 24/7, but will endeavour to visit the page occasionally during the week.

References

  1. Chambers R, Schmid M, Al Jabbouri A et al (2018) Making Digital Healthcare Happen in Practice. Otmoor Publishing, Bristol.
  2. Department of Health and Social Care (2019) NHSX: New Joint Organisation for Digital, Data and Technology. http://gov.uk/government/news/nhsx-new-joint-organisation-for-digital-data-and-technology (Last accessed: 6 July 2020.)
  3. Gunnars K (2020) How Does Facebook Make Money? 7 Main Revenue Sources. https://stockanalysis.com/how-facebook-makes-money/ (Last accessed: 20 July 2020.)
  4. Liddy C, Hunter Z, Mihan A et al (2017) Use of Facebook as part of a social media strategy for patient engagement. Canadian Family Physician. 63, 3, 251-252.
  5. Moore K, Cottrell E, Chambers R (2018) Facebook in general practice: a service evaluation in one health economy. BJGP Open. 1, 4, bjgpopen17X101181. doi: 10.3399/bjgpopen17X101181.
  6. Newman G, Johnson JM (2018) Utilising Facebook to Improve Uptake in Breast Screening. http://www.rsph.org.uk/uploads/assets/uploaded/d9a17623-a4da-46a7-bcd61e16325459d7.pdf (Last accessed: 7 July 2020.)
  7. NHS Digital (2018) Breast Screening Programme, England 2016-17. http://files.digital.nhs.uk/pdf/m/f/breast_screening_programme__england__2016-17_-_report__v2.pdf (Last accessed: 9 July 2020.)
  8. Ofcom (2018a) Proposed Annual Plan 2019/20. http://ofcom.org.uk/__data/assets/pdf_file/0020/128810/Proposed-Annual-Plan-2019-20.pdf (Last accessed: 9 July 2020.)
  9. Ofcom (2018b) Adults’ Media Use and Attitudes Report. http://ofcom.org.uk/__data/assets/pdf_file/0011/113222/Adults-Media-Use-and-Attitudes-Report-2018.pdf (Last accessed: 9 July 2020.)
  10. Public Health England (2019) How the North Midlands Breast Screening Team Uses Facebook to Increase Breast Screening Uptake. http://phescreening.blog.gov.uk/2019/04/09/how-the-north-midlands-breast-screening-team-uses-facebook-to-increase-breast-screening-uptake/ (Last accessed: 9 July 2020.)
  11. Redmoor Health (2019a) Primary Care Social Media Toolkit. http://redmoorhealth.co.uk/wp-content/uploads/redmoor-primary-care-social-media-toolkit.pdf (Last accessed: 9 July 2020.)
  12. Redmoor Health (2019b) Guide to using Facebook in Primary Care. http://redmoorhealth.co.uk/wp-content/uploads/redmoor-guide-to-using-facebook-in-primary-care-toolkit.pdf (Last accessed: 9 July 2020.)
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