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).

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.

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.

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).

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.