Using social media and social media marketing tools in health ...

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social media marketing activities related to health promotion. Material and Methods. ... JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ○ No.1/2015 ○ zdrowia. .... (36.1%; 138) campaigns are most often undertaken by.
● JOURNAL OF OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● No. 1/2015 ● ●JOURNAL PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● ●No.1/2015 JOURNAL OF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE 2/2014(59-64) ●● ●

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Using social media and social media marketing tools in health promotion by the Polish communes (Korzystanie z mediów społecznościowych i narzędzi social media marketingu w promocji zdrowia przez polskie gminy) M Syrkiewicz-Świtała A,D, T Holecki B,E, K Sobczyk C,F, M Wróblewski B, K Lar B Abstract – Introduction. The ubiquitous Internet and its modern information tools determine the current approach to communication with present society. Access to the net poses challenges not only for businesses but also for state institutions (e.g. communes), which want to effectively communicate with their environment. The communes active in the field of health promotion have at their disposal social media and social media marketing tools. The range of these tools is broad and should meet current demands and expectations of today’s consumers in the field of health promotion and education. Aim of the study. The aim of this study was to verify whether Polish communes use internet marketing tools, in particular in social media marketing activities related to health promotion. Material and Methods. 207 Polish communes were examined in the fourth quarter of 2013. The study was carried out by two methods: CAWI and CATI, with the use of an original survey questionnaire. The results were processed using standard statistical methods. Results: 91.3 % of the surveyed communes are engaged in activities in the field of health promotion. The main fields of interest are stimulants (31.4%) and cancer (25.5 %). In the opinion of Polish communes, most attractive, convincing and trustworthy form of promotion among patients are traditional forms as information posters (14.7%) , direct promotion and leaflets (11.4%), fillers information (11.4%) and TV spots (10.9 %). 51.6% of the surveyed communes do not use portals and social networking sites. Others declare that to promote health they use: Facebook (11.6 %) or Wirtualna Polska (7.8 %). 74.1 % of communes do not apply the tools of social media marketing. Only 13 respondents are active users of social networking sites, 11 read and resend fan pages and 9 communes participate online in discussions on forums about health. Conclusions.The majority of Polish communes do not use social media tools in marketing activities in the field of health promotion. It is postulated to pay more attention to social media and social media marketing tools in the ongoing activities in the field of health promotion by the commune authorities in order to improve the communication efficiency with the current information society. Key words - marketing communication, social media, social media marketing, health promotion.

Streszczenie – Wstęp. Wszechobecny Internet i jego współczesne narzędzia informacyjne determinują aktualne podejście do sposobów komunikacji z obecnym społeczeństwem. Dostępność do sieci buduje także współczesne wyzwania nie tylko dla przedsiębiorstw ale także dla instytucji państwowych (np. gmin), chcących w sposób efektywny komunikować się ze swoim otoczeniem. Gminy podejmując wszelkie działania również z zakresu promocji zdrowia mają do swojej dyspozycji media społecznosciowe i narzędzia social media marketingu. Wachlarz tych narzędzi jest szeroki i powinien sprostać obecnym wymogom oraz oczekiwaniom współczesnych odbiorców akcji z zakresu promocji i edukacji zdrowotnej. Cel pracy. Celem badania było sprawdzenie czy polskie gminy wykorzystują narzędzia marketingu internetowego ze szczególnym uwzględnieniem social media marketingu w działaniach z zakresu promocji zdrowia. Materiał i metoda. Przebadano 207 polskich gminach w czwartym kwartale 2013r. Badanie przeprowadzono dwoma metodami: CAWI i CATI z użyciem autorskiego kwestionariusza ankietowego. Wyniki opracowano za pomocą standardowych metod statystycznych. Wyniki: 91,3 % przebadanych gmin angażuje się w działania z zakresu promocji zdrowia a ich głównymi tematami są używki (31,4%) i choroby nowotworowe (25,5%). W opinii pracowników polskich gmin najbardziej atrakcyjną, przekonywującą i budzącą zaufanie wśród pacjentów formą promocji są formy tradycyjne jak: plakaty informacyjne (14,7%), promocja bezpośrednia i ulotki (11,4%), wrzutki informacyjne (11,4%) i spoty telewizyjne (10,9%). 51,6% badanych gmin nie korzysta z portali i serwisów społecznościowych. Pozostałe deklarują, że wykorzystują w przekazach promocyjnych dotyczących zdrowia: Facebook (11,6%) czy Wirtualną Polskę (7,8%). 74,1% gmin nie stosuje narzędzi social media marketingu. Tylko 13 badanych urzędów jest aktywnym użytkownikiem portali społecznościowych, 11 czyta i przesyła fanpage (like page) a 9 gmin uczestniczy w dyskusjach na forach internetowych na temat zdrowia. Wnioski. Polskie gminy w większości nie stosują narzędzi social media marketingu w działaniach z zakresu promocji

● ●JOURNAL OFOF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● ●No.1/2015 JOURNAL PUBLIC HEALTH, NURSING AND MEDICAL RESCUE 2/2014 ● ● zdrowia. Postuluje się o zwrócenie większej uwagi na media społecznościowe i narzędzia social media marketingu w prowadzonych działaniach z zakresu promocji zdrowia przez gminy w celu poprawy efektywności komunikacji z obecnym społeczeństwem informatycznym. Słowa kluczowe – komunikacja marketingowa, media społecznościowe, social media marketing, promocja zdrowia. Author Affiliations: Medical University of Silesia in Katowice, Faculty of Public Health, Healthcare Management and Economics Department Authors’ contributions to the article: A. The idea and the planning of the study B. Gathering and listing data C. The data analysis and interpretation D. Writing the article E. Critical review of the article F. Final approval of the article

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dissemination of certain information [5]. Due to social media development, new online marketing instruments have emerged, in particular those related to social media marketing, which is essentially “a collection of accounts, behaviours, feelings, experiences and interactions between consumers and brands, wherein multi-way communication takes place through an exchange of experiences via advanced communication tools” [6]. The Internet has not only become a medium which allows its users to build social relations, but also a database on entertainment, culture and information. The Internet stores business information about products and services, as well as about ideas. This, in turn, provides space where new social attitudes and beliefs can be formed [7]. Social media marketing enables monitoring of social opinions or attitudes and testing of new actions in the field of health promotion and education [8]. Thus, the Internet uses words and pictures to serve as an effective tool in communication with target groups in the field of health promotion [9].

Correspondence to: Magdalena Syrkiewicz-Świtała Ph.D., [email protected], Str., PL-41-902 Bytom,e-mail: [email protected] Accepted for publication: December 11, 2014.

I. INTRODUCTION he 21st century has brought dynamic development of information technologies. Revolutionary changes connected with the development of the Internet and modern communication technologies condition existence of many entities in numerous markets and sectors. Health care market and its main agents can also take profit from modern communication technologies in many areas of their activity [1-4]. Virtual and mobile technologies help substantially reduce costs related to communication and cooperation of institutions or enterprises with their environment and message recipient groups. Nowadays, the Internet has become not only a popular medium, but also an effective and easily available messaging channel. It enables us all to quickly search out and enter new data online, as well as to use it individually at the same time [4]. It provides smooth and fast transfer of the necessary content. Internet users get together setting up social networking sites through which they build social media. Efficient flow of information in social media has been facilitated by the development of digital devices which undoubtedly facilitate immediate and low-cost

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Aim of the study The overriding aim of the study was to verify whether in the era of the ubiquitous Internet Polish communes make use of online marketing tools, in particular social media marketing tools, in their health promotion actions. Relevant objectives of the study, which referred to health promotion activity in communes and application of social media marketing tools, were defined as follows:  Identification of fields of activities concerned with health promotion in communes, the smallest local self-government units.  Identification of marketing communication tools which communes use in activities connected with health promotion.  Determining whether and if so, how communes use social media marketing tools in their activities concerning health promotion.  Presentation of results differentiation by type of the commune.  Possible recommendations for communes in order to improve their communication effectiveness in the field of health promotion.

II. MATERIALS AND METHODS Material The study was of quantitative nature. It was carried out on a random sample in the fourth quarter of 2013. Its

● ●JOURNAL OFOF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● ●No.1/2015 JOURNAL PUBLIC HEALTH, NURSING AND MEDICAL RESCUE 2/2014 ● ● scope covered entire Poland and its target group included communes – the smallest self-government units in the country. Direct respondents of Commune Offices participating in the study were health officers who represented either Health Department or Health Promotion Office, depending on the commune’s structure. The analysis results presented in this article are part of the more extensive studies carried out in an entity affiliated by authors which investigated social involvement of selfgovernment units and non-governmental organisation operating in Poland. Methods The study was conducted by two methods, the primary being CAWI (Computer-Assisted Web Interview) and CATI (Computer Assisted Telephone Interview) as its supplementary method, with the use of one research tool – a questionnaire survey prepared by authors. The CAWI questionnaire was used in the first place and the choice of such research method was driven by the desire to reduce costs and time needed to collect data, eliminate error associated with inference of a person carrying out a survey, enhance respondents’ feeling of anonymity, get to respondents by means of the mailing list and ensure a random choice of interviewed persons with regard to time and place of the survey. Such research method was applied and representative sample of the studied population was obtained only due to the fact that all communes have access to the Internet. A phone helpdesk (business days: 8:30am-4:30pm) and e-mail helpdesk (24/7) were opened for the CAWI target group and made available to any person taking part in the study in need of personal contact and information about technical issues concerning completion of the questionnaire, the study itself and any related matters. Since an expected return rate has not been achieved, a missing number of questionnaires was obtained by way of telephone interview (CATI - Computer Assisted Telephone Interview). To this end, a call centre was opened. This method allowed experienced interviewers to carry out the survey by phone, which was to ensure higher probability of getting responds than in the case where a respondent would devote some time to fill in an online questionnaire. Other advantages which determined the choice of this method include: speed of the interview procedure, the level of the interviewer’s control over the quality of the questionnaire and automatic filters which minimise the possibility of error or missing data. Thanks to this method, interviewers’ work could be controlled on an ongoing basis, which provided more reliable and better data. CATI studies were carried out

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with the use of eCRF.biz™, a state-of-the-art original programme. In the first place, email invitations to take part in the survey were sent to all 2,479 communes in whole Poland (including 305 urban, 1,566 rural and 608 urban-rural communes) [10]. Invitations contained a cover letter, basic information about the project underway, and a link to an online questionnaire (CAWI). E-mail addresses were taken from Biostat’s database, a company responsible for the technical side of the study, and messages were sent to entities operating in a health-related business. Mailings were sent three times every few days. The strategy involved population sampling, which was not based on random selection of persons. Due to an unsatisfactory response rate, the CATI method was applied. In order to complete the missing number of questionnaires, a call centre was opened (CATI) and the CATI survey was carried out on all persons who had not provided answers in the online survey (CAWI). In this case, respondents were selected based on a simple random procedure, thanks to which all Commune Offices were equally likely to be the chosen sample. All properly filled-in questionnaires were subject to analysis before the survey termination date, December 31st 2013. Eventually, the study involved 207 communes comprising a representative sample on the basis of which analyses and findings could be referred to the whole population. In the studies, the confidence interval was 0.95 and maximum error was 0.6. Results were processed according to STATISTICA 10 standard statistical methods.

III. RESULTS The study involved 207 communes from whole Poland, the highest number of which are located in Śląskie (20; 9.66%) and Lubelskie Provinces (20; 9.66%). The lowest number of surveyed communes are located in Świętokrzyskie (4; 1.93%), Lubuskie (6; 2.90%) and Kujawsko-pomorskie Province (8; 3.86%) (Fig. 1). In the studied group of self-government units, the highest number constituted rural communes, representing 56% (116) of all entities under analysis, then urban and rural communes (54; 26.1%), and lastly – urban communes (37; 17.9%).

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Number of studied communes

Figure 1 Communes under study in given provinces Source: own studies Involvement of communes in activities related to health promotion and education was subject to analysis in the first place. 91.3% (189) of the communes declare their participation in health promotion related activities, and only 8.7% (18) do not undertake such actions. Most preferably, communes engage in health education activities concerning stimulants (31.4%; 160), cancer (25.5%; 130) and family violence (24.8%; 126). They are considerably less active in fighting child obesity (6.9%; 35), cardiovascular diseases (4.9%; 25) or lung diseases (4.5%; 23). Communes are least inclined to undertake any activities related to adult obesity (2%; 10). From the statistical point of view, tests carried out for the quantitative variables whose p-value was higher than a significance level did not show any statistically material correlation between the type of a commune and activities undertaken in the field of health promotion and education. Since communes in particular declare that they focus on activities against stimulants and cancer, their main areas of interest in promotional and educational actions were defined. Anti-alcohol (39.5%;151) and anti-drugs (36.1%; 138) campaigns are most often undertaken by communes in the context of health promotion actions concerning stimulants. Anti-tobacco actions, considered less common in Polish communes, take the third place (24.3%; 93). As regards cancer-prevention activities, communes consider women to be their target group, focusing in particular on the types of cancer which directly threat them – breast cancer and cervical cancer (73,5%; 122). Further, activities targeted by communes at men concerns the problem of prostate cancer (16.9%; 28). Education about other cancers is provided to local communities to a considerably lesser extent (9.6%; 16).

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Analysis also included forms and means of marketing communication which can be applied to health promotion and education. These studies aimed to examine opinions of employees at commune offices as to which is the most attractive, convincing and trustworthy form of health promotion campaign according to their recipients. Out of the all available marketing forms of health promotion, respondents could tick a maximum of 5 answers, which is why the results presented here do not total 100. As the most attractive, convincing and trustworthy forms of health promotion commune employees find information posters (14.7%; 104). They also listed direct promotion and leaflets (11.4%; 81), fillers information (11.4%; 81), TV spots (10,9%; 77), brochures (8,8%; 62) and press releases (7,8%; 55). Other forms, including those based on the Internet, are, according to commune employees, definitely less important for recipients of health promotion and education campaigns. Tests carried out for the quantitative variables whose p-value was higher than a significance level did not show any statistically material correlation between the type of a commune and a promotion method. In the employees’ opinion, the marginal importance of the online forms of health promotion affects an extent to which communes use social media such as portals or social networking sites in their health promotion activity. Over half of the communes (51.6%; 133) participating in the study do not use social media. Other state that to promote health they use: Facebook (11.6%; 30), Wirtualna Polska (7.8%; 20), Onet (8.5%, 22), Ezdrowie (5.8%; 15), or Znanylekarz (2.7%;7). Only single communes use other portals and social networking sites in their health promotion activities. The study also involved defining which social media marketing tools are most preferably used by communes for their health promotion and protection purposes. Interviewed employees of commune offices could tick a maximum of three responds out of the tools provided in the questionnaire, which is why the results do not total 100. The analysis of results showed that the majority of communes (74.1; 157) do not use such tools. Employees from only 13 surveyed offices stated that their communes actively use social networking sites, whereas in 11 entities employees declared they eagerly visit and resend fan pages of the brands they trust. Only 9 communes take part in online discussions on forums about health. Using other available social media marketing tools to promote health is scarce in Polish communes. Tests carried out for the quantitative variables whose p-value was higher than a significance level did not show any statistically materi-

● ●JOURNAL OFOF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● ●No.1/2015 JOURNAL PUBLIC HEALTH, NURSING AND MEDICAL RESCUE 2/2014 ● ● al correlation between the type of a commune and the use of social media marketing tools.

IV. DISCUSSION Thanks to its common availability and usage as a medium, the Internet in Poland has gained importance in the recent years. According to the Public Opinion Research Center (CBOS) data, in years 2002-2012 regular internet usage was dynamically increasing, while now the pace of growth is slowing down. In 2013, 60% of all adults were regularly online [11]. In 2012, as in the previous year, the number of adult internet users totalled 56%, whereas ten years earlier only 17% of adult Poles used the Internet on a regular basis (at least once a week) [12]. The CBOS study finds that all adults with a higher education degree and two-thirds of persons with secondary education use the Internet, whereas the group of the digitally excluded consists primarily of elderly and poorly educated persons. Most often, they go online at home (97% of adult Poles) and over two-thirds of the Internet users (73%) use wireless network via mobile devices. 29% read blogs, 5% run them and the same number have their own websites. 47% use text messengers, and 33% of adults have an account on a social networking site (representing 59% of all users). Every fourth Internet user (26%) participates in online discussions on forums, and 62% of them browse social networking sites looking for new friendships and relationships, as well as for entertainment, culture and other information [13]. According to the Central Statistical Office of Poland (GUS) data concerning persons aged 16-74, 38% of all persons using the Internet in 2012 were looking for health-related information [14]. 53% of Poles have a very positive attitude towards this medium and find a lot of benefits in the Internet and new technologies in IT and mobile network, claiming that they make the world a better place to live [15]. New communication and information technologies facilitate communication process, reducing its cost and improving its efficiency. In this way, it can be easily adapted to fluctuating market conditions and expectations of its recipients. Rapid development of mobile communication and electronic mass media evolution lead to material changes of specific entities, households, local communities, and national institutions on the global scale [16]. Nowadays, consumers, including patients, have wider access to information, therefore they choose media they consider fit for their needs. The Internet and mobile technologies allow them to immediately exchange views

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and form discussion groups. This also applies to health communication as it creates a new communication area for health promoting activities. The Internet allows for easier and less expensive gathering of information about a relevant health problem. Also, persons receiving health promoting messages are becoming more demanding as they want to get them in the most convenient and accessible way suited to their needs, which obliges their authors to create them with a more innovative approach [17]. Internet communication tools, including social media marketing instruments, are storming into more and more market areas in which entities run their businesses [18]. Undertaking their activities, communes should take the challenge and adjust to present requirements and expectations of various social groups to whom they communicate health promotion and educational information. A substantial target group of health promotion campaigns run by communes demands that they follow current trends in online communication. In particular, young persons (e.g. generation Y – born in 1980-1995) are increasingly more distrustful of traditional forms of promotion (e.g. advert), whereas lack of time, greater flexibility and wider access to online information result in departure from traditional media: TV, radio or press in favour of internet media [19]. Therefore, it is recommended that communes pay more attention to social media and social media marketing tools in order to improve efficiency of their health communication. V. CONCLUSIONS In the era of the ubiquitous Internet Polish communes generally do not use internet marketing tools; in particular, they do not make use of social media and social media marketing in their activities aimed to promote health. Most preferably, communes get involved in health promotion and education actions concerning stimulants and cancers. Most popular actions include anti-alcohol and anti-tobacco campaigns. As for cancer-preventive activities, they focus on breast and cervical cancer. As the most attractive, convincing and trustworthy form of promotion employees of Polish communes indicate traditional information posters, direct promotion or leaflets. In their opinion, other forms, in particular those based on the Internet, are of far less importance. Over half of the communes taking part in the study do not use social media (portals and websites) in their health promotion activities, whereas one-tenth of them uses Facebook and Wirtualna Polska portal. Two-thirds of Polish communes do not use social media marketing tools in their promotional

● ●JOURNAL OFOF PUBLIC HEALTH, NURSING AND MEDICAL RESCUE ● ●No.1/2015 JOURNAL PUBLIC HEALTH, NURSING AND MEDICAL RESCUE 2/2014 ● ● campaigns and the rest marginally engage in social network portals, read and resend fan pages of the brands they trust, or take part in internet discussions on forums about health. None of the surveyed areas showed any results differentiation with respect to the type of a commune. It is recommended that communes pay more attention to social media and social media marketing tools in their health promotional activities with a view to improving efficiency of their communication with current information society. VI. REFERENCES [1] Bażydło M, Kotwas A, Karakiewicz B. Informatyzacja w opiece zdrowotnej - elektroniczna weryfikacja uprawnień świadczeniobiorców. JPHNMR 2013 (2):14-17. [2] Strzelecka A, Nowak-Starz G. Jednolity system informatyczny a oczekiwania pacjentów podstawowej opieki zdrowotnej. JPHNMR 2013 (2):23-29. [3] Strzelecka A, Nowak-Starz G, Kopański Z. The opinion of primary healthcare patients on the proposed solutions in e-Health in the light of selected social factors. JPHNMR 2014 (4),32-37. [4] Pabian A. Środki i formy marketingowego oddziaływania na konsumentów. Częstochowa; Wyd. Politechniki Częstochowskiej, 2008. [5] Pabian A. Promocja nowoczesne środki i formy. Warszawa; Difin, 2008. [6] Trzeciak D. Era social media, Marketing w praktyce. 2009; 12 (142):70. [7] Andreasen AR. Marketing social marketing in the social change marketplace. J Public Policy Mark 2002; 2:3-13. [8] Szymanek P. Na Facebook procentują pomysły, Marketing w praktyce. 2009; 12 (142): 56. [9] Evans W D. How social marketing works in health care. J Public Policy Mark 2006; 332 (7551): 12071210. [10] Zestawienie jednostek podziału terytorialnego, www.stat.gov.pl [11] CBOS Research Report, Internauts 2013, Warsaw 2013, available online: http://www.cbos.pl/ [12] CBOS Survey Report. Korzystanie z Internetu (Use of the Internet), Warsaw 2012, available online in Polish: http://www.cbos.pl/SPISKOM.POL/2012/K_081_12 .PDF [13] CBOS Survey Report. Korzystanie z Internetu (Use of the Internet), Warsaw 2012, available online in Polish: http://www.cbos.pl/SPISKOM.POL/2012/K_081_12 .PDF

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