Connecting the Dots: Measuring Behavior Change with Social Media

As health communicators, we often struggle to demonstrate the success of our campaigns and show their impact on health behavior. We are relegated to the basic ‘click’, ‘tweet’, and ‘like’ data that is readily available to us to show results – and yet that is a small measure of success and does not demonstrate health behavior change.

So how do we beyond this and start measuring behavior change?

Well, I am going to make a statement here – and it may seem like a strong one – that measuring behavior change with social media is possible.

Yes, yes, I know. You may be consternated by this statement saying that that is impossible. But I do hope to show you some of the thinking around how it is actually possible in this post.

But before we get to social media, let’s take a step back and start with social networks in general. These have always been influential.

So here’s a little history.

Contrary to popular opinion, the concept of ‘6 degrees of separation’ wasn’t always associated with Kevin Bacon.

No, the concept actually started in the 1960s, when Stanley Milgram conducted a study to see how people would move a letter from Nebraska to Boston using only their social connections – and through this experiment, he found that people were connected within 6 degrees of each other.

But as connected and influential social networks moved online, the ‘6 degree’ model was challenged.

So in 2002, a guy named Duncan Watts and his colleagues ran a study again asking people to use only their social networks to move a letter. Only this time, it was an email and the to- and from- points were worldwide. Watts asked people to send an email to key intermediaries using only their social connections – and here again, they found the key intermediaries were connected within 6 degrees of each other.

Then Malcolm Gladwell came on the scene and he said that “…in the world of ‘6 degrees of separation’, not all degrees are equal.“

Moreover connection is only part of the equation

So in 2009, two researchers, Christakis and Fowler, posited that while people may be connected by six degrees, our circle of influence is actually limited to only three degrees.

This changed the thinking because no longer was about the linkages but it became about the influence.

So how does this apply to public health?

Well, thought leaders in this space tell us that social media is uniquely positioned to provide the tools to mine the data in these networks and that, in fact, social media is the conduit for this behavior change opportunity.

So as Darren Cahr of SocialMediaToday says, “the interactive aspects of social media suddenly provide…a wealth of tools to understand their consumers and build correlation models to better comprehend what they do and why they do it.”

BJ Fogg takes this one step further to say that these interactive technologies can and do change people’s attitudes, intentions and behaviors. “Interactive technologies can change people’s attitudes and behaviors using influence strategies established by the social sciences… persuasive technology is ubiquitous on the Web, and many Web services are successful in bringing about behavior change.”

Finally, Pew Center’s Internet and American Life Project brings us full circle back to the power of peer-to-peer influence when it writes that health behavior change doesn’t happen in a vacuum but that it is about the peer-to-peer networks that are established and brought to bear that really influence an individual’s health behaviors. “”I know, and I want to share my knowledge” is the leading edge of health care.”

But how do you measure this change?

Well, as health behavior theory tells us, an individual’s readiness to perform a given behavior is assumed to be an immediate antecedent of behavior. So as health communicators, as we are planning our campaigns and programs and we are considering our planning frameworks and/or logic models, if digital media is an activity, and click-through-rate (CTR), impressions, likes, tweets, etc. are the immediate outputs, then we need to start mining the data to show short-term outcomes in order to be able to get to those long-term outcomes.

But how do you show short-term outcomes within social media?

Well, for starters we have to go beyond the click, the “like”, and the tweet. While these have long been the standard of measurement, they are not enough. Lotame Solutions, Inc., a digital technology platform, says, “the click—that single infinitesimal metric ingrained in the hearts and minds of a generation of online marketers who had nothing else to lean on in its place and everything to lose without enough of them…” What that means is that we have to look holistically at the data that social media can provide – not just the click data but the insights and actions of a campaign as well.

So what’s beyond the click?

A few blog posts ago, I wrote about my Strategic Communication, Insights and Learnings (S.O.C.I.A.L.) Framework. Well, since that post, I have evolved the evaluation part of that framework. While the main concept remains the same – the elements for evaluation have evolved slightly. The concept is that in order to frame your digital media results, you can look at digital data in terms of reach, insights, actions and now – value.

Connecting the Dots blog post

Reach looks at the visibility of the campaign as measured through impressions delivered, click-through-rate (CTR), etc. Insights looks at what was learned throughout the campaign through survey results, sentiment analysis, etc. Finally, Actions looks at what tangible actions resulted from the campaign- either taken by the brand or the consumer – and could take the form of Facebook comments, responses posted, etc. New to this framework is the inclusion of the Value vertical which looks at how to assess the value of the campaign and show ROI.

And where you find data beyond the click-through is in the Insights and Actions verticals of the S.O.C.I.A.L.  framework.

So what has been done in the public health space to-date?

Well, in 2009, CDC conducted a study of its website visitors and found that amongst users who engaged with the social media tools on the site, 46% responded that they would change their behavior, i.e. get vaccinated/take medications.

Then, in 2010, the results of a study done by Brigham and Women’s Hospital and Mass General Hospital showed that the use of text message reminders increased sunscreen application adherence amongst 98% of participants.

Finally, in 2010, CDC’s National influenza Vaccination Campaign ran a digital media campaign that showed a 24% increase in intention to get vaccinated amongst the most at-risk, i.e. those that had not been vaccinated in the past 5 years or could not remember the last time they were vaccinated.

So how did they do it?

Well, what is common about all of these studies is their use of surveys to gauge change in intention and behavior.

But this captures but one moment in time – and we want to measure behavior change. We want – no we need – to build a better mousetrap.

One of the most common ways to assess the change in knowledge is the use of pre- and post-tests. This method involves giving the target audience a survey assessing knowledge of the particular topic prior to the launch of the media campaign. After the launch of the media campaign, a post-test would be administered to the same target audience.

So one way to improve on what has been done would be to field surveys at two different points in time to measure change over that time period. A comparison of the pre-test and post-test results would provide insight into changes in the target audience knowledge, attitudes, and behaviors.

You could also apply this model to your social media communities, i.e. Like Facebook, Twitter, YouTube and even individual social networks built on platforms like Ning, to glean insights like consumer response, personal stories and patterns of engagement. We spend all this time building and managing these communities that we should be using them to gauge results and ultimately change.

Ultimately, the key message here is that surveys and other forms of data mining in social media are key to measuring impact beyond CTR – and achieving those short-term goals

So in summary, I leave you with four main points:

  • There is a movement to use social media to measure behavior change – and it’s currently being done.
  • To measure this change, it is critical to move beyond the immediate program outputs like CTR.
  • Looking at short-term outcomes can help identify what measures get us closer to demonstrating behavior change.
  • Consider the “Insights” and “Actions” vertical of the S.O.C.I.A.L. Framework for data to support short-term outcome needs


This post was originally posted to SMQ’s MarketMaven’s blog.

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