Digital health promotion: possibilities and limitations

 

Health and fitness content on Pinterest

 

On Tuesday I am giving an invited presentation at an event organised by VicHealth on the theme of ‘Harnessing the Power of Digital Technologies’. Some of the issues I’ll be focusing on include covering the different ways in which digital devices and software are used for health promotion, and what the social issues are. I’ll be drawing on my recent and current research projects looking at the social aspects of how people use digital health and self-tracking technologies (see my blog post summarising the findings of these projects here).

The critical sociological approach I’ll be advancing is discussed in a range of my publications over the past few years. The most recent of these publications include my book Digital Health: Critical and Cross-Disciplinary Perspectives, a chapter on wearable devices (available OA here), an article on what health professionals and healthcare consumers see as valuable about digital health and what its future may be (available OA here), a special journal issue I edited on self-tracking, health and medicine (the editorial for this is OA here) and an article reporting my research project on the use of social media by healthcare workers (available OA here).

Here are some of the points I’ll be making in my talk:

Among public health and health promotion professionals, social media campaigns and dedicated websites are popular forms of communicating with target groups. These approaches often take an individualistic and to-down approach, using old-style paternalistic health education and social marketing models of behaviour change and applying them to the new media contexts. They often fail to recognise that people are spontaneously and actively searching for information about health and medicine on the internet and using social media and apps to generate and share this information.

Health promotion professionals are competing for consumer engagement with a digital health ecosystem in which the commercial/corporate sector offers a far more compelling range of products. It was estimated last year that there are over 325,000 health and medical apps available on the major app stores. Social media are now a key site for the dissemination of health-related news and information. People use Facebook, Instagram, Tumblr, Twitter and Pinterest to access and share information about health, medical care and physical fitness. A large range of blogs and discussion forums have been established for people to have a say on health-related matters and respond to others. Wearable devices like Fitbit and Apple Watch provide opportunities for people to monitor and measure their health and fitness levels.

Visual media have become important in people’s engagements online, including selfies, memes, GIFs and videos. YouTube offers countless videos made by consumers about their health and fitness experiences and insights. ‘Healthy lifestyle’ influencers on platforms like Instagram and YouTube have a huge reach and impact, particularly for young people. Hashtags like #fitspo, #cleaneating, #fitnessaddict, #iquitsugar, #wellness and #weightlossjourney are used to organise content and attract like-minded audiences. Communities that challenge mainstream health promotion messages and seek to promote resistant modes of embodiment use hashtags like #badfatty, #thinspo, #proana, #selfinjury and #blithe (used for content about self-harm, eating disorders and depression), particularly on Tumblr.

My research on how public health professionals use social media found that they recognised that these communication channels were important for consumer engagement and also found them beneficial to connect with other professionals working in their fields. However, they experienced many constraints such as lack of institutional knowledge about how best to use social media, rules about not using social media in the workplace, lack of access to the internet, or peers disapproving of social media. If they were working in a contentious or sensitive area of public health, these professionals had to consider the possibility of being attacked by members of the public on social media, or inadvertently saying the wrong thing publicly.

There is a need for a social perspective on digitised health promotion. The different ways in which social groups use and respond to digitised health promotion need to be considered (for example, attributes such as gender, age, social class, education level, ethnic/racial background, health status and geographical location). My research identifies several key differences between the different groups I have included. For example, women with young children use Facebook a lot for sharing information about pregnancy and childcare and to arrange in-person meetings. Young people, on the other hand, prefer YouTube, Instagram and Snapchat to access and share health information. My project on self-tracking cyclists found that they loved to use platforms like Strava to share their data and compete with and provide support to each other. In contrast, my project on everyday self-trackers, who monitored a range of attributes about their bodies and lives, and another of my projects on women’s use of digital health technologies, found that very few were interested in sharing their data with others beyond family members or their doctors.

Personal data privacy and security are important issues when discussing how digital technologies can be used for health promotion. Across my research projects, there was very little awareness of or concern about how internet companies and app developers collect, use and share people’s often very sensitive health-related information when they engage with these technologies. This included public health professionals, who were not considering these issues in relation to their work-related activities.

Some findings from my research on Australians’ use of digital health and self-tracking technologies

Today I am giving a keynote presentation at the Australian Telehealth Conference 2018 in Sydney. I am talking about the findings of four empirical projects I have conducted over the past three years on Australians’ use of digital health and self-tracking technologies.

Here are some of the key findings I will be discussing.

Women’s Use of Apps and Other Digital Media for Pregnancy and Parenting Project

This project involved two parts: an online survey completed by 410 women around Australia and a focus group study involving women living in Sydney. All participants were either pregnant or had at least one child aged 3 years or under at the time of the research.

The participants were keen users of Google Search, constantly using it to find information. They also often used pregnancy apps (three-quarters of the survey participants) and parenting apps (half of the survey participants). Facebook was popular as well, especially for establishing local mothers’ groups that included opportunities to meet face-to-face and share local knowledge. The participants valued websites and online discussion forums as ways of seeking and providing support 24/7. They sought information, reassurance and social connections through these digital media. For many women, digital media were life-lines at times when they were struggling with loneliness, anxiety and the significant demands of caring for babies and young children.

Publications from this project can be found here, here and here.

Self-tracking Cyclists Project

This project involved female and male commuting cyclists in Canberra and Melbourne who regularly used digital technologies (bike computers, apps, wearable devices, cycling platforms) to track their rides. We used GoPro cameras worn on the cyclists’ helmets to videotape one of their cycling commutes, and interviewed the participants while watching the video together. We were interested in how they incorporated the use of digital self-tracking into their everyday routines, and how they engaged with the data generated by these practices.

We found that most of the cyclists enjoyed tracking their rides to monitor their fitness or speeds, to compete against other cyclists or to document their personal bests on platforms like Strava. Some responded to their data in real-time as they cycled, particularly if they used a bike computer they could easily consult while in motion. These people found self-tracking to be motivating, giving them confidence and feelings of accomplishment when they could see that their speed or fitness were improving.

Publications from this project can be found  here, here, here and here.

Australian Self-Trackers Project

This project involved semi-structured telephone interviews with women and men across Australia who identified as a ‘self-tracker’ for any reason, using any kind of method, digital or non-digital.

The findings from this project demonstrated that while digital self-tracking technologies were popular, especially computer spreadsheets and apps, many people were using the time-honoured paper-and-pen form of recording their information, or even just committing details to memory. It was common for people to use a combination of these methods to track a range of indicators. The most popular aspects they were tracking were food/nutrition, physical fitness or activity levels and body weight, but tracking finances, blood pressure, sleep, work productivity, social relationships, medication, home energy use, chronic health conditions, moods and alcohol were also common. Unlike the self-tracking cyclists, few of these participants were interested in sharing their data with others, and few were motivated by competitive challenges. They saw self-tracking as a largely private endeavour, undertaken to  collect information as a way of ‘being responsible’ and exerting control over their health and lives.

The production of publications from this project is still in progress. One book chapter has been generated from it thus far and can be found here.

Australian Women and Digital Health Project

This project involved a combination of focus groups, face-to-face semi-structured interviews and telephone interviews with Australian women across a range of age-groups. They were asked to talk about which kinds of digital health technologies they used and which they found most valuable and useful.

Here again, the importance of Google Search as a tool to find health information was to the fore. Almost every participant said that they regularly googled to search for information.  They also used websites regularly for health information, often directed to them by searching online. In-person interactions with doctors or other healthcare professionals as well as family and friends were still important sources of health information, but the opportunity to go online at any time was highly valued by these participants. Many searched for health information on behalf of their family members (partners, children – even adult children – or elderly parents) as part of their familial caring roles. Traditional media (books, television, radio) were hardly mentioned at all as a source of health information, although pamphlets were still consulted quite often when women were waiting to see the doctor. These women valued the access they had online to international sources of information, but still placed a lot of importance on being able to find Australian-based information and information that was specific to their local area. It was notable that none of these women used a fitness platform like Strava, although calorie-counting apps and Fitbits were quite popular.

Analysis from this project is in progress.

Findings from across the projects

• Websites and search engines (particularly Google Search) remain very important and highly-used sources of online health information.
• The broader ecosystem of technologies, including non-digital as well as digital, needs to be acknowledged.
• People are still not generally interested or concerned about who can access their personal health data generated from their online interactions or app use.
• When participants were asked what their ideal digital health or self-tracking technology would be, the most common responses were for tools that could be readily customised and personalised, or which could bring a lot of information or functions together in the one place. This could be an app or a website/platform.
• Factors such as people’s age, gender, caring responsibilities, working conditions, state of health, whether they are living with a disability, demands on their time and relationships and interactions with other people (both in person and online) are important contributors to their lived experiences of digital health and self-tracking technologies.
• The biographical features of people’s lives also emerged as central: such turning points as hitting a landmark birthday, the birth of children, or developing a chronic illness were key factors in people making changes in their lives related to their use of digital media and devices for health.