Predictors of intentions to use social media: contributions of each variable block to changes in R2 (N=175).
View this table
The purpose of this study was to determine use and factors predicting use and intentions to use social media for health-related purposes among medically underserved primary care patients. The first aim of the study was to determine to what extent patients used social media. Findings indicated that social media use is common among this underserved population. The most common social media tools used were cell phones for texting (73.7%) followed by Facebook (54.5%), email (52.1%), cell phone apps (37.1%), and YouTube (30.6%). These findings are consistent with other research among non-FQHC family practice patients who reported email, cell phone for texting, Facebook, and YouTube as most commonly used sources of social media . Further analysis of our findings revealed that Hispanic respondents reported greater use of 7 of 10 social media tools. These findings are similar with other research that indicates Hispanics are using social media and mobile devices at higher rates than whites [ ]. The Pew Research Hispanic Trends Project reports that 68% of Latino Internet users use Facebook, Twitter, or other social networking sites compared to 58% or all Internet users in the United States [ ]. A total of 86% of Latino adults own a cell phone compared to 84% of whites and 90% of blacks. Additionally, 49% of Latino adults own a smartphone compared to 46% of whites [ ].
The second aim of the study was to determine patient preferences for how their health care provider should use social media to share health information and to help them stay healthy. The use of various technologies, such as emailing, texting, and smartphone apps, can enhance patient-provider relations among the underserved primary care patients ; however, the prevalence of health care providers’ use of various social media for communicating with patients is limited. In a survey of US doctors, 49% reported using email in the past 6 months to communicate with their patients [ ]. A study in the Netherlands showed that patients’ motives for using social media for patient-provider communication were low, including only 18% for Twitter and 10% for Facebook. Similar results were found among providers; 28% said they use Twitter to communicate with patients and 14% used Facebook [ ].
In general, patient preferences for their health care providers social media use are consistent with their own personal daily use of these same apps. For example, Hispanic respondents preferred their provider use cell phones for texting; using cell phones for texting was the most common social media tool used daily. For conveying health information, both groups preferred texting and email. Although the study did not specifically ask respondents what type of health information they would like to be conveyed through email or texting, personal health information may be best communicated in these ways due to privacy concerns . Previous research from the Pew Internet Project has revealed that privacy concerns have led to more than half of mobile phone users uninstalling or not installing apps on their phones [ ].
For sharing information to help them stay healthy, again the majority preferred texting and email, with the addition of Facebook and cell phone apps. This suggests that patients may be limited in their understanding of how providers could use a variety of social media apps to help them stay healthy. This may be because few providers have used social media for interactions with patients or that patients just have not explored that possibility. The only statistically significant differences seen between Hispanic and white respondents were related to sharing of health information using Facebook, Twitter, and YouTube, with Hispanic respondents reporting greater preferences. These differences may reflect that Hispanics use these apps more often than whites . This lack of differences between the 2 groups also suggests that a social media communications strategy may not need to be based on race and ethnicity. However, a study evaluating the success of using social media to reach Hispanic cancer survivors found that this audience is very receptive to these technologies [ ].
For those health care providers working to reach medically underserved community health center patients with important health information, cell phone texting and email are important to patients for health care purposes. Facebook, Twitter, and YouTube provide promising avenues of communication, especially for Hispanics. These social media applications offer an opportunity for providers to connect with underserved patients where many are interested in getting health information through social media channels. Although these avenues are promising, few studies have evaluated the use of social media for health care purposes among Hispanics . Future research might explore its use in greater detail for these and other underserved populations.
A third aim of the study was to determine what factors influence the use of social media for health care-related purposes. As outlined in the TPB, attitude, subjective norms, and perceived behavioral control are important to one’s behavioral intention and behavior. Understanding the TPB factors predicting intention to use social media among patients can help to provide valuable understanding that can increase adoption of these technologies for obtaining health information. Studies have demonstrated the prominent role of social factors (ie, influence of others/groups) in predicting the use of computer technologies for health information seeking, exchange, decision making, social and emotional support, and behavior change among patients . Findings from the current study revealed that subjective norms significantly predict use and intentions to use social media for health-related purposes. That is, patients in this study had higher use and intentions to use social media if important people in their lives felt the technology was important and use it for health care-related purposes. Strategies aimed at increasing the use of social media for obtaining health information and support should emphasize that important people in their life (eg, friends, family members) use social media for this purpose.
Perceived behavioral control predicted social media use but not intentions to use suggesting obtaining health information through social media channels is easier for those who are capable of using the technologies. This finding is consistent with other studies on patient use of computer technologies for health care  and might indicate that individuals experience barriers related to using technology to access and share health information. Barriers of this nature could include a lack of knowledge in using social media apps, costly data plans, language barriers, or health care providers that do not engage patients in such settings. Future research efforts could corroborate these findings and, if true, design strategies to minimize barriers.
Because patients are using social media as identified in this study, ignoring social media may come with risks to community health centers. These risks could come in the form of inaccurate information being shared among patients while they are online, not being aware of threats to organizational reputation, and lack of clear social media policies that can protect against liability and violation of the Health Insurance Portability and Accountability Act (HIPPA) . Social media tools should be implemented by health care organizations following a planning process that includes understanding target audiences and fitting the best social media apps to meet identified communication needs [ ]. Health care providers should also have clear internal and external social media use policies that guide both patient and staff involvement with the social media apps [ , ].
Although this study provides valuable insights for social media use among underserved populations, findings should be interpreted based on the following limitations. First, this study is cross-sectional and, therefore, cause cannot be assigned to any particular independent variable. Second, the study only included those individuals who reported that they had access to a computer and used the Internet. Not all patients receiving care through community health centers will benefit from a social media plan. However, many of those that are connected see value to its use for health care–related purposes. Furthermore, individuals with missing values were excluded from each analysis, which accounts for differences in the sample sizes used in each table. Missing values are not uncommon in datasets collected in locations such as FQHCs that primarily serve underprivileged individuals. Third, although reliability measures of internal consistency were acceptable, we lacked sufficient validity evidence for these scales as measures of intention to use social media for health-related purposes. Future research can help to strengthen validity evidence beyond that achieved by an expert panel. Lastly, the age range of participants included in this study included mostly individuals younger than 40 years of age. A true comparison of age would include a greater proportion of older participants. Nevertheless, we included age in multivariate analyses, but it was not significant, which may be attributable to its lack of variance. Future studies of this nature may benefit from ensuring participation from older individuals.
This study helps to demonstrate the use and factors predicting intentions to use social media among community health center patients. Community health centers deliver affordable, comprehensive, patient-centered care that is close to communities in need . Optimizing primary care as motivated by the PPACA requires greater attention to advancing patient-centered medical homes, a model that community health centers value [ ]. Although social media can provide another tool for primary health care providers to be even more patient-centered and provide greater personalized care [ ], understanding use and factors predicting use can increase adoption and utilization of these technologies among underserved and disadvantaged patients.
Conflicts of Interest
Multimedia Appendix 1
Theoretical constructs and survey questions.
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Edited by G Eysenbach; submitted 03.03.14; peer-reviewed by S Nutt, T Toscos, Qi Li; comments to author 17.07.14; revised version received 17.10.14; accepted 25.10.14; published 26.11.14
©Carl L Hanson, Josh West, Rosemary Thackeray, Michael D Barnes, Jordan Downey. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.11.2014.
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