KPIs and metrics that are used to evaluate the performance of the healthcare social media and digital marketing activities.

1. Health Promotion Practice
http://hpp.sagepub.com/
Use of Social Media in Health Promotion : Purposes, Key Performance Indicators, and Evaluation Metrics
Brad L. Neiger, Rosemary Thackeray, Sarah A. Van Wagenen, Carl L. Hanson, Joshua H. West, Michael D. Barnes and
Michael C. Fagen
Health Promot Pract 2012 13: 159
DOI: 10.1177/1524839911433467
The online version of this article can be found at:
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2. 433467 HPPXXX10.1177/1524839911433467Neiger
et al. / Measuring the Impact of Social MediaHealth Promotion Practice / Month XXXX
Evaluation and Practice
Use of Social Media in Health Promotion:
Purposes, Key Performance Indicators, and
Evaluation Metrics
Brad L. Neiger, PhD, MCHES1
Rosemary Thackeray, PhD, MPH1
Sarah A. Van Wagenen, BS1
Carl L. Hanson, PhD, MCHES1
Joshua H. West, PhD, MPH1
Michael D. Barnes, PhD, MCHES1
Michael C. Fagen, PhD, MPH2
Despite the expanding use of social media, little has Zickuhr, 2011). Public health is also expanding its use of
been published about its appropriate role in health social media as evidenced by the finding that 60% of
promotion, and even less has been written about evalu- state health departments now use at least one application
ation. The purpose of this article is threefold: (a) (Thackeray, VanWagenen, Koch Smith, Neiger, & Prier,
outline purposes for social media in health promotion, 2011). In addition, one third of adults use social media to
(b) identify potential key performance indicators asso- access health information, and nearly 80% of physicians
ciated with these purposes, and (c) propose evaluation who consult with patients online use social media chan-
metrics for social media related to the key performance nels to create or share medical content (Hughes, 2010).
indicators. Process evaluation is presented in this article As use of social media develops within health pro-
as an overarching evaluation strategy for social media. motion settings, it will become increasingly important
to track key performance indicators (KPIs) and metrics,
Keywords: Internet/electronic interventions; social both common measures in web analytics research. A
marketing/health communication; technology metric is any single variable that gets measured (e.g.,
number of posts, tweets, fans, etc.), whereas a KPI is a
unique form of a metric identified by an organization
T
he term social media refers to activities among as central to its assessment of social media and related
people gathered online who share information benefits (Sterne, 2010). Although KPIs are often
using conversational media that make it easy to expressed as specific measurements such as ratios or
create and share content in the form of words, pictures, averages (e.g., the average number of comments to a
videos, and audios (Safko & Brake, 2009). Categories of post) they can also represent broader or more general
social media defined by Sterne (2010) include the fol- constructs (e.g., influence or engagement).
lowing: forums and message boards, review and opin-
ion sites, social networks, blogging and microblogging, 1
Brigham Young University, Provo, UT, USA
bookmarking, and media sharing. 2
University of Illinois at Chicago, Chicago, IL, USA
The use of social media is expanding rapidly. Sixty-
five percent of adult Internet users now report using a
social networking site such as MySpace, Facebook, or Associate Editors, Evaluation and Practice Department
LinkedIn compared with 29% in 2008 (Madden & Michael Fagen, PhD, MPH, is a Clinical Assistant Professor,
Community Health Sciences, in the School of Public Health
at the University of Illinois, Chicago.
Health Promotion Practice Brad L. Neiger, PhD, MCHES, is a Professor and Associate
March 2012 Vol. 13, No. 2 159­ 164
– Dean in the College of Life Sciences at Brigham Young
DOI: 10.1177/1524839911433467 University, Utah.
© 2012 Society for Public Health Education
159
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3. Process evaluation, or the measurement of factors misunderstandings of antibiotic use (Scanfeld, Scanfeld,
that contribute to the success or failure of a program, & Larson, 2010). This information was used to develop
including tracking the number of products, services, or strategies to promote positive behavior change and share
participants (McKenzie, Neiger, & Thackeray, 2009), as accurate information about antibiotics. Similar content-
well as KPIs and metrics, is recommended here as an related blogs that focused on specific audience segments
overarching evaluation strategy for social media. Since (e.g., breast cancer survivors) could be particularly
social media is a communication or promotions tool insightful.
and not a causal factor in behavior change or improved
health status, summative evaluation (i.e., impact or out-
come evaluation) is not viewed as relevant. Conversely,
>>
Establish and Promote
a Brand With Consumers
attention to process evaluation will provide decision
makers and other stakeholders with a data collection strat- Health promotion programs embedded within
egy to assess the implementation of social media with larger organizations often struggle to create a mean-
various types of interventions or as a stand-alone tool. ingful brand (i.e., a distinguishing feature) for a pro-
Despite the expanding use of social media, little has gram, product, or service and are adversely affected
been published about its appropriate use in health pro- by a lack of brand awareness or the degree to which
motion. Even less has been written about evaluation. consumers are aware of the brand and have an under-
Accordingly, the purpose of this article is threefold: (a) standing of what it represents (Farris, Bendle, Pfeifer,
outline purposes for social media in health promotion, & Reibstein, 2010).
(b) identify potential KPIs associated with these pur- Kelly (2011) suggests that use of social media to
poses, and (c) propose evaluation metrics for social enhance brand awareness progresses through four stages:
media related to the KPIs. exposure, influence, engagement, and action. An example
Five broad purposes for use of social media in public of these stages to enhance brand awareness is drawn from
health/health promotion have been proposed: (a) com- “the 84” campaign from the Massachusetts Department of
municate with consumers for market insights (Centers Health. According to Silverman (2011), to promote the
for Disease Control and Prevention [CDC], 2010, Kruse, social norm that most adolescents do not smoke (84%)
2010); (b) establish and promote a brand with consumers and to promote positive alternative behaviors, the cam-
(Kruse, 2010); (c) disseminate critical information (CDC, paign has featured a website that reflects a youth-oriented
2010); (d) expand reach to include broader, more diverse voice and user-generated applications such as forums,
audiences (CDC, 2010); and (e) foster public engagement user profiles, and a special interest blog to promote “the
and partnerships with consumers (CDC, 2010). 84” brand. Since 2007, more than 700,000 adolescents in
Massachusetts have become involved through both online
and off-line activities, including social networking via
>>
Communicate With
MySpace and YouTube, and the movement has grown
Consumers for Market Insights
every year since its inception (Silverman, 2011).
Social media can be used to gather both primary and
secondary data during the formative research process
to ensure that programs, products, and services are >>
Disseminate Critical Information
consumer oriented. A primary data collection strategy With the ubiquity of digital devices and social media
might involve a product/services review website, an applications, health promotion practitioners are recog-
ongoing blog or a social networking group to elicit nizing social media’s capacity to reach large audiences,
input or feedback from consumers. For example, a almost instantaneously, using cost-efficient methods.
question could be posted on an organization’s Facebook Many health-related organizations maintain a Facebook
wall requesting a response. A Facebook “group” could profile for the sole purpose of disseminating health
also be created to acquire information from a segment information to friends and fans. For example, Bender,
of the population that has experience with a particular Jimenez-Marroquin, and Jadad (2011) report that of the
topic. Discussions on these Facebook walls could also 620 identified breast cancer Facebook groups (totaling
provide insight. 1,090,397 individual members), 236 or 38% of the
An example of secondary data could be a content groups existed for the purpose of raising awareness
analysis of posts and comments on social media sites about breast cancer. The CDC (2011a) has used Twitter
that are not initiated by the organization. For instance, to share flu-related updates and information with
researchers analyzed Twitter posts to identify people’s 160,528 current followers.
160 HEALTH PROMOTION PRACTICE / March 2012
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4. Evaluation and Practice
Analysis of CDC’s Twitter presence across five pro- established the Dove Self-Esteem Fund to develop pro-
files (i.e., CDC eHealth, CDC Emergency, CDC Flu, grams that raise self-esteem among girls and young
CDCgov, and CDC Espanol) since 2008 revealed more women. To promote the fund, several YouTube videos
than 1,617 updates, 1,411,359 followers, and 48,125 were created, including Evolution, which has received
clickthroughs (CDC, 2011b). After launching a Facebook more than 13.5 million views and nearly 7,000 com-
profile in January 2009, the CDC site grew to 68,014 ments. Using YouTube as a promotional platform led to
friends by December 2010 (CDC, 2011b). In addition, high exposure and generated strong engagement from
CDC has maintained over 100 videos on YouTube viewers (Dove, 2004).
resulting in almost 3.6 million views (CDC, 2011b). During
the 2008-2009 outbreak of salmonella-contaminated
peanut butter and peanut products, the FDA developed a
>> Public Engagement and
Foster
Partnerships With Consumers
database that allowed consumers to enter a product
name or barcode to determine if the product had been Engagement in this context is defined as establishing
recalled. CDC then developed a widget that could be a connection with others to contribute to a common
posted on a website or blog that also gave access to the good. Social media can be used to build online partner-
database, thus significantly increasing access to the tool ships and engage communities in support of causes
and to vital information (Currie, 2009). and to respond to crises. Social media research indi-
cates that engagement may be prompted when anchored
in blogs and social networking sites and this is espe-
>> Reach to Include
Expand
cially true if participants are at least somewhat active
Broader, More Diverse Audiences
in off-line community participation (Smith, Schlozman,
Although social media cannot eliminate health dis- Verba, & Brady, 2009). Merchant, Elmer, and Lurie
parities, it can help provide a voice for disproportion- (2011) summarized how social media has engaged and
ately affected audiences and provide better access to even mobilized populations in emergency prepared-
those in need of programs and services. Seventy-three ness/response efforts. They cite speak to tweet (voice
percent of online American teenagers now use social messages sent out as tweets) communication about
networking websites compared with 55% in 2006 safety and health within days of the 2011 Egyptian
(Lenhart, Purcell, Smith, & Zickuhr, 2010). In addition, uprising and use of crowd sourcing to link health care
use of digital communication is increasingly detached providers to those with supplies after the 2010 earth-
from desktop computers, which is especially true for quake in Haiti.
people of color (Smith, 2010). In fact, among Internet Social media can also be used to bring health profes-
users, Blacks and English speaking Latinos use social sionals together to establish a foundation for public
media applications more often than Whites and minor- engagement. For example, the Substance Abuse and
ity Americans are also more likely to use social media Mental Health Services Administration (SAMHSA) has
to keep abreast of activity in their neighborhoods created Social Health Hub with the premise that peer
(Smith, 2010). learning and sharing is fundamental to the long-term
Ultimately, health promotion efforts to engage diverse success of public engagement (SAMHSA, 2011).
audiences such as minority populations and adoles- SAMHSA maintains a depository of social media tools,
cents may be most successful if they involve social including a directory of the principal hashtags used by
media applications that interface easily with mobile its Twitter account as well as blog posts related to its
devices. Individuals from these demographics are less public awareness and support strategic initiative
inclined to use applications such as blogging that (SAMHSA, 2011).
involve sometimes-lengthy posts and responses. Rather,
adolescents in particular are increasingly involved with
microblogging through applications such as Facebook
>> Performance
Key
Indicators and Metrics
or Twitter. Moreover, the shift to microblogging and
other processor-lite applications will likely increase The five purposes of social media in health promo-
exposure to African Americans and Hispanics because tion highlighted in this article (market insights, estab-
both groups are rapidly adopting the Internet, using lish a brand and create brand awareness, disseminate
handheld devices (Hughes, 2010). critical information, expand reach to more diverse
In addition to microblogging, video sharing via audiences, and foster public engagement and partner-
YouTube holds potential to reach adolescents. In 2004, ships) are all associated with one or more of the follow-
Dove launched the Campaign for Real Beauty and ing KPIs: insights, exposure, reach, and engagement.
Neiger et al. / Measuring the Impact of Social Media 161
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5. These four KPIs are defined in this article as follows. evaluation measures variables such as fidelity, dose
Insights pertain to consumer feedback from social delivered, recruitment, reach, and context. For exam-
media applications that can be derived from practices ple, an organization could begin a process evaluation by
such as sentiment analysis or data mining that use algo- first determining why it wants to use social media (i.e.,
rithms to extract consumer attitudes and other perspec- purposes). This relates to fidelity, which tracks the
tives on a particular topic from social media sites. implementation of social media to ensure both content
Exposure measures the impressions or number of times and applications are designed and delivered appropri-
the content on a social media application is viewed, ately and that they match the intended purposes.
and reach is the number of people who have contact Next, KPIs would be selected. For example, if an
with the social media application. organization wanted to use social media to establish a
Engagement is a measurement that links social brand and create awareness for cervical cancer screen-
media to action and can range from low to medium to ing, it might decide that low, medium, and high engage-
high. Low engagement assesses the degree to which ment would serve as KPIs. Low involvement would
people are merely acknowledging an agreement or pref- relate to the extent to which women were acknowledg-
erence for content. Medium engagement means people ing and agreeing with content, medium engagement
are involved in creating and sharing content with the would relate to women actually creating and sharing
capacity to influence others. For example, Klout.com content and trying to influence other women, and high
(2011) scores use data from social networks to measure engagement would relate to the number of women
how many people are influenced, how much users using social media applications who actually visit a
influence others, and the influence of a personal net- health care provider for screening.
work. High engagement relates to actual participation As a final step, the organization would identify met-
in off-line interventions either as a consumer or as a rics to measure KPIs (see Table 1). This would involve
program partner, volunteer, or sponsor and results from elements of process evaluation, such as dose delivered,
some exposure to a social media application. recruitment, and reach. These variables, respectively,
With respect to social media, evaluation metrics are would relate to the extent to which social media appli-
often application specific and give an initial indication cations are actually delivered, the manner in which
of social media’s ability to communicate with and women are invited to participate with the social media
engage consumers (see Table 1). For example, to assess applications (and the extent to which all women in the
the activity level of blogs, metrics will likely relate to priority population have an opportunity to participate),
the frequency of posts and comments. Likewise, met- and the percentage of women in the population who
rics associated with a microblogging application such actually participate. Finally, context would be assessed
as Twitter will generally relate to the frequency of by examining factors that both promote and inhibit use
tweets and retweets, and so forth. Some social media of the social media applications.
applications have associated analytic tools available at
no charge, whereas other third-party programs are
available at varying costs, depending on the sophistica-
>>
Conclusion
tion of analysis required. For websites or blogs, web Health promotion organizations and practitioners
analytic software such as Google Analytics or Omniture must be able to match their program needs with reason-
are used to collect data related to traffic sources includ- able expectations for what social media can deliver. For
ing visitors, views, time on page, and so forth. This example, social media should not be viewed as a solu-
software can be free or require a subscription. Social tion to the complexities of behavior change and
networking sites have similar analytic software availa- improved health outcomes though there are certainly
ble to all page users (e.g., Facebook Insights), which applications that can support the change process.
provides data on number of fans, unsubscribed fans, Rather, use of social media in health promotion should
fan interactions, and fan demographics. Twitter’s cor- be valued for its potential to engage with audiences for
responding analytic is called Twitter Analyzer. enhanced communication and improved capacity to
As organizations track KPIs through various metrics, promote programs, products, and services. These out-
process evaluation represents an approach that can comes are more likely to occur when a comprehensive
bring added value to the assessment of social media’s process evaluation strategically tracks variables related
usefulness in communication and promotional efforts. As to KPIs and metrics and then informs improvements in
described by Saunders, Evans, and Joshi (2005), process the use of social media.
162 HEALTH PROMOTION PRACTICE / March 2012
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6. Evaluation and Practice
Table 1
Key Performance Indicators and Metrics Related to Social Media Use in Health Promotion
Key Performance
Indicator Definition Metric
Insights Consumer feedback from social Number and types of suggestions or recommendations
media applications
Exposure The number of times content Visits
on a social media application Clickthroughs
is viewed Number of comments
Number of ratings
Number of reviews on rating site
Facebook impressions
Views on a video
Viewed blog posts (page views)
Asset popularity (which content is viewed most often)
Proportion of posts and videos viewed
Reach The number of people who Fans/page likes
have contact with the social Number of people participating in discussions
media application and the Unsubscribed fans
related content Number of followers or subscribers
Demographics of subscribers/fans/followers
Virality (growth rate of fans, followers, and friends)
Engagement The number of people who Ratings
(low) acknowledge agreement or Likes on Facebook posts
preference for content Like rates
Frequency of favorites
Likes or dislikes on videos
Engagement The number of people who par- Posts or tweets by users
(medium) ticipate in creating, sharing, User-generated content (e.g., videos)
and using content and the Comments on posts
degree to which they influ- Comment rate
ence others Number of threads on discussion topics
Frequency of new discussions, new topics
Downloads
Uploads
Klout scores (see Klout.com)
Number of retweets
Retweet rate
Mentions
The number of times a post, video, or link was shared
Engagement The number of people who Number of people who register for services/make an
(high) engage in offline events appointment
(which may be in addition to Number of people who participate in off-line advocacy
continued online activity) as a events as volunteers or sponsors
consumer or as a program Number of people who attend off-line events as parti-
partner, volunteer, or sponsor cipants
Number of people assisted
Number of participants satisfied
Neiger et al. / Measuring the Impact of Social Media 163
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