How can we take advantage of new communication technologies in creating more prolific change while reaching far more people than we ever could have imagined? There is little reason to believe that people with a broken wrist or inflamed tonsils want to become part of a social network of people who share the same transient health issue. To build purposeful and effective social networks, it is important to consider the following factors.
- Trust: Participants feel the network is a trusted source of useful knowledge.
- Relevance: The knowledge that is shared applies directly to participants on an ongoing basis.
- Urgency: The resources shared help members solve a problem quickly and meaningfully. There is often an emotional tie to the issue.
- Chronicity: The issue is ongoing and merits getting involved and staying involved.
- Incentive: Participation provides a personal benefit. Collaborating helps advance career or job status, personal health, and son on-from the participant’s point of view, it’s worth it.
- Serial reciprocity: Participants believe, "If I help others with my knowledge or experience, they may help someone else, and someone else may help me."
However, in order to build such social networks, we need to know the participant. Criteria that allow us to know the participant are difficult to identify-let alone act upon-given most current uses of new communication technologies. In fact, most of today’s computer-mediated or IVR and wireless health interventions tend to offer one-way communication-the producer of the site provides static information about a health topic that goes from the site to the user. It is assumed that accurate information is sufficient to activate a behavior change or at best provide questions with branching logic to deepen the level of detail of the information provided. Even sites that offer bulletin boards are limited. Postings are categorized by topic, and off-topic communication is discouraged. This makes it difficult for people to get to know one another the way they might during the general chitchatting, visiting, and relationship forming that happens in the real world when groups get together regularly around a common topic or cause.
So what are the types of issues that are appropriate for online communities and social networks to address? Here are just a few. On the illness end of the health spectrum, communities can affect diabetes, cancer, obesity, Crohn’s disease, Lyme disease, and substance addiction. For caregivers, online communities can help with caring for children with disabilities or for patients with Alzheimer’s disease or with end-of-life care. On the health management and health promotion end of the spectrum, areas such as weight loss, smoking cessation, new parent support, and worksite-based team physical activity (cycling, walking, calorie expenditure, and so on) are all suitable targets for online communities.
What are the behaviors we wish to encourage within an online community that will help motivate health behavior change? They are the same behaviors found in other forms of social interactions: receiving support, searching for relevant information and resources when needed, learning how to apply information to personal circumstances, sharing our own stories and resources, and connecting with others regarding our circumstances.
People may share details about their life circumstances or backgrounds that allow them to connect in an infinite variety of unpredictable ways. They may talk about pets, kids, politics, or a local sport team. While such connections may seem inconsequential, over time they allow people to feel a sense of belonging that can build confidence, which is often as significant as the behavior change itself. Without these connections, the participants’ bond to the group is only as strong as their interest in the very specific issue that they came for. In the world of social support, such limited interest is rarely enough to sustain the relationship over the long term. The goal is to build as many strands of social capital as possible. You may come to a Web community for one specific reason. You often stay for many additional ones.
We are not suggesting that social networks replace existing health management interventions. Quite the opposite! One way for a social network or online community to be used in worksite health promotion is to leverage such tools to increase the participation of employees and their dependents in the many different interventions that are offered by a corporation. The contextually relevant recommendations of others can drive participation through personal stories, ratings, and even incentives tied to using the social network. For example, it is possible to match people with similar fitness interests and goals. The network becomes a place not only to find a cycling buddy but also to create virtual competitions with other employees-regardless of location or department-that can be displayed and shared on the Web. Participants can score points for tracking their times and progress, virtual teams can be formed, stories and pictures can be shared, and people with common interests or capabilities can be matched to encourage ongoing participation.
Not all of this will have to depend on the employee’s initiative. Imagine that when you complete a health risk appraisal, it is possible to identify risks you prefer or feel most confident to address. From these data, along with personal profile information, you can be matched to the best programs available from the company. Moreover, you can be provided with an up-to-date search of selected information sources on the Web and then introduced to a support community of people like you. You can read their stories about how they successfully improved their health condition or risk status and then connect with them.
But we can go further yet. By integrating community with coaching, it becomes possible for a telephonic coach to not only intervene with an employee but also facilitate groups of employees receiving similar coaching who can support each other. Instead of a coach making five separate calls to 15 different employees (75 coaching sessions), the coach may only need to complete two calls to each participant, introduce members to each other, and facilitate ongoing sessions. This not only reduces the cost of the coaching intervention but also creates far more opportunities for ongoing support and intervention, taking advantage of employees by making them both recipients and providers of the intervention. In an age of consumer-directed health care, the inclusion of social networks around the existing suite of health promotion interventions creates a more effective and efficient system that actually models the concept of consumer directedness.
Beyond this integration, a community can also provide a means to tie health management to actual health care delivery. There is a growing movement for the use of electronic medical records (EMR) and personal health records (PHR). There is a similar growth in the use of on-site health care clinics. Imagine if we can not only connect phone coaches with employees within the community but also link medical providers to this process, ensuring that there is a closed loop between the employee (consumer) and the whole spectrum of health care and management providers.
To accomplish this sort of integration will require a different set of tools and skills than most programs currently maintain. The expansion of social networking, online communities, and collaborative technologies has several implications for the future of worksite health management. Inherent in these technologies are capabilities that will change the way we communicate and intervene with worksite populations. We will need to collect data not only about risks, diseases, and demographics but also about the preferences of users. We will need to understand that relationships drive behavior as much as information. We will need to understand that knowledge is the domain of the user as well as the provider. Ultimately, our role as professionals will include being facilitators as much as being purveyors of truth.
In return for building these new capabilities, practitioners will be in a position to create a truly integrated approach to delivery of health and medical care within the context of a community of care and caring. The opportunities are exciting and limited only by our imagination. The technology exists to do all this today. The dogs are hungry and ready for us to give them something to eat.