Background: In Australia, there is growing use of technology supported knowledge translation (KT) strategies such as social media and mobile apps in health promotion and in Indigenous health. However, little is known about how individuals use technologies and the evidence base for the impact of these health interventions on health behavior change is meager.
Objective: The objective of our study was to examine how Facebook is used to promote health messages to Indigenous people and discuss how KT can support planning and implementing health messages to ensure chosen strategies are fit for the purpose and achieve impact.
Methods: A desktop audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people using Facebook was conducted.
Results: Our audit identified 13 out of 21 eligible campaigns that used Facebook. Facebook pages with the highest number of likes (more than 5000) were linked to a website and to other social media applications and demonstrated stickiness characteristics by posting frequently (triggers and unexpected), recruiting sporting or public personalities to promote campaigns (social currency and public), recruiting Indigenous people from the local region (stories and emotion), and sharing stories and experiences based on real-life events (credible and practical value).
Conclusions: KT planning may support campaigns to identify and select KT strategies that are best suited and well-aligned to the campaign’s goals, messages, and target audiences. KT planning can also help mitigate unforeseen and expected risks, reduce unwarranted costs and expenses, achieve goals, and limit the peer pressure of using strategies that may not be fit for purpose. One of the main challenges in using KT systems and processes involves coming to an adequate conceptualization of the KT process itself.
In Australia, the use of technology supported knowledge translation (KT) strategies like social media, mobile software apps, patient-mediated tools, and clinical decision support systems in health promotion and in Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) health is growing [, ]. This corresponds with a growing use of social media among Australians in general, and in particular among Indigenous people, whose use of Facebook is 20% higher than the national average [ ].
Despite this growing use, little is known about how individuals use technologies and evidence of the benefit and impact of these social media applications on health behavior change is meager. In their review of use in Indigenous populations, Brusse and colleagues found that the benefit and impact of social media applications was tentative and scattered, suggesting that producers of health promotion projects needed to obtain a thorough understanding about who engages with these strategies, why they engage, and how they engage . The authors recommended further research in KT and implementation to better understand how to translate principles of commercial success in social media and mobile software into effective health promotion interventions and how to better integrate these methods into health research [ ].
KT in health is defined as a “dynamic and iterative process that includes synthesis, dissemination, exchange, and ethically sound application of knowledge to improve health, provide more effective health services and products, and strengthen the health care system” . Using KT strategies to support the design and deployment of health technologies is likely to increase their effectiveness and facilitate more efficient use of resources. However, Goering and colleagues suggest that whereas researchers and others are being encouraged to incorporate KT activities and strategies into their research applications, many are unclear about precisely what this means or how it should be assessed [ ].
Three applications of KT, the Barwick KT planning Template  and the simple, unexpected, concrete, emotional, stories (SUCCESS) and social currency, triggers, emotion, public, practical value, stories (STEPPS) frameworks [ , ] are processes that have been developed to identify and shape KT strategies so they are fit for purpose for a particular context and a defined audience and for achieving a set of goals and impact. The Barwick Template incorporates a set of guiding questions and evidence-based checklists and refers to other KT models and frameworks that are associated with planning for implementation (eg, Consolidated Framework for Implementation Research, Knowledge to Action, Reach Effectiveness Adoption Implementation Maintenance RE-AIM) and for impact (eg, stickiness frameworks such as SUCCESS and STEPPS, and planning for evaluation eg, measurement indicators) [ ]. The SUCCESS and STEPPS frameworks support planning for impact [ , ]. A health message or strategy should have impact such that it “catches on” or is understandable, memorable, and effective in changing thought or behavior. These characteristics are known as stickiness factors ( ) [ , ].
In this study, we examined how Facebook is used to promote health messages to Indigenous people on tobacco smoking prevention and cessation. We discuss how KT planning can support teams to plan, develop, and implement health messages to ensure chosen strategies are fit for purpose and designed to achieve impact. Although this study focussed on health promotion campaigns about tobacco use for Indigenous people, the outcomes are generalizable to other types of health campaigns and topics.
In 2015, a desktop audit was undertaken of the Indigenous HealthInfoNet health promotion resource database for tobacco campaigns published from 2005 to 2015. Campaigns were selected for inclusion in the study if they addressed smoking cessation and prevention, were nonpaper-based with an associated social media presence, and were audiovisual. Social media presence was confirmed by a search using Google Chrome (Google, Mountain View, CA, USA), Facebook (Facebook, Inc, Menlo Park, CA, USA), YouTube (YouTube, LLC, San Bruno, CA, USA), and Twitter (Twitter, Inc, San Francisco, CA, USA). Campaigns were excluded if they could not be retrieved, were duplicates, or also targeted a mainstream audience. A subset using Facebook were subjected to further analysis.
Data Extraction and Analysis
Data about the campaign, the year and state in which it was developed, the producer, type of media strategy, number of likes, links to other websites, and average posts per month were entered into a Microsoft Excel database.
Campaigns were ranked from the highest number of likes to the least number of likes. A “like” indicates an appreciation, enjoyment, or support of the content posted on the Facebook page. The total number and mean number of posts per month were calculated for each Facebook page and pages were categorized into 2 groups: pages with more than 5000 likes and pages with less than 1800 likes (range is 35 to 11,000 likes). The number and type linkages between Facebook and Web-based applications such as websites and other social media applications (eg, Twitter and YouTube) were also analyzed.
The KT Planning Template and stickiness frameworks, SUCCESS and STEPPS, were then used to identify factors that may have contributed to the differences in overall likes, and to analyze key characteristics of interventions to assess the extent to which strategies are “fit for purpose” and to explain their uptake or impact.
Ethics approval was not sought as the desktop audit collected data that were publicly available and freely accessible from public profiles on Facebook.
We identified 113 tobacco-related campaigns. Of these, 30 were selected based on our inclusion criteria. Of these, 6 were identified as duplicates and 3 were excluded because they were for Indigenous as well as mainstream audiences resulting in 21 campaigns for further examination ().
A range of social media applications were used in the 21 campaigns. The most popular were websites, YouTube, Facebook, and Twitter (). The most popular format to promote messages was videos.
Facebook pages with the highest number of likes (more than 5000) were linked to a website and to other social media applications. Linking social media applications and websites allows owners to consistently promote campaigns across all social media applications to ensure a broad range of audiences is captured and to “trigger” a reminder for audiences that use one or more applications.
Based on the average number of posts per month and posts' content, it appears pages with the highest number of likes (Deadly Choices, 11,000; Drug Info, 6829; Rockhole, 6304; Indigenous lung cancer ads, 5326) also shared similar stickiness characteristics such as social currency, triggers, emotion, public, stories, simple, credible, and practical value ().
|Making ideas stick framework|
|Simple||Finding and delivering the core of message in a way that is so profound that a person could spend a lifetime learning to follow it.|
|Unexpected||Engaging people’s curiosity over long periods of time by systematically opening gaps in their knowledge and filling those gaps. Involves attracting a person’s attention (surprise) and holding that attention (interest).|
|Concrete||Helping people understand and remember messages through the use of concrete images such as the use of proverbs.|
|Credible||Ensuring messages carry their own credentials through the use of external (eg, an expert or authority figure) and internal credibility (eg, use of evidence and statistics).|
|Emotional||Messages that make people feel something by using the power of association, appealing to self-interest, and identify.|
|Stories||Stories can tell people how to act or how they can inspire (ie, give people the energy to act).|
|Social currency||People like to make a good impression, so products and ideas that make people look good are more likely to be shared.|
|Triggers||Triggers and cues lead people to talk, choose, and use. Social currency gets people talking. Triggers keep people talking. Top of the mind means tip of the tongue.|
|Emotion||Similar to making ideas stick framework—see above. Activating the right type of emotions is the key to transmission. When we care, we share.|
|Public||People are said to imitate one another. So if people can’t see what others are doing, they can’t imitate them. Making products and ideas popular means making them more publicly observable. If something is built to show, it’s built to grow.|
|Practical value||Practical value is about helping. Information that contributes to something being useful in terms of saving money, making people happier, or saving time is news you can use.|
|Stories||Similar to making ideas stick framework—see above. A narrative that people will want to share.|
|1||Give up the smokes||2015||Bega Garnbirringu||WA||Video|
|2||My QuitBuddy||2015||Quit Now||National||Mobile app|
|3||Quit for you - quit for two||2014||Quit Now||National||Mobile app|
|4||Indigenous mothers talk||2014||Rural Health Channel||QLD||Video|
|5||Puyu paki (Don\'t smoke - give it up)||2014||Puntukurnu Aboriginal Medical Service||WA||Video|
|6||Breathe clearly, live healthy, quit smoking||2014||Mawarnkarra Health Service||WA||Video|
|7||Skinnyfish music health promotion videos||2013||Skinnyfish music||NT||Video|
|8||Indigenous lung cancer ads||2013||The Lung Foundation||National||Video|
|9||Rockhole||2013||Indigenous Hip Hop Projects||National||Video|
|10||Tomorrow\'s dream advertisement||2013||Aboriginal Health Council of Western Australia||WA||Video|
|11||Deadly Choices - smoking television commercial #1||2013||Deadly Choices||QLD||Video|
|12||Stickin it up the smokes: Ellie Lovegrove and Daniel Summer||2013||Lovegrove E. and Summer D.||SA||Video|
|13||Tobacco addiction story – English||2013||No Smokes||NT||Video|
|14||Smoking and pregnancy||2013||No Smokes||NT||Video|
|15||Quit Now online calculator||2013||Quit Now||National||Online calculator|
|16||Smoke-free homes and cars||2013||Aboriginal Tobacco Control Project||NSW||Video|
|17||Blow away the smokes: A guide to quitting cigarettes for Aboriginal and Torres Strait Islander people||2012||Baker F. and Gould G.||NSW||Video|
|18||Stay strong and healthy: Pregnancy resources for Aboriginal women||2012||NSW Ministry of Health||NSW||Mix|
|19||No durri for this Murri||2012||North Coast Aboriginal Corporation for Community Health||QLD||Video|
|20||VACCHOb World No Tobacco Day||2011||Gallagher, J. Victorian Aboriginal Community Controlled Health Organisation||VIC||Video|
|21||DrugInfo||2011||Australian Drug Foundation||National||Website|
aNSW: New South Wales; NT: Northern Territory; QLD: Queensland; SA: South Australia; VIC: Victoria; WA: Western Australia.
bVACCHO: Victorian Aboriginal Community Controlled Health Organisation.
|Social media application||Number of tobacco prevention and cessation campaigns|
|Other (SoundCloud, Pinterest, Vimeo)||5|
|No.||Title of health promotion program||Year||Producer||Statea||Type||Likes||Linking||Average number of posts per month|
|1||Deadly Choices (smoking television commercial #1) ||2013||Deadly Choices||QLD||Video||11,000||Facebook to embedded videos and website |
Website to Facebook and Twitter
|2||DrugInfo ||2011||Australian Drug Foundation||National||Website||6829||Facebook to Website |
Website to Twitter
Twitter to Website
|3||Rockhole ||2013||Indigenous Hip Hop Projects||National||Video||6304||Facebook to embedded videos |
Website to videos
|4||Indigenous lung cancer ads ||2013||The Lung Foundation||National||Video||5326||Website to Facebook and videos||12|
|5||Tobacco addiction story - English ||2013||No Smokes||NT||Video||1741||Facebook to Twitter and videos (Youtube and Vimeo) |
Twitter to Website and videos
|6||Smoking and pregnancy ||2013||No Smokes||NT||Video||1741||Facebook to Twitter and videos (Youtube and Vimeo) |
Twitter to Website and videos
|7||VACCHO World No Tobacco Day ||2011||Victorian Aboriginal Community Controlled Health Organisation||VIC||Video||989||Facebook to Website and videos (Youtube) |
Twitter to Website
Website to Facebook, Twitter, Youtube, and Soundcloud (audio)
|8||Stay strong and healthy: Pregnancy resources for Aboriginal women ||2012||NSW Ministry of Health||NSW||Mix||831||Facebook to Website||4|
|9||Smoke-free homes and cars (Facebook- I quit because)||2013||Aboriginal Tobacco Control Project||NSW||Video||466||Facebook to Website and embedded videos |
Website to videos
|10||Blow away the smokes: A guide to quitting cigarettes for Aboriginal and Torres Strait Islander people ||2012||Baker, F. and Gould, G.||NSW||Video||55||Website to Facebook and videos (vimeo)||0|
|11||Give up the smokes ||2015||Bega Garnbirringu||WA||Video||52||Website to Youtube||0.1|
|12||Tomorrow\'s dream advert ||2013||Aboriginal Health Council of Western Australia||WA||Video||42||Facebook to Website |
Website to Facebook, Twitter, Google Plus, PinInterest, Soundcloud
|13||Breathe clearly, live healthy, quit smoking ||2014||Mawarnkarra Health Service||WA||Video||35||Twitter to Facebook||0|
aNSW: New South Wales; NT: Northern Territory; QLD: Queensland; SA: South Australia; VIC: Victoria; WA: Western Australia.
|Stickiness factors||Stickiness factors from Facebook pages with high number of likes more than 5000|
|Social currency||Demonstrating the adoption of current trends or the rollout of new initiatives such as tackling smoking |
Promoting and sharing photos and video posts that showed people with a known sporting identity at a health promotion event where participants received a t-shirt or some other incentive
|Triggers||Routine and regular posts of photos, videos, and information at different times of the day about upcoming campaigns |
Linking of social media applications to allow sharing of posts between platforms, thereby providing regular reminders
|Emotion||Posting stories about personal life journeys and experiences such as quit smoking stories |
Use of music and dance to promote health promotion messages
|Public||All profiles were public profiles - free to access |
Using tags to share posts with other Facebook profiles
Linking of social media applications to allow sharing of posts between platforms such as YouTube and Facebook
|Stories||Posting videos of ex-smokers sharing their stories about quitting smoking or about the death of a loved one due to lung cancer|
|Credible||Stories and videos were from an individual’s personal life journey and experience |
Advertisements promoted statistics about smoking and lung cancer
|Practical value||Posting of videos about how to stay fit and healthy |
Posting of educational messages
For example, the Deadly Choices Facebook page demonstrated the following characteristics:
- Simple: Core message promoted consistently through written posts, photos, and videos.
- Unexpected: Frequently promoted competitions, free giveaways, and meet and greets.
- Triggers: The page frequently posted messages at different times of the day. It used different forms of media such as text, photos, and videos. The page was also linked to other social media platforms to allow sharing of posts to Twitter and YouTube.
- Social Currency and Public: The campaign appeared to have recruited known sporting and public personalities to promote campaigns. The page also posted photos and videos of people with sporting and public personalities at various health promotion campaigns.
- Stories, Emotion, and Credibility: The page posted or linked to videos of Indigenous people telling their stories about their quit smoking journey. There were also good news stories about the benefits of a healthy lifestyle through diet and exercise.
- Practical Value: Provided information about how to stay fit and healthy or how to cease smoking and get fit and healthy.
Using social media like Facebook has certain appeal: the potential to reach large numbers of people with ease of set up and at a minimum cost. There appears to be a perception that few resources, if any, are required to make health messages “sticky.”
However, this type of thinking is deceiving. The findings from this study show that the use of social media applications like Facebook do not guarantee that a campaign will have the desired impact and reach, such as through high numbers of likes, shares, and comments. Making health messages sticky through social media such as Facebook requires, at a minimum, content to be sourced and translated into a format that incorporates stickiness characteristics, routine posts that maintain page currency, routine monitoring and evaluating to assess impact and effectiveness, and a skilled and experienced workforce. Workforce expenses are the “hidden costs” of social media applications.
In addition to social media, there are several other strategies to translate knowledge. For example, strategies like knowledge brokers, champions, media campaigns, and pop-up stalls may be more suitable for campaigns that wish to provoke interest and raise awareness in groups that do not use social media or have limited access to the Internet. These strategies may have been more suitable for health promotion campaigns that received less than 500 Facebook likes. However, strategies like financial incentives, new policies, patient education sessions, and communities of practice could be used in combination with social media applications to impart knowledge and inspire change. For example, the Deadly Choices page promotes Indigenous designed t-shirts that are given to individuals who complete the annual health assessment. Once strategies are identified, the next step makes them sticky.
KT planning can be used as a tool to support individuals and teams to craft the delivery of health messages so that they are best suited and well-aligned to the campaigns’ goals, messages, and target audiences. KT planning has clear potential to help mitigate unforeseen and expected risks, reduce unwarranted costs and expenses, achieve goals, and limit the peer pressure of using strategies that may not be fit for purpose.
Due to privacy requirements, the desktop review did not have access to Facebook metrics, such as Page Insights, to measure the reach and uptake of posts. Page insights provide information about the number of people to whom a post has reached; who have clicked on a post; liked, commented, or shared a post; or viewed a video. This level of analysis would be important in any evaluation of specific campaigns.
The uptake and use of frameworks and practices like KT planning will take time and will undoubtedly face challenges and barriers. The main challenges are conceptualizing KT and then applying it effectively to the local context . Until this and other challenges (eg, limited organisational KT capacity, limited to access to KT workforce) are addressed, we will continue to use systems and processes that are familiar or easy to use but may be ineffective or have variable uptake and impact.
All authors were involved in the planning and design of the study. SS collected and analyzed the data and drafted the manuscript. All authors read and were involved in critically revising the manuscript and all of them have approved the final manuscript.
Conflicts of Interest
- Sweet MA. Social media: new links for Indigenous health. Med J Aust 2013 Jul 8;199(1):18. [Medline]
- Brusse C, Gardner K, McAullay D, Dowden M. Social media and mobile apps for health promotion in Australian Indigenous populations: scoping review. J Med Internet Res 2014;16(12):e280 [FREE Full text] [CrossRef] [Medline]
- Callinan T. Remote Australians Rely on Facebook to Stay in Touch. NITV; 2014 Aug 27 URL: http://www.sbs.com.au/nitv/nitv-news/article/2014/08/26/remote-indigenous-australians-rely-facebook-stay-touch [accessed 2016-09-28] [WebCite Cache]
- CIHR-IRSC. Knowledge Translation - Definition About Us URL: http://www.cihr-irsc.gc.ca/e/29418.html [accessed 2016-09-27] [WebCite Cache]
- Goering P, Ross S, Jacobson N, Butterill D. Developing a guide to support the knowledge translation component of the grant application process. Evidence & Policy 2010;6(1):91-102.
- Barwick M. 2008. Knowledge Translation Training and Tools. Toronto, ON: Melanie Barwick; 2008. URL: http://www.melaniebarwick.com/KTTemplateFillable_dl.php [WebCite Cache]
- Heath C, Heath D. Made to Stick: Why Some Ideas Survive and Others Die. New York, NY: Random House; 2007.
- Berger J. Contagious: How to Build Word of Mouth in the Digital Age. London: Simon & Schuster UK Ltd; 2013.
- Facebook. Deadly Choices Smoking Television Commercial. Facebook. 2013. URL: https://www.facebook.com/deadlychoices/ [accessed 2016-09-28] [WebCite Cache]
- Australian Drug Foundation. DrugInfo. 2011. URL: https://www.facebook.com/AustralianDrugFoundation [accessed 2016-09-28] [WebCite Cache]
- Indigenous Hip Hip Projects. Facebook. 2013. URL: https://www.facebook.com/Indigenoushiphopprojects/ [accessed 2016-09-28] [WebCite Cache]
- Facebook. Lung Foundation Australia. 2013. URL: https://www.facebook.com/lungfoundation/ [accessed 2016-09-28] [WebCite Cache]
- Facebook. No Smokes. 2013. URL: https://www.facebook.com/NoSmokes.com.au/info/?entry_point=page_nav_about_item&tab=page_info [accessed 2016-09-01]
- Facebook. Victorian Aboriginal Community Controlled Health Organisation. 2011. URL: https://www.facebook.com/VACCHO/?fref=nf [accessed 2016-09-28] [WebCite Cache]
- New South Wales Ministry of Health. Stay strong and healthy: pregnancy resources for Aboriginal women. Facebook. 2012. URL: https://www.facebook.com/StayStrongAndHealthy/info/?entry_point=page_nav_about_item&tab=page_info [accessed 2016-09-01]
- Aboriginal Tobacco Control Project. Facebook. 2013. I Quit Because URL: https://www.facebook.com/IQuitBecause/info/?entry_point=page_nav_about_item&tab=page_info [accessed 2016-09-01]
- No Smokes North Coast. Facebook. Blow Away the Smokes - Smoke Free Aboriginal Country. 2012. URL: https://www.facebook.com/Blow-Away-The-Smokes-Smoke-Free-Aboriginal-Country-271034862949684/info/?entry_point=page_nav_about_item&tab=page_info [accessed 2016-09-01]
- Bega Garnbirringu. Facebook. Give Up the Smokes. 2015. URL: https://www.facebook.com/pages/Bega-Garnbirringu-Health-Services/150729521633534 [accessed 2016-09-27] [WebCite Cache]
- Aboriginal Health Council of Western Australia. Facebook. 2013. URL: https://www.facebook.com/AHCWA/?fref=ts [accessed 2016-09-27] [WebCite Cache]
- Facebook. Mawarnkarra Health Service. 2014. URL: https://www.facebook.com/Mawarnkarra/?fref=ts [accessed 2016-09-28] [WebCite Cache]
|KT: knowledge translation|
|STEPPS: social currency, triggers, emotion, public, practical value, stories|
|SUCCESS: simple, unexpected, concrete, emotional, stories|
|VACCHO: Victorian Aboriginal Community Controlled Health Organisation|
Edited by G Eysenbach; submitted 31.05.16; peer-reviewed by P Yao, M Sweet, J Apolinário-Hagen; comments to author 31.07.16; revised version received 18.08.16; accepted 19.09.16; published 05.10.16Copyright
©Sanchia Shibasaki, Karen Gardner, Beverly Sibthorpe. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 05.10.2016.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.