Has the Class Divide Gone Cyber?

This fall I am taking a class called "Social Justice and the Obama Administration," taught by Anita Hill. She's a fantastic teacher, getting the entire class engaged and talking. It's the kind of class where you leave with your head spinning in a good way. This is partly due to the fact that Professor Hill has a teaching style I've noticed in any teacher I've had who's also a lawyer - any point you make is valid and welcomed, pending you can back it up. For you lawyers out there this might seem like standard fare; for the rest of us this is a nice respite from dry lectures and less successful means of getting people talking.

We cover a wide range of subjects, and are required to present to our peers a few times during the semester. By the end of the semester you get a good sense of what your peers are interested in - education, child welfare, economics, obesity, etc. I'm the social media kid, and thus my most recent presentation was on social networking, with a social justice bent.

I've had the idea to look at class divides online since hearing a news story in 2007 regarding a military decision to limit access to certain spaces online. It was a particular low point in the Bush years/Iraq war, with record low approval ratings for the prez and general unrest about the debacle in Iraq. STRATCOM decided to shut down a few websites, citing bandwidth issues, and in doing so cut off the social networking site used more often by soldiers (MySpace), while leaving the social networking site used by Officers (Facebook) intact. While this could certainly be positioned as saving valuable bandwidth, this could also easily be interpreted as an effort to prevent soldiers from reporting back to their families about their interpretation of the conditions overseas. Officers, however, were free to maintain contact with their loved ones.

It seemed unfair, and it seemed class based.

Looking at numbers alone, each site is a behemoth. As of this moment, Facebook ranks as the #2 website in the United States, and MySpace is #5. Even with MySpace numbers falling off, they still have over 120 million users (Facebook has topped the 200 million mark). The question, however, is who chooses to use each site. As social networking expands, which it is has done so rapidly that research documenting these changes can hardly keep pace, where you choose to see and be seen is quickly becoming your personal brand. Just as you might choose Gucci over Coach (or vice versa), or Dunkin' Donuts over Starbucks (or vice versa), you might choose Facebook over MySpace (or vice... you get my point).

I'm certainly not the only one thinking about this. In fact, someone beat me to the punch in a far more eloquent manner. danah boyd wrote her doctoral thesis on the topic of social networking and teens, dedicating a number of pages to how teens perceive each of these sites. Fascinating stuff.

Still, I thought it worthwhile to share with my class, and get them thinking on this topic. I wanted to know if they believed that there really was a divide, or if it was simply market forces that drove people to one or another. It kept them talking for quite some time - a sign of a successful presentation.

In case you wanted to give it some thought as well, below are the slides I put together. My speaker notes aren't included (neither are the fancy animations) so you'll have to either take it up with your friends and family, or start the conversation here.




With that presentation done, I'm now on to write up my final paper - leveraging Twitter for social justice causes. Again, lots of material to pull from!

APHA 2009 - Social media, social media, social media

I am just back from the 2009 American Pubic Health Association conference, which took place this past week in Philadelphia. I thought I'd write down some of my takeaways while it was still fresh.

If you read nothing else below, the takeaway is that social media is a huge topic across interest areas. I’ve attended this conference for 10 years (give or take), and there were more presentations on this topic than ever before. If I were in advertising, I might sum it up by saying, “Social Media: if we do it’s right, it’s the future. If we do it wrong, it’s the future."

People twittered throughout the conference. You can search #apha09 to see what they were talking about.

Onto the conference bits. You may want to grab a cup of coffee/tea, as there are a number of bits…

Setting the stage

Dr. Christopher Gibbons led a very good talk laying the groundwork for why we should care about social media, and the potential impact. His ideas resonate very much with my own, so on a personal level it felt validating. On a professional level, he has written several papers and edited a book on the topic of health and technology which are worth checking out.

He also mentioned a report recently released from AHRQ that reviewed a number of research on this topic. The focus is on outcomes, which is a huge gap in this field. We are currently long on shiny new toys, but short on what impact, if any, they have.

Programs using Social Media

As this is APHA, there was a lot of focus on programs, and how the tools are being employed. Here's two that I found interesting, and one general note:

• Alaska Palliative Care telehealth initiative: Given the vast expanse and rural nature of the state (the presenter spoke about an area the size of Ohio with 24 miles of paved roads total), and the limited human resources making it hard to attend remote sessions, they tested out a teleconference approach. Options to attend included in person, at a group site, or online. They tracked site usage stats, and saw people coming in from all over the world. Production cost was much less ($28k vs. $125k when all done in person) and the feedback was highly positive. They are already planning the next one for April 2010.
• A Facebook-esque interface for a smoking cessation program aimed at African American smokers using an identity framework (personal, group, and relational) presented by Dr. Jennifer Warren of the University of Minnesota, allowing participants to interact with various spaces in a virtual neighborhood (barbershop, health center, church, others). The goal was to allow participants to hear the messages in ways that resonated. This also used local community leaders in video segments, adding an element of personalization and local relevance. This is still in testing.
• In general, the CDC Health Communications group (which I know is about to undergo some changes) is doing some really innovative, slick, and relevant work in this area. Of the federal agencies, they seem to be the most actively involved in using web 2.0 tools.

Research and Evaluation

Rarely was there an evaluation component to programs, aside from process evaluation. This is problematic, as it gives no sense as to the utility and/or evolution of these tools, and if/how they are linked to any outcomes. Perhaps it is too early in this field to know best practices, but developing new theoretical frameworks is needed.

That said, there was some research covered during sessions. The bulk of this was reviewing the latest Health Information National Trends Survey (HINTS) data from the National Cancer Institute. I attended at least three presentations where preliminary analyses of the recently released 2007 data were shared. A data point I noted down was that of those people who are online, African Americans were 1.58 times more likely to use social networks (not health focused networks, just in general). Other data reiterated previous findings that those who are online looking for health info are more likely to be white non-Hispanic, female, more educated. Sylvia Chou from NCI has a paper in press on this topic, slated to appear in the Journal of Medical Internet Research in the next month or so.

There was no trending analysis making comparisons among this growing dataset (this is the third iteration of this survey). I was hoping someone would look at the data over time but no luck. Perhaps something I can do. Additionally, the research being done by Susannah Fox and her colleagues at the Pew Internet and American Life Project is well regarded and oft cited.

Further thinking

In general, social media was seen as a supportive resource, and not a replacement for seeing a provider. However, unless I happened to raise the question, there was no mention of people without regular access to a provider (or a consistent provider who knows them) and how this subgroup may leverage various social media tools. Or if they already are, for that matter. What research exists on the topic does not seem to include health insurance coverage metrics. The health disparities researcher in me has many questions on this topic.

The IT geek in me is left wondering about the interoperability of platforms. I am seeing a future where how we interact with health related tools (some explicitly health focused, some not) is much more decentralized, and thus I am continuing to raise the issue of how we get all of this information to be compatible; in essence, I wonder how we can create the whole person out of the bits of themselves that they put out in disparate spaces online. I also wonder how/if formal networks (I’m thinking EMRs, or other provider-related information) will be joined with informal social networks (patientslikeme and the like) outside of the traditional health care system. Or is this just a new world, and I’m stuck in old thinking on this matter?

The age old conundrum, of course, is that research takes time. Private sector development will always be faster. To that extent, I am left wondering how private/public partnerships can be created to combine development and evaluation of benefits.

If anyone has questions or feedback on the above, or want to talk further on this, please do. I look forward to continuing to engage on these topics!