If You Build (and Moderate) It, They Will Come: The ...

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This analysis explores the impact of modifying the Smokefree Women Facebook social media strategy, from primarily promoting resources to encouraging ...

DOI:10.1093/jncimonographs/lgt019

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If You Build (and Moderate) It, They Will Come: The Smokefree Women Facebook Page Samantha D. Post, Shani C. Taylor, Amy E. Sanders, Jeffrey M. Goldfarb, Yvonne M. Hunt, Erik M. Augustson Correspondence to: Jeffrey M. Goldfarb, MBA, MMG, Government Services Department, 700 King Farm Blvd, Ste 500, Rockville, MD 20850 (e-mail: [email protected] mmgct.com).

J Natl Cancer Inst Monogr 2013;47:206–208

Online social network sites, such as Facebook (FB), represent potentially powerful tools for reaching and engaging smokers in cessation efforts (1). Social network platforms have the capacity to reach large numbers of people at a relatively low cost, representing a distinct advantage relative to traditional cessation treatment approaches. Furthermore, these platforms provide unique opportunities to harness social support, generate social influence, and modify social norms via an “architecture of participation (2)” that allows users to share information and connect with others in real time. The importance of social network influences on health behavior is well established (3), and a body of literature supports the efficacy of network interventions in real-world settings (4–8). However, less is known about optimal strategies for initiating and maintaining behavior change in online social networks (9). To our knowledge, few studies have examined the behaviors of individuals participating in online support communities for smoking cessation or have provided implications for community moderation. However, relevant literature indicates that first posts to online cessation networks are from recent quitters struggling with their quit attempts and that users who have remained abstinent for a month or more are often the first ones to respond (10). The majority of posts within these communities provide emotional support and encouragement, share personal experiences, express gratitude, offer congratulations, give practical advice and tips, and discuss smoking cessation medications (11). Various groups of “superusers” have been identified within these communities and are responsible for generating a large volume of posts and for initiating discussions with other members of the community. The purpose of the current analysis was to explore the impact of modifying the social media strategy on the Smokefree Women FB page, an extension of the Web-assisted tobacco intervention women.smokefree.gov moderated by a trained public health 206

professional, using lessons learned from the literature to better provide support and facilitate dialog among women attempting to quit smoking. On May 12, 2012, the strategy was modified from providing support through resource dissemination to featuring user-generated content about cessation-related milestones, questions, tips, and advice via moderator posts to facilitate dialog, engage existing and new superusers, and provide support among the community. Data from FB Insights (12) were retrospectively collected from a period approximately 9 months before the strategy shift (October 2011) and 4 months following the new strategy (September 2012) to provide 1 year’s worth of data to allow for a comparison before and after the strategy change. Descriptive statistics of the user-based FB metrics (Table 1) were evaluated both before and after strategy shift to identify changes in the level of activity through the year. A  correlation analysis was conducted to see whether any statistically significant relationships existed between these variables and the frequency of moderator posts. During the time of the study, 426 moderator posts were created in 366  days. Before the strategy shift, 144 moderator posts were generated in 244  days (averaging 0.64/day). Following the strategy shift, 282 moderator posts were generated in 142  days (averaging 1.99/day), increasing the frequency of moderator communication by nearly 209%. Our results revealed a statistically significant correlation (P < .05) between moderator posts and both engagement (0.7317) and reach (0.7315) on the same day the posts originated, indicating that the increased frequency of moderator posts between the two time periods is partially responsible for the increased engagement. Figure  1 provides an illustration of how engagement measures increased after the strategy shift. However, as indicated in Table  1, the increase in reach and engagement, measured on a per-day basis, was greater than the increase in the number of posts, evaluated on a per-day basis, suggesting that the Journal of the National Cancer Institute Monographs, No. 47, 2013

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This analysis explores the impact of modifying the Smokefree Women Facebook social media strategy, from primarily promoting resources to encouraging participation in communications about smoking cessation by posting user-generated content. Analyses were performed using data from the Smokefree Women Facebook page to assess the impact of the revised strategy on reach and engagement. Fan engagement increased 430%, and a strong and statistically significant correlation (P < .05) between the frequency of moderator posts and community engagement was observed. The reach of the page also increased by 420%. Our findings indicate that the strategy shift had a statistically significant and positive effect on the frequency of interactions on the Facebook page, providing an example of an approach that may prove useful for reaching and engaging users in online communities. Additional research is needed to assess the association between engagement in virtual communities and health behavior outcomes.

Table 1.  Percentage difference in frequency of moderator post, engagement, and reach before and after strategy shift Moderator posts/day

Engagement*, daily mean

Reach†, daily mean

0.64 1.99 209%

11.9 63.1 430%

343.22 1785.9 420%

Before strategy shift After strategy shift % Change

* The number of people sharing stories about the page (eg, liking the page; posting to the page’s wall; liking, commenting on, or sharing page posts; answering questions posted; mentioning the page; or phototagging the page). † The number of unique users who have seen any content associated with the page.

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Figure 1.  Smokefree Women Facebook activity October 1, 2011, through September 30, 2012.

content of the posts was also affecting engagement. There was no spike in the daily number of new fans joining the community after the implementation of the new strategy; however, the community did grow from 2789 to 4073 fans during the study period. These results suggest that the increased interaction observed was not simply caused by having a larger community. Rather, it appears that changing the topics posted by the moderator to highlight specific information posted by fans may have encouraged women to share more information and may have functioned to elicit more meaningful engagement among community members. As noted by Cobb and Graham, our findings indicate that health information dissemination strategies designed to capitalize on the evolution of online social behavior may be particularly useful in supporting health behavior interventions with a social support component (13). Building and motivating an audience to actively engage with online resources can be an arduous process—one

that is further complicated by the temporal need for information and support to change health behaviors. The updated Smokefree Women FB strategy described in this study is an example of an approach that may prove useful for other efforts attempting to use eHealth/mHealth to reach and engage users in health behavior change interventions. As noted by Mierlo et al. and Cobb et al., this study supports the need to dedicate resources toward identifying and encouraging superuser participation, to grow and expand the reach and engagement of online support communities (14,15). Although provocative, limitations should be considered regarding the analyses presented in this paper. First, no data are available to indicate whether the increased interactions and activity reported had an impact on smoking cessation outcomes. Future research should examine whether participating in online communities increases the likelihood of behavior change. Second, as the comparison condition was defined by pre- and poststrategy change, we

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cannot rule out the possibility that the change in behavior observed may have been caused by factors outside of the strategy change. However, the steep change in the trajectory of fan behavior that occurred at the time of the strategy change offers some support to the hypothesis that the strategy change played a causal role in the subsequent changes in fan behavior. Qualitative analyses of usergenerated content in online communities should be conducted to fully understand the unique needs of target audiences and provide them with desired resources and content. References

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Funding The National Cancer Institute’s Tobacco (HHSN2612010000351).

Control

Research

Branch

Affiliations of authors: MMG, Government Services Department, Rockville, MD (SDP, SCT, AES, JMG); Tobacco Control Research Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD (YMH, EMA).

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1. Cobb NK, Graham AL, Byron MJ, Niaura RS, Abrams DB; Workshop Participants. Online social networks and smoking cessation: a scientific research agenda. J Med Internet Res. 2011;13(4):e119. 2. O’Reilly, T. Web 2.0: Compact Definition? Radar O’Reilly Web Site. http://radar.oreilly.com/2005/10/web-20-compact-definition.html. Published October 5, 2005. Accessed October 15, 2012. 3. Cohen S. Social relationships and health. Am Psychol. 2004;59(8):676–684. 4. Valente TW. Network interventions. Science. 2012;337(6090):49–53. 5. Smith KP, Christakis NA. Social networks and health. Annu Rev Soc. 2008; 34(1):405–429. 6. Shaw LH, Gant LM. In defense of the Internet: the relationship between Internet communication and depression, loneliness, self-esteem, and perceived social support. Cyberpsychol Behav. 2002;5(2):157–171. 7. Idriss SZ, Kvedar JC, Watson AJ. The role of online support communities: benefits of expanded social networks to patients with psoriasis. Arch Dermatol. 2009;145(1):46–51.

8. Kawachi I, Berkman LF. Social ties and mental health. J Urban Health. 2001;78(3):458–467. 9. Chou WS, Prestin B, Lyons C, Wen K. Web 2.0 for health promotion: reviewing the current evidence. Am J Public Health. 2012; 103(1): e9–e18. 10. Selby P, van Mierlo T, Voci SC, Parent D, Cunningham JA. Online social and professional support for smokers trying to quit: an exploration of first time posts from 2562 members. J Med Internet Res. 2010;12(3):e34. 11. Burri M, Baujard V, Etter JF. A qualitative analysis of an internet discussion forum for recent ex-smokers. Nicotine Tob Res. 2006;8(suppl 1):S13–S19. 12. Facebook insights. Facebook Web Site. https://www.facebook.com/ help/399262596797358/. Accessed May 1, 2013. 13. Cobb NK, Graham AL. Health behavior interventions in the age of Facebook. Am J Prev Med. 2012; 43(5): 571–572. 14. van Mierlo T, Voci S, Lee S, Fournier R, Selby P. Superusers in social networks for smoking cessation: analysis of demographic characteristics and posting behavior from the Canadian Cancer Society’s Smokers’ Helpline online and StopSmokingCenter.net. J Med Internet Res. 2012;14(3):e66. 15. Cobb NK, Graham AL, Abrams DB. Social network structure of a large online community for smoking cessation. Am J Public Health. 2010;100(7):1282–1289.

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