The Adoption of Social Media in Health and Medicine

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answering the following questions: 1) What social networking sites are most used ..... The list of social media sites for healthcare seekers can be requested from ...

The Adoption of Social Media in Health and Medicine: A Case Study of Healthcare Professionals in Oman Ali H. Al-Badi1, Wafa S. Al- Qayoudhi2 Department of Information Systems, Sultan Qaboos University, Oman Email1: [email protected]; Email2: [email protected]

Abstract Social networks have become the most efficient tools used in many different aspects of human life. They have offered various services in terms of improving peoples' lives. These services range from simply being used as a communication tool to using such tools in one’s own business. Therefore, recently, social networks have become powerful tools for attracting both health seekers and healthcare staff. As more healthcare seekers make use of social networks to look for solutions to their health problems, healthcare staff and their organizations are presented with opportunities to meet them and share the information which could help them. This research investigates the adoption of social networking by patients/healthcare seekers with the aim of answering the following questions: 1) What social networking sites are most used by healthcare staff?; 2) Do their organizations support them in adopting social networks?; 3) What are the main obstacles preventing them from adopting social networks?;4) Do the local telecom providers provide the appropriate infrastructure and technical support? 5) What are the benefits gained by health professionals in adopting social networks?; and 6) What are the main concerns when using social networking. To achieve these objectives the research employs various methodologies. These include descriptive/interpretive studies of the literature and previous studies by academics and industrial institutions. It utilizes an online survey completed by healthcare professionals (i.e. doctors and nurses) to elicit the opinions of different people in Oman concerning the usage of social networking in the field of health and medicine. It was found that healthcare professionals are not really using specialized social networking as yet. This could be due to them being unaware of its availability or, maybe, lack of trust in it. Most healthcare professionals are using social networking to read posted articles, to communicate with other members and to post questions about health and medicine. Keywords: Web 2.0, Medicine 2.0, social networks, health and medicine, healthcare staff

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1. Introduction If we look back five years, the only means of procuring medical advice and medicine was the traditional way, in which the doctors worked in their surgeries and their patients came to them. Doctors are not available around the clock. Patients can only meet their doctor within certain hours, and even then only in their surgeries. If the patients do not see their doctor during working hours they will wait for another day to meet him/her, which could increase their pain. The advent of Internet technology transformed the world into a ‘small village’, which made a huge difference to the daily activities of most professionals. This transformation enabled people to work from home, buyers to buy from home and patients and doctors to communicate anytime and anywhere. Information technology, like social networks, is a most efficient tool that has transformed the field of work. Social networks have recently invaded the world of healthcare and have changed the processes by which it functions. For example, sufferers of bad health have various options for comparing the care and the cure they receive [Hawn, 2009]. These options, supported by platforms such as PatientsLikeMe which is a kind of social networks [Hawn, 2009]. The objective of this research is to explore the impact of social networking on healthcare staff (both negative and positive impacts): 1. To investigate their concerns regarding the adoption of social networking sites in the field of health and medicine. 2. To explore the motives of healthcare staff for using social networking sites. 3. To explore how the healthcare staff (doctors) utilizes social networks to improve their performance and provide better services. Finally, to provide a set of recommendations for healthcare staff opting to utilize SNs in order to enhance their profession and achieve better patient satisfaction. Hereafter, the paper is organized in the following way. The following section provides a brief literature review and background to the topic in hand. That is, we provide an overview of the social media, definitions, classifications and rate of growth. Then we present some examples of social networks in health and medicine. The section following this presents the research findings. We end the study by presenting key conclusions and contributions. 1. Research Methodology The primary aim of this research is to explore the impact of social media on health and medicine. It seeks to provide an outline of the current relevant literature with regard to the impact of social media on health and medicine. It aims to investigate the acceptability of the use of social media in health and medicine, and hence, recommend ways to employ social media in this field. To achieve these ends the research employs various methodologies. Firstly, researchers conducted descriptive/interpretive studies of the literature and previous studies by academics and industrial institutions. Secondly, an online questionnaire was carried out among health care providers (or doctors) in order to solicit their opinions regarding this issue. 2. Literature Review 2.1. Overview of Social Networks: Definition The concept of social networks was coined by J.A. Barnes, the specialist in modern sociology, anthropology, geography, social psychology, organizational studies and computer science for last few decades, in 1954 [Musiał and Kazienko, 2013]. However, Stanley Milgram invented the term ‘modern social networks’ and his first idea was to study the small-world problem, aiming to come up with a mechanism to help people communicate by means of indirect relationships [Musiał and Kazienko, 2013]. The concept of social networking seems to be quite obvious, but almost every researcher describes it in a slightly different way [Musiał and Kazienko, 2013]. The network itself incorporates a set of social systems and the relationship between them [Roberson and Colquitt, 2005]. Social networks are "sites that are web-based services that allow individuals to (1) construct a public or semipublic profile within a bounded system, (2) articulate a list of other users present within the system" [boyd and Ellison, 2008]. According to Newman et al. (2002) a social network is a set of people or groups of people, ‘actors’ in the jargon of the field, with some pattern, interactions or ‘ties’ between them [Newman et al., 2002]. The general definition of a social network, according to the free on-line dictionary of computing , is that it is “ a Website where one connects with those sharing personal or professional interests, places of origin, education at a particular school, etc.” [Zhou et al., 2012]. Social networks can be used in different fields (e.g. education, business 2

and communication). Social networks enable communication, collaboration and the collection of information and sharing in the health care space [Keckley and Hoffmann, 2010]. In the health field , a health social network is a website where consumers may be able to find health resources at a number of different levels [Swan, 2009]. In addition , Magalhães et al. (2013) define a health social network as an online information service which facilitates information sharing between closely related members of a community [Magalhães et al., 2013]. 2.2. History of Social Networks Social networks did not start with computers; they started with telephones [Edosomwan et al., 2011]. During the 1950s phone pricing appeared, which was used for searching telephone networks by using homemade electronic devices [Edosomwan et al., 2011]. During the 1960s, the email appeared but the Internet was not available to the general public until 1991 [Edosomwan et al., 2011]. In 1969, the Advanced Research Project Agency (ARPA) created ARPANET which laid the foundation for the internet, and this was the time when sharing between computers [Edosomwan et al., 2011]. In 1970 social media was further developed [Edosomwan et al., 2011]. In 1997 the first social networking site was launched [boyd and Ellison, 2008]. In 1998, SixDgrees.com was launched and allowed users to create profiles and list their friends as well as being the first site to combine these features[boyd and Ellison, 2008]. Unfortunately it failed, and it closed in 2000 because people were not interested in meeting strangers and there was nothing to do on the site except to accept friendship [boyd and Ellison, 2008]. In 1999, LiveJournal was lunched at the same time the Korean Virtual Worlds site Cyworld, was also launched, and Cyworld added some new social networking features to their site in 2001[boyd and Ellison, 2008]. In 2001, Ryze.com was launched, which provided a new feature that could manage business networks[boyd and Ellison, 2008]. In 2002 Friendstar was launched [boyd and Ellison, 2008]. Which is the first famous social networking site that allowed users to create their own profile as well as to control it [Dwyer et al., 2007]. In 2003 “the social network sites proliferated quickly” [Kamel Boulos and Wheeler, 2007] and social networking sites appeared that collected data about specific subjects and then saved it as a user profile which could be shared between other site members [Kamel Boulos and Wheeler, 2007]. 2.3. Growth of Social Networks Informal social networks have been there since the beginning of the web [Kamel Boulos and Wheeler, 2007]. "Social networks are growing in size, with hundreds of millions of user accounts between them" [Golbeck, 2006]. Members within social networks are increasing every day. In 2008 Facebook had 67 million users and more than half of them spent 20 minutes per day on the site [Park et al., 2009], and by the spring of 2012 the number of users had increased to 901 million [Larson, 2012]. According to a recent poll, 22% of teenagers log on to their favourite social media sites more than 10 times a day [O'Keeffe and Clarke-Pearson, 2011]. There are, (at present, around 165,000,000 users on social networks [Golbeck, 2006]. Other statistics indicate that Facebook has more than 400 million users, while Twitter has more than 40 million users who are exchanging over 50 million tweets per day [Polakis et al., 2010]. Today, more than 145 million users send, on average, 90 million ‘tweets’ per day, each consisting of 140 characters or less [Kietzmann et al., 2011]. In April 2006 the most visited social networking websites were Facebook, MySpace and Friendster [Fogel and Nehmad, 2009]. At that time, the most popular social networking website is Facebook at 90% [Stutzman, 2006] and another study reports that Facebook use as most popular with 78.8% who ‘‘sometimes” or ‘‘often” use Facebook [Hargittai, 2007]. MySpace used to be the most popular website with 38.4 million visitors [Fogel and Nehmad, 2009]. All these numbers show that social networking sites are attracting millions of users with their unique features. In 2012 there were 140 billion ‘friend’ connections [creotivo, 2012]. In March 2012 the number of Facebook users reached 835,525,280 throughout the world [InterentworldStats, 2012]. In May 2012 the total number of registered users on Twitter was 500,000,000, and later on in the same year the total number of active users had reached 140,000,000 [Bennett, 2012]. 3. Social networks and Health/Medicine Social networks are the most effective way of sharing knowledge between clinicians, their patients, and members of the general public [Kamel Boulos and Wheeler, 2007]. Patients always need more information about their medicines and health from their providers (doctors, organizations etc.). Such needs necessitate a mechanism to act as a social enabler so that people can communicate with each other, and so as to enable two-way communication between healthcare seekers and healthcare providers [Kamel Boulos and Wheeler, 2007]. Therefore, social networks play an important role as an enabler in health care, for organizations, clinicians and patients [Kamel Boulos and Wheeler, 3

2007]. The advance in technology and the appearance of social networks has expanded to reach the field of health care without reaching the traditional doctor’s surgery [Hesse et al., 2005]. For example, patients who suffer from diabetes communicate and share personal clinical information with other patients and doctors through Facebook in order to receive feedback, guidance and emotional support [Greene et al., 2011]. 3.1. The type of social networks used for health and medicine In recent years the new Web 2.0 technologies have always been considered a hot topic. Web 2.0 is a term describing the new collaborative Internet [McLean et al., 2007], and allows patients to share and distribute electronic health records. Both patients and clinicians can gain secure access to these records regardless of their location, and with high speed of access [Kamel Boulos and Wheeler, 2007]. Wikis, blogs and podcasts are some other types of Web 2.0 applications that are used by patients and doctors to exchange information about health [McLean et al., 2007]. A blog is "an informal online journal, usually reflecting the author’s personal thoughts [McLean et al., 2007]. An example of a blog for health is DrugScope [Kamel Boulos and Wheeler, 2007; Drugscope, 2013]. Nowadays there are more than twenty social networking sites relating to health such as PatientsLikeMe, CureTogether, DailyStrength, MedHelp, HealthChapter, MDJunction, Experience Project, peoplejam, and OrganizedWisdom [Swan, 2009]. The largest and the most famous one is PatientsLikeMe [Swan, 2009]. These online groups for health are often called the online equivalent of a doctors’ lounge [Hawn, 2009]. Some of these sites are dedicated to the patients and some sites are dedicated to professionals in health. Table 1, in Appendix A, summarizes the social networks related to professionals. The broad adoption of these Web 2.0 technologies in the health field have led to a new term which is “Medicine 2.0” [Kargioti et al., 2010]. Medicine 2.0 is defined as comprising “web-based services for health care consumers, caregivers, patients, health professionals, and biomedical researchers who use Web 2.0 technologies, as well as semantic web and virtual reality tools to enable and facilitate specifically social networking, participation, apomediation, collaboration, and openness within and between these user groups” [Kargioti et al., 2010; Eysenbach, 2008]. ‘Participation’, which allows end users to get more involved and empowered for participation and engagement with other users, and Wikis are the best examples of this theme [Eysenbach, 2008]. ‘Apomediation’ is “a new socio-technological term that was coined to avoid the term “Web 2.0” in the scholarly debate, and it characterizes the ‘third way’ for users to identify trustworthy and credible information and services” [Eysenbach, 2008]. ‘Collaboration’ means “to connect groups of people with each other who have not, or have insufficiently, interacted with each other” [Eysenbach, 2008]. A social network is at the center of Web 2.0 for use in health and medicine [Eysenbach, 2008]. As an example, traditionally, clinicians can record the information of patients in electronic records but there is no relationship or interaction between patients and doctors [Eysenbach, 2008]. Social networks provide the interaction and communication between them using these electronic records [Eysenbach, 2008]. There are many channels patients use to reach the physicians [Beacon, 2011]. These channels are: e-mail with 66%; direct mail, with 62%; medical conferences, with 62%; mobile-optimized smart phone, with 17%; social media, which has 28%; e-detailing, 34%; and the web, with 48% [Beacon, 2011]. The best type of social media is social networking. There are many types of social network which are used for medical and health care. For example, the LibraryThing Medicine Group [Kamel Boulos and Wheeler, 2007; Librarything, 2012]. Another example is the MySpace ‘CURE DiABETES group’ [Myspace, 2012] run by patients and supporters [Kamel Boulos and Wheeler, 2007]. Facebook provides a forum for reporting personal problems and allowing patients to ask questions [Greene et al., 2011]. Internet-based social networks can enable communication, interactions, collaboration and information collection and sharing experiences in the health care arena [Keckley and Hoffmann, 2010]. Internet users have gained great benefits from using the internet for health and medicine [Nicholas et al., 2004]. For example, the website PatientslikeMe [patientslikeme, 2013] provides patients with a way to access information and learn from real life [Keckley and Hoffmann, 2010]. Moreover, Medhelp [Medhelp, 2013], which has just begun as a social networking site, offers a number of tools for pain, weight and other chronic conditions [Keckley and Hoffmann, 2010]. Social networking websites have proliferated in recent years. In this research, researchers sifted the Internet and other research studies in the field and, hence, classified the social networking sites that are used in healthcare systems in two groups: healthcare professionals and healthcare seekers. Table 1, in ‘Appendix A’ shows the social media sites for the first group. The list of social media sites for healthcare seekers can be requested from the authors. 4

3.2. The increasing use of social networks in health Keckley and Hoffmann (2010), in their report, find that 60% of the surveyed physicians and 65% of surveyed nurses are interested in using social networks for professional purposes. 90% of 18 to 24 year olds said they would trust medical information shared by others on their social media networks [Miller, 2012]. Moreover, studies show that 74% of all US adults use the Internet, and 61% have looked for health or medical information on the Internet [Cohen and Adams, 2011]. Also, 49% have accessed a website that provides information about a specific medical condition or problem [Cohen and Adams, 2011]. The National Health Interview Survey (NHIS), in their data, find that among adults aged 18 and over, women are more likely than men to have used the Internet for health information (50.9%)[Cohen and Adams, 2011]. As the Internet is increasingly used by individuals in health, the study of information technology in health is also increasing, and has become an important field to be studied by researchers. For example, the HINARI Research in Health website has collected around 9000 journals and 7000 books to distribute to 5200 institutions in 115 countries and territories in 2013 [Board, 2013]. This will help to access all the health literature, knowledge and research related to health [Board, 2013]. The May 2011 Pew Research Center’s Internet study shows that, of 3,001 US adults surveyed, approximately 80 percent of the internet users use online media for healthcare information [KPMGInternational, 2011] 3.3. General impact There are several paths by which social networks can affect the communication patterns and uptake information presented on social networking sites [Sales et al., 2010]. Because of the limited capacity for self-regulation, recent research indicates that children are at risk when using social networks [O'Keeffe and Clarke-Pearson, 2011]. Social networks can impact children by provoking certain behaviours (e.g. bullying, clique-forming and sexual experimentation) and can also lead to other problems (e.g. internet addiction, sleep deprivation and privacy issues) [O'Keeffe and Clarke-Pearson, 2011]. Other research indicates that social networks may not increase the number of strong ties between members [Valenzuela et al., 2009] which means that the relationship between members within social networks can be weak and there may not be much co-operation between members. A new phenomenon is appearing which called ‘Facebook depression’. This manifests itself when people go on Facebook for a long time and they start feeling depressed which can lead to isolation [O'Keeffe and Clarke-Pearson, 2011]. On the other hand, social networks can impact positively on an organization as SNs allow employees throughout the organization to share their knowledge [Chow and Chan, 2008]. The other positive impacts of social networking include [O'Keeffe and Clarke-Pearson, 2011]: 1. Community engagement through raising money for charity and volunteering for local events, including political and philanthropic events. 2. Enhancement of individual and collective creativity through the development and sharing of artistic and musical endeavours. 3. The growth of ideas through the creation of blogs, podcasts, videos, and gaming sites 3.4. The Impact of Social Networks on Health and Medicine When adopting technologies like electronic health records (EHRs) the organization can improve efficiency and patient care [Jones et al., 2010]. In addition, EHRs “can be used for the digital input, storage, display, retrieval, printing, and sharing of information contained in a patient’s health record” [Black et al., 2011]. Thus social networks can have a significant impact in the health care industry [Keckley and Hoffmann, 2010]. Social networking health sites provide many different services: for example, clinical trials access, (quantified self-tracking physician Q&A), and emotional support and information sharing [Swan, 2009]. These services have a great impact on the users of these sites. Physicians use these services by sharing insights about medicine and specific diseases [Hawn, 2009]. Social networks give an opportunity for patients and doctors to collaborate and share information In the area of personal healthcare data [Almansoori et al., 2012]. Social networks provide a good opportunity for professionals to share their ideas about healthcare, and to post articles/ papers in medical journals [KPMGInternational, 2011]. In addition, social networks help to reduce the cost to healthcare providers as they do not have to use paper, telephone calls and other overhead components [KPMGInternational, 2011] 4. Findings and Discussion 4.1. An overview of the participants 67% of the participants were male and 33% were female, most of them being from Asia (97%). 53% of them rated their skills in using computers and the Internet as medium and 37% as high. This high confidence must be the reason why the majority of them (92%) are using social media. The surveyed healthcare professionals had different specialties: 23% of them were physicians or pharmacists; 20% were nurses and 10% were surgeons. 5

4.2. Usage of social networks The surveyed healthcare professionals have used social networks for varying periods of time. The longer they have been using them, the more experienced the professionals have become in using the tools. Out of the surveyed professionals, 60% have been using social networks for more than two years, 23% of have used them for a period of between 1 to 2 years, and only 17% have used them for less than 1 year. Although the majority of the participants have used the social networks for more than two years, most of them are not using social networking sites that are specific to health and medicine. Only 17% of them are using Librarything and Patientslikeme and 10% are using Patients.about. However, 45% of the healthcare staff members are using other types of social network such as Facebook and Twitter. These latter sites are not designed for healthcare professionals but, rather, for more general services such as communication, creating user profiles and pages and posting articles on different subjects (e.g. in educations, health, business, etc.). Healthcare professionals are using social networks mainly for getting news and media (37%), for doing their research (27%) and to communicate with their family and friends (10%). 4.3. The benefits of using social networks Social networks have general benefits as well as specific benefits for healthcare professionals. The general benefits as highlighted by the participants are: 1. They increase efficiency and effectiveness at work. The majority of the participants said that this was how they received the most benefit from using social networks at work. They also saved time and cost when they did their tasks, and the quality of their work improved. 2.

They increase patient satisfaction by enabling them to communicate with each other. Most of the participants chose this benefit. They could see that social networks had increased patient satisfaction by enabling them to communicate with each other. Even when we asked them, “Do you advise patients to use social networks to find solutions for their health problems?”, the majority of them said “Yes”. They have good reasons to advise patients to use social networks. Two of these reasons are that patients can get cured by sharing information and can find medicines without seeing doctors. In addition, they get detailed medical information from social networks about their problem and will have more time to research it and come up with questions for the doctors, as well as being able to share their experiences with other patients who have similar conditions. However, the patients much choose a trustworthy site which provides them with accurate information and treatment. However, some participants do not advise their patients to use social networks to search for solutions to their diseases because they may get hurt if they receive incorrect information. In addition, some doctors declare that “We have a lot of patients and they keep us busy all day with their questions. The patient must continue to communicate with the doctor through the network constantly”. The main task in a doctor’s job is taking care of their patients and helping them by answering questions and providing them with appropriate medicine. Saving time and providing flexibility in their work (you can contact patients and reply to them any time). Most of the participants have chosen this as the greatest benefit for healthcare staff, who can gain from using social networks generally. This benefit is the most appropriate for those doctors who are busy. They can work anytime and anywhere.

Healthcare professionals also stated that they gained specific benefits/opportunities using social networking in their professions. The benefits/opportunities that were selected by most of the participants are as follows: 1. Increasing patients’ hopes of being cured. 2. Increasing profit (if you are selling medicine). 3. It is an effective way for health professionals to work from home (answering patients’ questions) instead of sitting in a traditional office. 4. It is an easier way to access patients’ profiles than by using electronic records. 5. It reduces costs and saves time. 4.4. Reasons for using/not using social networks in health The healthcare professionals, when asked about the main reasons that attract them into using social networking, highlighted the following reasons: 1. Peer pressure i.e. because all their peers are using it 6

2. 3. 4. 5.

To search for new articles To search for solutions to patients’ problems To communicate with patients To answer patients’ questions and give them advice

The majority of the participants said that the main reason for using social networking was peer pressure. This means that they started using social networks through social influence, either from their peers/colleagues or from their friends and family, or both. On the other hand, there are issues that cause some professionals in healthcare to stop using social networks. For example, the majority of professionals who stopped due to time concerns, claiming that they didn’t have time to waste on social networking. Another stated reason was the difficulty of choosing between too many social networking sites. It seems that they face problems in choosing ones that are the most efficient and appropriate for them. Another issue is privacy concerns: since many people consider their health records to be confidential, to be able to tell the truth and make sure the information won’t get into the wrong hands is a big concern in the field of health and medicine. Another very important point is that many health care professionals think that patients might exaggerate their problems online and hence they cannot give advice without a proper medical diagnosis, which would require seeing patients face to face. 4.5. Obstacles encountered in using social networks One of the main objectives of this research was to explore the obstacles that dissuade healthcare professionals from using social networks. After examining data the collected it became clear that they have some solid and very common concerns. There are four main issues which are considered as being the main reasons for healthcare professionals not using social networks. 1. Privacy concerns 2. Time concerns 3. There are too many of them; which one to choose? 4. Their institution does not yet recognize them as being accredited media. The privacy issue of patients records was the main concern, and the one most stated by healthcare professionals. There are many researchers who have studied the privacy issue. For example, [Talukder et al., 2010] in their research, presented a privacy protection tool called Privometer “that measures the amount of sensitive information leaked in a user profile and suggests self-sanitization actions to regulate the amount of leakage”. 4.6. Organization, Technical Infrastructure and Support We asked participants: “Do you believe that the telecom providers provide the appropriate technical infrastructure and support for the access to, and use of, SNs?” 57% of the participants said “Yes” and 20% of them said “No”. 17% of them said “To some extent”. However, the majority of healthcare professionals believe that their organizations do not support them in this regard. Therefore, when asked whether they believed that their organizations (hospitals) provided enough technical infrastructure and support to access and use SNs, 57% of them said “No” and 7% of them said “Yes”. 20% of them said “To some extent”. 5. Conclusions As social networks have a significant impact on various aspects life, they have an impact on the healthcare sector too. They provide emotional support, medical information and solutions to patients’ diseases. They are also efficient and effective when healthcare professionals use them in their work. In addition, they save time and provide flexibility within the work. The sites which are dedicated to health and medical issues are not known or used by healthcare professionals in Oman. Most of them are using general social networks like Facebook. The healthcare professionals said that their organizations do not support them, although the technical infrastructure to access them is provided by telecom providers.

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Healthcaresuccess, (2012), Healthcaresuccess, Accessed on 10/12/2012, Available at: [www.healthcaresuccess.com] Hesse, B. W., Nelson, D. E., Kreps, G. L., Croyle, R. T., Arora, N. K., Rimer, B. K. and Viswanath, K., (2005), Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey, Archives of Internal Medicine, vol. 165 (22), pp. 2618. InterentworldStats, (2012), FACEBOOK USERS IN THE WORLD Facebook Usage and Facebook Growth Statistics, Accessed on 17/05/2013, Available at: [http://www.internetworldstats.com/facebook.htm] Jones, S. S., Adams, J. L., Schneider, E. C., Ringel, J. S. and McGlynn, E. A., (2010), Electronic health record adoption and quality improvement in US hospitals, Am J Manag Care, vol. 16 (12), pp. SP64-SP71. Kamel Boulos, M. N. and Wheeler, S., (2007), The emerging Web 2.0 social software: an enabling suite of sociable technologies in health and health care education1, Health Information & Libraries Journal, vol. 24 (1), pp. 2-23. Kargioti, E., Kourtesis, D., Bibikas, D., Paraskakis, I. and Boes, U., (2010), MORMED: Towards a multilingual social networking platform facilitating Medicine 2.0, In the proceeding of XII Mediterranean Conference on Medical and Biological Engineering and Computing 2010, 971-974 Keckley, P. H. and Hoffmann, M., (2010), Social networks in health care: Communication, collaboration and insights, Deloitte Center for Health Solutions. Retrieved from http://www. deloitte. com/assets/DcomUnitedStates/Local% 20Assets/Documents/US_CHS_2010SocialNetworks_070710. pdf. Kietzmann, J. H., Hermkens, K., McCarthy, I. P. and Silvestre, B. S., (2011), Social media? Get serious! Understanding the functional building blocks of social media, Business Horizons, vol. 54 (3), pp. 241-251. KPMGInternational, (2011), Increasing Importance of Social Media in Healthcare., Accessed on 17/5/2013, Available at: [http://www.kpmg.com/Global/en/IssuesAndInsights/ArticlesPublications/Issues-monitorhealthcare/Documents/im-healthcare-october-2011.pdf] Larson, D., (2012), Infographic: Spring 2012 Social Media User Statistics, Accessed on 9/November, Available at: [http://blog.tweetsmarter.com/social-media/spring-2012-social-media-user-statistics/] Librarything, (2012), Medicine, Accessed on 8/12/2012, Available at: [www.librarything.com/groups/medicine] Magalhães, C., Souza, E., Jorge, C. N. and Vilar, G., (2013), Recommender Systems: an Experience with GenNet health-care Social Network, In the proceeding of eTELEMED 2013, The Fifth International Conference on eHealth, Telemedicine, and Social Medicine, 276-279 McLean, R., Richards, B. H. and Wardman, J. I., (2007), The effect of Web 2.0 on the future of medical practice and education: Darwikinian evolution or folksonomic revolution?, Medical Journal of Australia, vol. 187 (3), pp. 174. Medhelp, (2013), MedHelp it's your health, Accessed on 25/2/2013, Available at: [http://www.medhelp.org/] MedicalMingle, (2012), MedicalMingle, Accessed on 8/12/2012, Available at: [http://www.medicalmingle.com/] Miller, M., (2012), 33% of U.S. Consumers Use Social Media for Health Care Info [Survey], Accessed on 2/5/2013, Available at: [http://searchenginewatch.com/article/2169462/33-of-U.S.-Consumers-Use-Social-Media-forHealth-Care-Info-Survey] Musiał, K. and Kazienko, P., (2013), Social networks on the internet, World Wide Web, vol. 16 (1), pp. 31-72. MyMedPort, (2012), MyMedPort, Accessed on 6/12/2012, Available at: [http://www.mymedport.com/] Myspace, (2012), cureDiABETES, Accessed on 25/2/2013, Available at: [http://www.myspace.com/] Newman, M. E. J., Watts, D. J. and Strogatz, S. H., (2002), Random graph models of social networks, Proceedings of the National Academy of Sciences of the United States of America, vol. 99 (Suppl 1), pp. 2566-2572. Nicholas, D., Huntington, P. and Williams, P., (2004), Digital consumer health information and advisory services in the UK: a user evaluation and sourcebook. O'Keeffe, G. S. and Clarke-Pearson, K., (2011), The impact of social media on children, adolescents, and families, Pediatrics, vol. 127 (4), pp. 800-804. Onmedica, (2012), Onmedica, Accessed on 10/12/2012, Available at: [http://www.onmedica.com/default.aspx] OzmosisESP, (2012), OzmosisESP, Accessed on 6/12/2012, Available at: [http://ozmosis.com/] Park, N., Kee, K. F. and Valenzuela, S., (2009), Being immersed in social networking environment: Facebook groups, uses and gratifications, and social outcomes, CyberPsychology & Behavior, vol. 12 (6), pp. 729733. patientslikeme, (2013), patientslikeme, Accessed on 25/2/2013, Available at: [http://www.patientslikeme.com/] Polakis, I., Kontaxis, G., Antonatos, S., Gessiou, E., Petsas, T. and Markatos, E. P., (2010), Using social networks to harvest email addresses, In the proceeding of Proceedings of the 9th annual ACM workshop on Privacy in the electronic society, 11-20 9

Roberson, Q. M. and Colquitt, J. A., (2005), Shared and Configural Justice: A Social Network Model of Justice in Teams, Academy of Management Review, vol. 30 (3), pp. 595-607. Sales, A. E., Estabrooks, C. A. and Valente, T. W., (2010), Study protocol The impact of social networks on knowledge transfer in long-term care facilities: Protocol for a study. Sermo, (2012), Sermo, Accessed on 6/12/2012, Available at: [http://www.sermo.com/] Studentdoctor, (2012), Studentdoctor, Accessed on 10/12/2012, Available at: [http://studentdoctor.net/] Stutzman, F., (2006), An evaluation of identity-sharing behavior in social network communities Journal of the International Digital Media and Arts Association vol. 3.1 (2006), pp. 10-18. Swan, M., (2009), Emerging patient-driven health care models: an examination of health social networks, consumer personalized medicine and quantified self-tracking, International journal of environmental research and public health, vol. 6 (2), pp. 492-525. Talukder, N., Ouzzani, M., Elmagarmid, A. K., Elmeleegy, H. and Yakout, M., (2010), Privometer: Privacy protection in social networks, In the proceeding of Data Engineering Workshops (ICDEW), 2010 IEEE 26th International Conference on, 266-269 Valenzuela, S., Park, N. and Kee, K. F., (2009), Is There Social Capital in a Social Network Site?: Facebook Use and College Students' Life Satisfaction, Trust, and Participation1, Journal of Computer‐Mediated Communication, vol. 14 (4), pp. 875-901. Zhou, X., Xu, Y., Li, Y., Josang, A. and Cox, C., (2012), The state-of-the-art in personalized recommender systems for social networking, Artificial Intelligence Review, vol. 37 (2), pp. 119-132.

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Appendix A: Social Networking sites for doctors and employees in healthcare field

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Table (1): Social Networking sites for doctors and employees in healthcare field Social Networking URL/Ref. Short Description Websites Doctors.net.uk http://www.doctors.net.uk/ The UK’s largest professional network of [Doctors.net, 2012] doctors. Sermo http://www.sermo.com/ is the largest online community. It contains [Sermo, 2012] over 125,000+ physicians in 68 specialties. It is an online Physician community where users can collaborate on difficult cases, exchange observations, get help with patient care, practice management and more. The student doctor http://studentdoctor.net/ A nonprofit educational organization for network. [Studentdoctor, 2012] health Biomedexperts www.biomedexperts.com/ is literature-based scientific social network [Biomedexperts, 2012] that helps bring biomedical researchers together and share information online. It contains :  425,000 registered members.  1,800,000 pre-generated profiles of life science researchers.  s2,700 academic & corporate organizations. DoctorsHangout http://www.doctorshangout.com/ Is an exclusive next generation social [Doctorshangout, 2012] networking service for Medical Students, Residents and Doctors. Medical Mingle http://www.medicalmingle.com/ is a social network for people interested in, [MedicalMingle, 2012] working in, servicing, or studying for a career in the healthcare and medical field. Onmedica http://www.onmedica.com/default Taking medical information further and the .aspx content of this website is intended for [Onmedica, 2012] healthcare professionals only. Healthcaresuccess www.healthcaresuccess.com/ Healthcare Success Strategies is a full[Healthcaresuccess, 2012] service medical marketing company that serves healthcare organizations of all sizes, including medical practices, hospitals, dental manufacturers, pharmaceuticals and other healthcare organizations and practices. Health.harvard http://www.health.harvard.edu/ Harvard Health Publications is the media [Health.harvard, 2012] and publishing division of the Harvard Medical School of Harvard University, under the direction of Dr. Anthony Komaroff, Editor in Chief. The goal of our publications is to bring people around the world the most current health information that is authoritative, trustworthy, and accessible, drawing on the expertise of the 10,000+ faculty physicians at Harvard Medical School. MyMedPort http://www.mymedport.com/ is a social network for healthcare [MyMedPort, 2012] professionals who are seeking information 11

OzmosisESP

http://ozmosis.com/ [OzmosisESP, 2012]

DocCheck

http://www.doccheck.com/ [DocCheck, 2012]

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and resources for business and a place where professionals can network with one and another in the industry. is a care collaboration platform that enables hospital systems and life science firms to drive collaboration around any clinical content, user group and workflow. It is a social network that provides physicians a resource where they can turn daily for trusted and reliable clinical, practice management and health policy information. It is the largest community of healthcare professionals in Europe. It offers information and services centred on medicine, for example, the edition of DocCheck News, the medical image database DocCheck Pictures, the extensive medicine wiki DocCheck Flexikon, an online store with nearly 40,000 medical products and much more.

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