Leveraging Social Media for Health Behavior Change

Sherry Pagoto, PhD@DrSherryPagotoAssociate Professor of MedicineFounder, UMass Center for mHealth and Social MediaUniversity of Massachusetts Medical School

Social contagionSocial contagionObesity is “socially contagious” such that people are significantly more likely to be obese when they have an obese spouse and/or friends (Christakis and Fowler, 2007)

Health habits are also shared in social circles

Challenge: To get healthier, you’re gonna need to find some healthy friendsGood news: If you adopt healthy behaviors, your family and friends may be more inclined to.

Peer-to-peer healthcarePeer-to-peer healthcare34% of internet users have read about someone else’s experience with a health condition on the internet (Pew Internet Survey 2012)

Susannah FoxCTO at Dept Health and Human

Services

Tweeting it off: Characteristics of Tweeting it off: Characteristics of People Who Tweet Their Weight People Who Tweet Their Weight

Loss JourneyLoss Journey

Purpose: to describe adults who use Twitter during a weight loss attempt and to compare the positive and negative social influence they experience from their offline friends, online friends, and family members.

Pagoto et al 2014 Journal of American Informatics Association

MethodsMethodsInvestigators tweeted the survey 58 times to get 100 complete responses for 1.72 surveys/tweetTweet: “Do you tweet about your weight loss journey? Complete a brief survey!”Survey evaluated:

– 5 areas of positive social influence for weight loss (comfort, helpful, informative, supportive, fun)

– 2 areas of negative social influence for weight loss (embarrassment, judgmental)

ParticipantsParticipants• 100 surveys completed• 82% female, mean age = 37.65 (range 21-58)• BMI = 32.0 (SD = 8.70); 23% were normal weight,

24% were overweight, and 53% were obese• Mean weight lost in current weight loss effort 43.72

lbs (SD=43.33; median= 28 lbs; range= 13-204 lbs)

A successful bunch of folks!

Positive InfluencePositive Influence*

*p<.01

Negative influenceNegative influence

*

*p<.01

What is going on?What is going on?People who tweet about their weight loss journey may be lacking support from in person ties (family in particular!)

Social network is hand-crafted, negative forces are easier to eliminate than in-person connections

Can we deliver weight loss counseling via an online social

network?

Get Social Pilot Studies Get Social Pilot Studies Is it feasible to do weight loss counseling via

an online social network?Can we recruit and retain people in this type

of intervention? Might this model be especially suited for

people with depression?

Four sequential phasesFour sequential phases

1. Traditional12 weekly visits (nondepressed)2. 12 weekly visits + Twitter Coaching

(depressed)3. 12 weekly visits + Twitter Coaching

(nondepressed)4. Twitter Coaching (1 visit) (nondepressed)

PrivacyPrivacyParticipants in social network conditions attended an orientation meeting in which they were assisted in setting up private, anonymous accounts using pseudonyms and avatars and to follow each other and the coaches.

Content LibraryContent LibraryFor Twitter only group, content from Diabetes Prevention Program Lifestyle intervention was converted into online articles and/or tweets.Each week’s tweets focused on the weekly topic

Pagoto et al 2016 Adapting behavioral interventions for social media delivery, JMIR

“ “Micro-counseling”Micro-counseling”Coaches login daily to generate discussion, post content, reply, comment, and “favorite/like” participant posts

Interactions on social media are fluid and asynchronous rather than in scheduled chats/meetings

Coach posts are strategically timed to cue healthy choices. Friday afternoon: “Anyone going out to eat tonight? What is the plan for keeping diet on track?”

““In the moment” supportIn the moment” supportPOST: So this is what my work does on Halloween. Does anyone else get a sugar rush just from the smell of sugar? 8:30am

PEER: STEP AWAY FROM THE BREAKROOM!! 9:24a 

PEER: My work has something like that too today! 9:33a

REPLIES:

PEER: Be strong! 9:08am

COACH: Imagine walking out the door knowing you resisted and how good that feels. 9:36aPOSTER: Thanks guys. Some co-workers and I decided to have the office participate in a 5K -- trying to build the health circuit (instead of the sugar and fat circuit). 1:39p

Participant Characteristics

45 participants 94% female74% Caucasian85% full time employmentAge = 46.79 (sd=10.97)BMI = 34.62 (sd= 4.54)

12 Week Results12 Week ResultsCONDITION N Depressed? Mean %

weight loss*% losing ≥5%

Drop-outs

Mean total tweets

Traditional 12 N 3.1% (4.1%)

33% 2 -

12 visits + Twitter group

10 Y 1.2% (3.6%)

20% 1 110.75 (112.40)

12 visits + Twitter group

11 N 3.0% (3.4%)

36% 2 121.90 (127.09) 

Twitter group (1 visit)

12 N 3.0% (3.1%)

42% 0 130.33 (124.06)

*Mean weight loss in DPP at 24 weeks was 6.9%

Other resultsTotal tweets was significantly associated with total weight loss at 12 weeks (r= -.46, p=.02)

FOCUS GROUPLiked best:

Reading about other’s experiencesAccountabilityPosts were “nudges” Support

Liked least: “Not sure what to post,” some discomfort posting about self, and lack of familiarity with Twitter

Engagement conundrumEngagement conundrum

Participants enjoy reading about each other’sexperiences….but at same time were hesitant to post about their own.

Where is the life of the Where is the life of the party?party?A study of an online social

network for smokersrevealed “superusers,” frequent posters who facilitate discussion, promote recruitment and retention, and are “valuable assets to an online social network.” (de Mielo et al 2012)

Can we Can we createcreate superusers? superusers?

Superuser Pilot StudySuperuser Pilot StudyWe randomized 56 participants into two Facebook-delivered weight loss intervention conditions:1.Superuser: 3 randomly selected participant were incentivized to be “superusers,” and given a prescribed posting schedule.2.Standard: No superusers.

Coaches were blinded to study condition.

Superuser InstructionsSuperuser InstructionsPost a status update to the group at least twice a weekAsk questions and/or reply with a comment to the counselor’s posts at least once a dayComment on other group members’ postsCompensation for the week ($25) provided for 2 weekly posts and 7 comments/questionsEmail prompts occurred on day 5 of every week if they were falling behind

What to post?What to post?Successes or difficulties in your weight loss journeyExample: “Walked 3 miles on the treadmill today! I haven’t gone that long in over a year!”Example: “I couldn’t help it, was really tired last night, and caved by stopping for Dunkin Donuts! UGH!”Questions related to weight loss to the coach, to the group, or to an group memberExample: “I need some very low calorie evening snack ideas. I get the urge to snack at night but don’t have many calories left!”Share your favorite recipes or post a pic of your creation, local events, articles, etc. Example: “I tried this new recipe tonight and LOVED it!! <link>Example: “I just signed up for the St Patty’s Day 5K in Worcester. I’m excited!”

InterventionIntervention12 weeks on a “secret” invitation only Facebook page

No intervention visits (only an orientation)

Posts based on evidence-based behavioral weight loss protocol

Two coaches logged in twice a day to generate discussion, field questions, and provide support

Fridays “weigh ins”

ParticipantsParticipantsSuperuser (N=30)

Standard(N=26)

Sex (% female) 90% 92%

Ethnicity (% white) 90% 93%

Age 46.38 (sd=11.47) 47.21 (sd=10.32)

Weight 197.15 (46.49) 183.53 (30.04)Work Status (% full time)

77% 92%

Did Superuser Condition engage more than Standard

Condition? SU (n=27)* ST (n=26) P valueOriginal posts 6 (6) 9 (17) 0.647Comments 51 (37) 43 (52) 0.158Like 145 (188) 70 (89) 0.011Total engagements 202 (215) 122 (147) 0.035

*The 3 “superusers” were not included

12 Week Weight Loss 12 Week Weight Loss ResultsResultsCONDITION N % losing ≥5% Drop-outs

SUPERUSER 30 27% 0 ALL† No incentives‡ 27 30% 0

Incentives 3 0 0

STANDARD 26 23% 3*

*Baseline weight value carried forward used for drop-outs† p=.11 vs standard‡ p=.08 vs standard

What were “superusers” What were “superusers” posts?posts?

39% informational articles21% asked for information 14% motivational image/meme14% reporting a success7% asked for help5% shared a challenge Got the most replies per post

Got the least replies per post

Fully compliant (100% received full incentive each week)

Our ongoing research…Our ongoing research…How do we identify and harness “real” superusers?

Will people engage more when their close ties are in the group?

How can we create an environment that makes people feel safe sharing their experience?

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