Student Forum Use of Social Media to Support Patients with Diabetes Mellitus Rebecca Lee, Heather P. Whitley The prevalence of diabetes is increasing, especially in the elderly population. Unfortunately, many seniors have limited access to ongoing health care, which may hinder improvements in these chronic disease states. Use of social media continues to increase among all populations. Thus, use of this venue to reach patients, including those with diabetes, is a reasonable undertaking. Countryside Diabetes is a Facebook page created and administered by Auburn University Harrison School of Pharmacy faculty and students to reach this growing and often underserved demographic. The aim is to provide ongoing education and support for people affected by diabetes. Information posted on the Web site began addressing usual diabetes-related topics such as nutrition, exercise, and selfcare. Each week the site focused on an individual topic, and specialists collaborated on these efforts, fortifying the site content through a multidisciplinary approach. Membership in the senior population continues to grow and garner participation. Key Words: Diabetes mellitus, Elderly, Electronic media,
Facebook, Geriatric, Public health, Social media, Technology. Abbreviation: QR = Quick response. Consult Pharm 2014;29:53-7.
Uncontrolled diabetes leads to numerous complications, both macrovascular and microvascular, and has a profound affect on the annual death toll and health care costs. In 2011, diabetes contributed to 231,000 deaths and $218 billion in health care dollars.1 Unfortunately, this debilitating and expensive disease affects a large and growing number of Americans; 18.8 million in 2011, which increased by 11.2% from the previous year alone. Diabetes affects the elderly population to a great extent—in 2011, 26.9% of those older than 65 years of age were diagnosed with diabetes.1 Many homebound elderly individuals or those in long-term care facilities have limited access to or ability to use transportation, meaning that they must rely on others to drive them to necessary health care appointments. Therefore diabetes-focused education and social support, supplemental to regular health care appointments, may be limited. An accessible social media site addressing the lack of educational and emotional support in diabetes care would likely be welcomed by many, including the elderly and those limited by transportation or mobility. Use of social networking sites from 2009 to 2011 increased by 150% for those 60 years of age and older.2 A survey of 111 rural Utah patients reported that 68% of those 26 to 40 years of age, 65% of those 41 to 64 years of age, and 43% of those 65 to 75 years of age use social media, with the primary medium being Facebook (66.3%).3 Some caretakers and health care experts use social media to facilitate support among others experiencing similar health complications.2,4 Thus, social media provides a unique opportunity for pharmacists to enhance long-term care facility patient care via an online resource, unhindered by time, space, or distance. The Facebook page, Countryside Diabetes (https://www.facebook.com/ pages/Countryside-Diabetes/250572551717498), is the first school of pharmacy, student-influenced social media site developed to provide support to community members concerned about diabetes. This paper outlines the process used to establish a diabetes-focused online educational and social support system. This model could easily be adapted and applied to other health-related efforts implemented within Facebook or another social media site.
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Student Forum Countryside Diabetes was developed in May 2012 to generate conversation and facilitate idea-sharing among members and to provide diabetes management education in a personal and meaningful way. Since individuals can respond and post ideas as they choose, they are able to help direct conversations and initiate topics discussed on the page. Thus, members can tailor content to suit their individual needs and interests. As diabetes not only affects those who have been diagnosed, but also those living with or around them, the site was also created to provide educational and social support for these groups, which, based on the high prevalence, includes a large number of individuals. As a freely accessible Web page, the initial step was to clearly define and display boundaries for the public through a description and disclaimer (Appendix A). To ensure the site was legally within the privacy bounds of the Health Insurance Portability and Accountability Act, only general information was provided; patient-specific medical advice would not be discussed. If members asked specific personal questions, the site administrators would refer them back to their own health care provider or team. To ensure that all legal restrictions were honored, an attorney reviewed the mission statement and disclaimer. Once the premise of the site was established, content and style of Web site posts were determined. To appeal to a wide demographic, the content covered various diabetesrelated topics. Posts could be informational, provide task-related challenges to improve lifestyle habits, or contain links to particular articles. Most would provide a probing question to stimulate discussion among members. By encouraging responses to posted information, sharing of personal experiences and inquiries, Countryside Diabetes facilitated intramember support and the sharing of ideas. It was essential that all Countryside Diabetes responses to messages and inquiries be respectful, timely, and accurate. Initially, and still to a large degree, membership was expanded by word of mouth. Patients seen in local clinics were told about the social media site. Establishing set days for topics (“Medication Mondays,” “Tasty Tuesdays,” and “Fitness Fridays,”) ensured reliability, variability,
54
and predictability for the membership. “Fitness Fridays” began in August 2012 to provide exercise-focused education and a weekly challenge to help members increase physical fitness, strength, and mobility. Collaboration with a kinesiologist to support the content of “Fitness Fridays” began in April 2013. Examples of specific topics include incorporating strength training into housework, and choosing the right exercise shoes. After allowing the “Fitness Fridays” theme to take root, Countryside Diabetes expanded to “Tasty Tuesdays” in September 2012 through collaboration with a registered dietitian and students studying nutrition. These posts focused on dietary-related information including healthy eating on special occasions, adjusting recipes to lower glycemic loads, nutritional information on various food products, and low-budget nutrition. “Tasty Tuesday” is perhaps the most popular themed day for Countryside Diabetes, as noted by increased membership responses to topics such as cooking with kale, nutritional benefits of pumpkins, or healthy alternatives for classic meals. Countryside Diabetes introduced its third themed day, “Medication Mondays,” in April 2013. These posts, which are authored by a clinical pharmacist and fourth-year pharmacy students, discussed various aspects of medication management. Every five to six weeks, a new medication or class of medications was introduced. Content was then developed and shared each Monday during that time period to provide well-rounded education for the medication class. Topics typically address indications, mechanisms of action, side effects, administration, and adherence. Formulating a collaborative network with a kinesiologist, a registered dietitian, and a clinical pharmacist, including students, has been beneficial from both an administrative standpoint as well as from a patient care perspective. Having several administrators functioning as content experts has alleviated the daily burden placed on any one individual to create and post content. Collaboration has also enhanced credibility so that the membership may have confidence in the information provided. Several posts were developed and shared after the start of all three themed days, introducing each member of the administrative team, defining roles with Countryside
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Use of Social Media to Support Patients with Diabetes Mellitus
Diabetes, and describing levels of expertise and/or educational backgrounds. This informed the membership of each administrator’s knowledge and proficiency, providing participants confidence in the content shared on the Facebook page. Furthermore, this partnership optimizes diabetes care through a multidisciplinary approach, which has consistently demonstrated benefits to patients. Finally, to increase sustainability, provide different viewpoints, and enhance educational efforts, fourthyear student pharmacists on rotation with the Auburn University Harrison School of Pharmacy faculty member, who is coadministrator on the Countryside Diabetes project, are required to research and develop 25 posts for every five weeks of their advanced pharmacy practice experience. These posts are reviewed, edited, and verified by the faculty advisor before being shared on the Web site. The incorporation of students into the administration of Countryside Diabetes not only allows for new creative styles of posts, but also provides a chance for pharmacy students to engage the community in a unique and innovative aspect of public health. Developing and posting new content for the Web site provided students with a way to relate to individuals living with diabetes. Membership development can be difficult without widespread advertisement or financial support. To help expand membership, a quick response (QR) code linking to the site was created and is printed on all related materials, including business cards and promotional flyers (Appendix B). This allows those with smart phones to easily access the site. To expand advertisement outside of local realms, Countryside Diabetes “likes” other local and national sites that are of related content and hold the same or similar goals and objectives, such as the American Diabetes Association, Diabetes Daily, and the regionally recognized Healthy Huntsville. This allows followers of those sites to be exposed to the content of Countryside
Diabetes, which has resulted in increased membership. While success of Countryside Diabetes would best be determined by tracking improvements in members’ diabetes-related surrogate markers, there are two reasons why this is not a reasonable assessment method. First, followers are not required to be diagnosed with diabetes. Second, it would be nearly impossible to gain access to such objective data. Thus, success of the page is determined through the insight trends provided by Facebook and objective benefits noted by the site administrators. Objective data stored on the Insight page of Facebook, which tracks success, include total ‘likes’ (membership), friends of fans, people taking about this, and weekly total reach. Collectively these indices describe the number of individuals specifically following Countryside Diabetes, actively participating, or engaged in the content shared, and those who saw any post provided by the Web site. Measurements also followed by the administrators to determine success include members requesting specific nutritional information, sharing personal struggles and successes, and responding to posts by fellow members offering encouragement and support. In light of the increasing problems posed by diabetes in the geriatric population, and the deficit of social support as a result of transportation and mobility problems, social media is proving to be a useful means of reaching more patients. Education is an integral part of diabetes management, and social media allow health care providers to continuously engage patients and caregivers about different aspects of disease management for any disease state. Not only is it a prime venue for direct education, but it also provides a support system to members that might be their sole outlet for such care. The hope is to provide geriatric patients with the support and opportunities received by younger generations by using a venue that is age-nonspecific.
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Student Forum Rebecca Lee Pharm D, is a PGY1 pharmacy resident, DCH Regional Medical Center, Tuscaloosa, Alabama. At the time of this writing she was a 2013 PharmD candidate, Auburn University Harrison School of Pharmacy, Auburn, Alabama. Heather P. Whitley, PharmD, BCPS, CDE, is associate clinical professor, Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy and associate clinical professor, Department of Community and Rural Medicine, The University of Alabama School of Medicine, Tuscaloosa, Alabama.. For correspondence: Heather P. Whitley, PharmD, BCPS, CDE, The University of Alabama School of Medicine, Tuscaloosa, Institute for Rural Health Research, Box 870326, Tuscaloosa, AL 35487-0326; Phone: 205-348-1333; Fax: 205-348-9417; E-mail: [email protected].
References 1. Diabetes statistics: data from the 2011 National Diabetes Fact Sheet. Alexandria, VA: American Diabetes Association; 2011. Available at http://www.diabetes.org/diabetes-basics/diabetesstatistics/?loc=DropDownDB-stats. Accessed September 30, 2012. 2. Prinz A. Social networking through the ages. Beginnings 2011;31:2, 30. 3. Fischer J, Clayton M. Who gives a tweet: assessing patients’ interest in the use of social media for healthcare. Worldviews Evid Based Nurs 2012;9:100-8. 4. Tsaousides T, Matsuzawa Y, Lebowitz M. Familiarity and prevalence of Facebook use for social networking among individuals with traumatic brain injury. Brain Injury 2011;25:1155-62.
Acknowledgements: The authors would like to acknowledge Sheena Quizon Gregg, MS, RD, LD, at The University of Alabama, for her nutrition-related support of Countryside Diabetes via Tasty Tuesdays; Danielle Wadsworth, PhD, at Auburn University, for contributions related to her expertise in physical activity for Countryside Diabetes via Fitness Fridays; and those Advanced Pharmacy Practice Experience students at Auburn University who contribute to daily posts and membership development. Disclosure: No funding was received for the development of this manuscript. The authors have no potential conflicts of interest. © 2014 American Society of Consultant Pharmacists, Inc. All rights reserved. Doi:10.4140/TCP.n.2014.53
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Appendix A. Description and Disclaimer About Countryside Diabetes An online alliance providing encouragement, and a platform to exchange information, among those living with and caring about diabetes. Description This community of diabetes-minded individuals is being developed to promote a support system that is not hindered by time, space, or distance. The purpose is to generate conversation and facilitate idea sharing among members in efforts to provide new insights and approaches to managing diabetes in a personal and meaningful way. Disclaimer: Countryside Diabetes is not a substitute for your regular health care visits. The operators of this site do not take responsibility for comments, recommendations, or statements posted by other individuals. Any tips or information posted on this site by the administrators is intended to expand support and facilitate discussion. Please consult your health care provider in case of emergency and before changing your diet, exercise, or medications.
Appendix B. Promotional Flyer Including the Quick Response (QR) Code
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Facebook, Geriatric, Public health, Social media, Technology. Abbreviation: QR = Quick response. Consult Pharm 2014;29:53-7.
Uncontrolled diabetes leads to numerous complications, both macrovascular and microvascular, and has a profound affect on the annual death toll and health care costs. In 2011, diabetes contributed to 231,000 deaths and $218 billion in health care dollars.1 Unfortunately, this debilitating and expensive disease affects a large and growing number of Americans; 18.8 million in 2011, which increased by 11.2% from the previous year alone. Diabetes affects the elderly population to a great extent—in 2011, 26.9% of those older than 65 years of age were diagnosed with diabetes.1 Many homebound elderly individuals or those in long-term care facilities have limited access to or ability to use transportation, meaning that they must rely on others to drive them to necessary health care appointments. Therefore diabetes-focused education and social support, supplemental to regular health care appointments, may be limited. An accessible social media site addressing the lack of educational and emotional support in diabetes care would likely be welcomed by many, including the elderly and those limited by transportation or mobility. Use of social networking sites from 2009 to 2011 increased by 150% for those 60 years of age and older.2 A survey of 111 rural Utah patients reported that 68% of those 26 to 40 years of age, 65% of those 41 to 64 years of age, and 43% of those 65 to 75 years of age use social media, with the primary medium being Facebook (66.3%).3 Some caretakers and health care experts use social media to facilitate support among others experiencing similar health complications.2,4 Thus, social media provides a unique opportunity for pharmacists to enhance long-term care facility patient care via an online resource, unhindered by time, space, or distance. The Facebook page, Countryside Diabetes (https://www.facebook.com/ pages/Countryside-Diabetes/250572551717498), is the first school of pharmacy, student-influenced social media site developed to provide support to community members concerned about diabetes. This paper outlines the process used to establish a diabetes-focused online educational and social support system. This model could easily be adapted and applied to other health-related efforts implemented within Facebook or another social media site.
The Consultant Pharmacist january 2014 Vol. 29, No. 1
53
Student Forum Countryside Diabetes was developed in May 2012 to generate conversation and facilitate idea-sharing among members and to provide diabetes management education in a personal and meaningful way. Since individuals can respond and post ideas as they choose, they are able to help direct conversations and initiate topics discussed on the page. Thus, members can tailor content to suit their individual needs and interests. As diabetes not only affects those who have been diagnosed, but also those living with or around them, the site was also created to provide educational and social support for these groups, which, based on the high prevalence, includes a large number of individuals. As a freely accessible Web page, the initial step was to clearly define and display boundaries for the public through a description and disclaimer (Appendix A). To ensure the site was legally within the privacy bounds of the Health Insurance Portability and Accountability Act, only general information was provided; patient-specific medical advice would not be discussed. If members asked specific personal questions, the site administrators would refer them back to their own health care provider or team. To ensure that all legal restrictions were honored, an attorney reviewed the mission statement and disclaimer. Once the premise of the site was established, content and style of Web site posts were determined. To appeal to a wide demographic, the content covered various diabetesrelated topics. Posts could be informational, provide task-related challenges to improve lifestyle habits, or contain links to particular articles. Most would provide a probing question to stimulate discussion among members. By encouraging responses to posted information, sharing of personal experiences and inquiries, Countryside Diabetes facilitated intramember support and the sharing of ideas. It was essential that all Countryside Diabetes responses to messages and inquiries be respectful, timely, and accurate. Initially, and still to a large degree, membership was expanded by word of mouth. Patients seen in local clinics were told about the social media site. Establishing set days for topics (“Medication Mondays,” “Tasty Tuesdays,” and “Fitness Fridays,”) ensured reliability, variability,
54
and predictability for the membership. “Fitness Fridays” began in August 2012 to provide exercise-focused education and a weekly challenge to help members increase physical fitness, strength, and mobility. Collaboration with a kinesiologist to support the content of “Fitness Fridays” began in April 2013. Examples of specific topics include incorporating strength training into housework, and choosing the right exercise shoes. After allowing the “Fitness Fridays” theme to take root, Countryside Diabetes expanded to “Tasty Tuesdays” in September 2012 through collaboration with a registered dietitian and students studying nutrition. These posts focused on dietary-related information including healthy eating on special occasions, adjusting recipes to lower glycemic loads, nutritional information on various food products, and low-budget nutrition. “Tasty Tuesday” is perhaps the most popular themed day for Countryside Diabetes, as noted by increased membership responses to topics such as cooking with kale, nutritional benefits of pumpkins, or healthy alternatives for classic meals. Countryside Diabetes introduced its third themed day, “Medication Mondays,” in April 2013. These posts, which are authored by a clinical pharmacist and fourth-year pharmacy students, discussed various aspects of medication management. Every five to six weeks, a new medication or class of medications was introduced. Content was then developed and shared each Monday during that time period to provide well-rounded education for the medication class. Topics typically address indications, mechanisms of action, side effects, administration, and adherence. Formulating a collaborative network with a kinesiologist, a registered dietitian, and a clinical pharmacist, including students, has been beneficial from both an administrative standpoint as well as from a patient care perspective. Having several administrators functioning as content experts has alleviated the daily burden placed on any one individual to create and post content. Collaboration has also enhanced credibility so that the membership may have confidence in the information provided. Several posts were developed and shared after the start of all three themed days, introducing each member of the administrative team, defining roles with Countryside
The Consultant Pharmacist january 2014 Vol. 29, No. 1
Use of Social Media to Support Patients with Diabetes Mellitus
Diabetes, and describing levels of expertise and/or educational backgrounds. This informed the membership of each administrator’s knowledge and proficiency, providing participants confidence in the content shared on the Facebook page. Furthermore, this partnership optimizes diabetes care through a multidisciplinary approach, which has consistently demonstrated benefits to patients. Finally, to increase sustainability, provide different viewpoints, and enhance educational efforts, fourthyear student pharmacists on rotation with the Auburn University Harrison School of Pharmacy faculty member, who is coadministrator on the Countryside Diabetes project, are required to research and develop 25 posts for every five weeks of their advanced pharmacy practice experience. These posts are reviewed, edited, and verified by the faculty advisor before being shared on the Web site. The incorporation of students into the administration of Countryside Diabetes not only allows for new creative styles of posts, but also provides a chance for pharmacy students to engage the community in a unique and innovative aspect of public health. Developing and posting new content for the Web site provided students with a way to relate to individuals living with diabetes. Membership development can be difficult without widespread advertisement or financial support. To help expand membership, a quick response (QR) code linking to the site was created and is printed on all related materials, including business cards and promotional flyers (Appendix B). This allows those with smart phones to easily access the site. To expand advertisement outside of local realms, Countryside Diabetes “likes” other local and national sites that are of related content and hold the same or similar goals and objectives, such as the American Diabetes Association, Diabetes Daily, and the regionally recognized Healthy Huntsville. This allows followers of those sites to be exposed to the content of Countryside
Diabetes, which has resulted in increased membership. While success of Countryside Diabetes would best be determined by tracking improvements in members’ diabetes-related surrogate markers, there are two reasons why this is not a reasonable assessment method. First, followers are not required to be diagnosed with diabetes. Second, it would be nearly impossible to gain access to such objective data. Thus, success of the page is determined through the insight trends provided by Facebook and objective benefits noted by the site administrators. Objective data stored on the Insight page of Facebook, which tracks success, include total ‘likes’ (membership), friends of fans, people taking about this, and weekly total reach. Collectively these indices describe the number of individuals specifically following Countryside Diabetes, actively participating, or engaged in the content shared, and those who saw any post provided by the Web site. Measurements also followed by the administrators to determine success include members requesting specific nutritional information, sharing personal struggles and successes, and responding to posts by fellow members offering encouragement and support. In light of the increasing problems posed by diabetes in the geriatric population, and the deficit of social support as a result of transportation and mobility problems, social media is proving to be a useful means of reaching more patients. Education is an integral part of diabetes management, and social media allow health care providers to continuously engage patients and caregivers about different aspects of disease management for any disease state. Not only is it a prime venue for direct education, but it also provides a support system to members that might be their sole outlet for such care. The hope is to provide geriatric patients with the support and opportunities received by younger generations by using a venue that is age-nonspecific.
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Student Forum Rebecca Lee Pharm D, is a PGY1 pharmacy resident, DCH Regional Medical Center, Tuscaloosa, Alabama. At the time of this writing she was a 2013 PharmD candidate, Auburn University Harrison School of Pharmacy, Auburn, Alabama. Heather P. Whitley, PharmD, BCPS, CDE, is associate clinical professor, Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy and associate clinical professor, Department of Community and Rural Medicine, The University of Alabama School of Medicine, Tuscaloosa, Alabama.. For correspondence: Heather P. Whitley, PharmD, BCPS, CDE, The University of Alabama School of Medicine, Tuscaloosa, Institute for Rural Health Research, Box 870326, Tuscaloosa, AL 35487-0326; Phone: 205-348-1333; Fax: 205-348-9417; E-mail: [email protected].
References 1. Diabetes statistics: data from the 2011 National Diabetes Fact Sheet. Alexandria, VA: American Diabetes Association; 2011. Available at http://www.diabetes.org/diabetes-basics/diabetesstatistics/?loc=DropDownDB-stats. Accessed September 30, 2012. 2. Prinz A. Social networking through the ages. Beginnings 2011;31:2, 30. 3. Fischer J, Clayton M. Who gives a tweet: assessing patients’ interest in the use of social media for healthcare. Worldviews Evid Based Nurs 2012;9:100-8. 4. Tsaousides T, Matsuzawa Y, Lebowitz M. Familiarity and prevalence of Facebook use for social networking among individuals with traumatic brain injury. Brain Injury 2011;25:1155-62.
Acknowledgements: The authors would like to acknowledge Sheena Quizon Gregg, MS, RD, LD, at The University of Alabama, for her nutrition-related support of Countryside Diabetes via Tasty Tuesdays; Danielle Wadsworth, PhD, at Auburn University, for contributions related to her expertise in physical activity for Countryside Diabetes via Fitness Fridays; and those Advanced Pharmacy Practice Experience students at Auburn University who contribute to daily posts and membership development. Disclosure: No funding was received for the development of this manuscript. The authors have no potential conflicts of interest. © 2014 American Society of Consultant Pharmacists, Inc. All rights reserved. Doi:10.4140/TCP.n.2014.53
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Use of Social Media to Support Patients with Diabetes Mellitus
Appendix A. Description and Disclaimer About Countryside Diabetes An online alliance providing encouragement, and a platform to exchange information, among those living with and caring about diabetes. Description This community of diabetes-minded individuals is being developed to promote a support system that is not hindered by time, space, or distance. The purpose is to generate conversation and facilitate idea sharing among members in efforts to provide new insights and approaches to managing diabetes in a personal and meaningful way. Disclaimer: Countryside Diabetes is not a substitute for your regular health care visits. The operators of this site do not take responsibility for comments, recommendations, or statements posted by other individuals. Any tips or information posted on this site by the administrators is intended to expand support and facilitate discussion. Please consult your health care provider in case of emergency and before changing your diet, exercise, or medications.
Appendix B. Promotional Flyer Including the Quick Response (QR) Code
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