The purpose of this study was to assess the degree to which SHDs were using social media and how they used it. The majority of SHDs are using at least one social media application with rates similar to large companies [14
], charities [15
], and nonprofit organizations [19
]. However, compared to these organizations, a greater percentage of SHDs used Twitter. The overwhelming preference for Twitter may be associated with keeping the public up-to-date with SHD-related news. Yet Twitter is used by less than 13% of internet users [13
], indicating a mismatch with audience preference for receiving information.
SHD's social media use varied by population density. These findings are in contrast to previous research that found no difference in individual use of social networking sites by urban or rural location [11
]. The results are similar to a study that showed rural hospitals used social media less frequently than urban hospitals [20
]. Additionally, on a typical day, people living in rural areas are less likely than urban residents to visit a video sharing site [21
] and only 9% of Twitter users live in rural areas [22
Audience reach with social media was limited. Relative to a state's population, the proportion of people who comprised followers, friends, and subscribers was small. An audience member's demographic characteristics, including occupation or professional affiliations, are unknown on social media applications. It is possible that the audience is the general population, or other public health professionals, including SHD employees.
Social media is more than another communication channel. As mentioned previously, there are several ways SHDs can use social media. If utilized effectively, social media has the potential to improve the way public health agencies engage, interact and communicate with its various audiences. Specifically, social media are technologies that facilitate opportunities for engaging with the audience [1
] and for creating and maintaining relationships [23
]. If public health agencies can use social media to engage their audiences and create relationships, something that has previously been hindered by time and distance restrictions, then they are one step closer to establishing true community-based partnerships to address public health problems.
This study showed that, SHDs are not capitalizing on social media's interactive potential. Their one-way social media communication pattern is similar to the results of an analysis of politicians and government agency Twitter posts that revealed the most common purpose was a one-way sharing of public information [24
]. Very few of the audience members were viewing the videos or photos. Using comments and likes as a proxy measure for reading posts, relatively few engaged in reading. A like indicates that a person has at least read a post or watched a video, and while there was a greater proportion of likes than comments received, it is only part of the engagement process. Research shows that if a person likes a product page, they are more likely to buy the brand, recommend the brand to others and share branded content [25
]. However, liking the page does not result in purchasing the product. This may be true for public health as well. Liking a page or a post may not equal following behavioral recommendations or participation in public health programs.
There may be a few reasons why SHDs have limited social media interaction. The first may be that there is a mismatch between the content that is posted and audience preferences. SHDs are posting and tweeting about health topics and not about the agency. The health topics may be a reflection of the national health observances that were occurring during February and March, including American Heart Month, National Nutrition month, National School Breakfast Week, and Colorectal Cancer Awareness Month. If the audience is primarily other health professionals, general health content may generate fewer comments. If the audience is the general public, the content may be poorly developed or the topics may be of little interest. The majority of Facebook posts were auto feeds, meaning there was little thought given to matching the content with audience preferences for information. SHDs cannot assume that because they post content on a social media application that people will respond. It is important to communicate information in a way that reflects the audience preferences, stimulates response or discussion, and is tailored to the social media application.
Public health agencies use of social media is in the early adoption stages. Because social media use is becoming so pervasive, it seems prudent for SHDs to strategically consider how to use it to their advantage. To maximize social media's potential, public health agencies should develop a plan for incorporating it within their overall communication strategy. We recommend a framework posted by Bernoff and Li as a starting point [23
]. The agency must identify what audience they are trying to reach, how that audience uses social media, what goals and objectives are most appropriate, and which social media applications fit best with the identified goals and objectives.
Some study limitations should be noted. First, there is not a universally accepted standard for which social media metrics measure presence, reach, or interactivity. Second, we identified the SHD as using social media if there was an institutional account as identified on the health department website home page. It is possible that individual programs or organizational units within a health department are using social media independent of a department-wide coordinated effort. Lastly, this was a cross-sectional study to establish a baseline of social media use by SHDs.