Sunday, March 23, 2014

#YourMomCares: But Is That Enough To Get You Enrolled For Health Insurance?

This week I saved a tweet that read "Celebrity mothers encourage young people to #getcovered."  I thought "celebrity mothers" would be familiar faces- celebrities that have children (e.g., Jennifer Garner, Reese Witherspoon).  So I was a little surprised when I clicked on the video and didn't recognize the faces.  It turns out that the video features mothers of celebrities- specifically the mothers of Jonah Hill, Adam Levine, Alicia Keys, and Jennifer Lopez.  I started out a bit skeptical, feeling like the "celebrity mothers" terms used to market the video could be misleading.

However after viewing the video several times, I think it has some positive characteristics to support the public health efforts to enroll people in a health insurance plan:

(1) Clear Audience: This video is targeted towards any "kid" over 18 years old.  Alicia Keys' mom says, "There is nothing worse for a mom than feeling that her child is not protected- no matter how old they are."

(2) Clear Focus on Qualities that Audience Members Value: No one wants to worry their parents or make them upset.  And certainly no one wants their parents to nag them over and over about something.  We value making our parents proud and happy.  Jonah Hill's mom says, "Taking care of yourself, so your mothers can sleep and have a nice life after all they've done for you, is not too much to ask in my opinion. [If you enroll] We will be so happy and so grateful and we wouldn't ask you to friend us on social media!"

(3) Humor/Engagement:  As a viewer, I could immediately relate to these moms.  They reminded me of people in my family!  They were funny, they told silly anecdotes about their celebrity kids (e.g., Jonah Hill once flooded the elementary school).  Their concern about the safety of their children made you immediately think of your own parents and how much they worry about you when you are sick, hurt, or unprotected.  These moms did a great job of engaging the audience in a short period of time.

(4) Clear Call to Action:  To me, this is the #1 most important quality in a public health video (and usually my #1 critique).  In this video, it was clear what they wanted the viewer to do: get covered, get enrolled for health insurance, and the resource to do so ( was stated both verbally and visually.  First Lady Michelle Obama tells viewers "Go to and enroll today."  The final screen includes the website, social media hashtag for more information/discussion (#YourMomCares), and the enrollment deadline (March 31st).  The viewer has all the key information needed to take action.

That said- I had a few other observations regarding the video and possible improvements:

(1) Does disabling the comment section on the YouTube video discourage conversation about the video and/or the #GetCovered initiative?  Of course the comment section is not always productive (e.g., spammers, abusive comments, etc)- but I wonder about the message sent by a disabled comment section?

(2) Is the video too long or does it wait too long to hit the topic?  The video runs 1 minute, 51 seconds but health insurance is not mentioned until 50 seconds into the video.  Jonah Hill's mom transitions into the topic by saying, "One thing we should never have to put up with is our kid not having health care."  Could they lose viewers by not getting to the point sooner?  Or was that first 50 seconds necessary to engage viewers?

(3) Does the solo focus on "Moms" vs. parents or other guardians limit the audience- or worse alienate any audience members?  I ask because the ad made me think of the recent #ThankYouMom campaign from Proctor & Gamble that ran during the Olympics.  Families are changing and it is no longer (or was it ever??) just moms taking care of children, or worrying about their children, or focusing on domestic responsibilities.  There was frustration with #ThankYouMom and I think we should keep that in mind when these types of campaigns are designed.

What Do You Think?  
I would love to hear feedback on these questions from my readers!:

Monday, March 3, 2014

Medals and Mental Illness: Olympic Athlete Sparks A Dialogue

Today's guest post comes from Julie Maier. Julie has a master’s degree in social work and is currently a PhD student in the Kinesiology Department at the University of Maryland (Physical Cultural Studies focus).  Her research interests focus on the intersection of mental health, gender, sexuality, and the body. If you'd like to get in touch, she can be reached at

Olympic season brings with it a plethora of news stories focused on some of the best athletes in the world.  In addition to factual accounts of Olympians’ performances, human-interest stories and sensationalized gossip pervade the print and online media.  Indeed, one would have to bury his or her head in the snow to avoid hearing about athletes during this time of year.  While many Olympic-centered articles are seemingly trivial, some stand out as having the potential to create a more socially just world.  For example, an Olympian came out describing his struggles with something that remains relegated to doctors’ offices or psychology classrooms: mental illness.  Though athletes’ discussion of mental health can be seen as a way to de-stigmatize this issue, the overall impact is dependent upon informed reporting that does not perpetuate misconceptions about various forms of distress.

  Upon winning the gold medal in the 1,000 meter men’s speed skating event in Sochi, the news reports that followed not only detailed the Dutch athlete Stefan Groothuis’ Olympic win, but his disclosure of his battle with depression.  According to Reuters, Groothuis had struggled with depression for years, which hindered not only his training, but his overall ability to enjoy life.  Casert, in an article by the Associated Press, noted that Groothius’ depression brought him to the point of contemplating suicide.  By opening up about mental illness, Groothius joins a handful of professional athletes who, through the years, have come out as living with particular forms of distress such as depression, borderline personality disorder, bipolar disorder, and obsessive compulsive disorder.

The significance of such attention to mental health issues cannot be overstated.  Though progress undoubtedly is being made to reduce the stigmatization of those who live with mental illness, there is still a long way to go.  For instance, in a 2014 article published in Psychiatry Services, Dr. Jennifer Stuber and colleagues found that negative attitudes towards people with mental illness were prevalent amongst the lay public, as well as some mental health providers.  Participants indicated being particularly afraid of individuals with schizophrenia due to the misperception that such people are inherently dangerous.  Additionally, over two-thirds of the general public and almost one half of mental health practitioners in the study reported not wanting somebody with schizophrenia to marry into their family.  Such stereotypes contribute to an environment in which those suffering from mental health conditions are subject to discrimination, marginalization, and various forms of abuse.  Greater openness about mental health may help to educate the general public about a topic that frequently arises only in light of sensationalized tragedies such as mass shootings, and then quickly disappears, sending the message that those with mental illness are a threat to public safety, and mental health is only appropriate to discuss when lives have been taken.

The fact that professional athletes are stepping out and talking about their experiences with distress is of particular importance.  In the realm of sport, a traditionally (and still!) masculine domain, mental illness is too often equated with weakness.  In fact, historian Dr. Roberta Park (2012) noted that sport was used as a way to toughen up men returning from war who were suffering from what we might now consider a form of post-traumatic stress disorder (PTSD). The idea that mental illness is a form of weakness or an excuse can be seen in many of the responses to NBA player Royce White’s coming out as having obsessive compulsive disorder and generalized anxiety disorder (GAD) in 2012, which included death threats.  Such negative reactions, however, only reaffirm the importance of celebrated athletes speaking up about mental health.

Although self-disclosure is of course not enough in and of itself to drastically change the lives of those living with depression, schizophrenia, or the like, it can have a positive impact on the discourse surrounding mental health.  This is dependent upon the way journalists and others craft and frame the athletes’, and other public figures’, stories.  For example, one headline pertaining to Groothius announced that “Groothuis gold ends years of misery, depression,” while another boasted that “Stefan Groothuis overcomes depression and wins Olympic gold.”  Such framing may perpetuate the misconception that most mental illnesses can be overcome, never to return, as opposed to an ongoing condition whose severity may ebb and flow throughout one’s life--something that can be managed, though never fully cured.  This is not to discount Groothuis’ experience; perhaps he has indeed ‘overcome’ depression. However, for many suffering from depression—particularly, major depressive disorder—they may never be fortunate enough to be totally free from depression (see psychiatrist Peter Kramer’s widely cited book, Against Depression, for more on this).  With that said, the aforementioned headlines may make people with depression who have struggled for years to recover feel further marginalized, while perhaps sending the message that mental illness is temporary.

Additional conversation surrounding mental health is desperately needed, and stories such as Groothius’ help to chip away at the deep-seated misunderstanding and stereotyping pertaining to mental illness.  Hopefully one day athletes coming out with their stories of depression will be a non-issue, but until then, such disclosures are vital for the health of all.

Pop Health Guest Posts

Hello to all my Pop Health readers!  I apologize for the lack of new blog posts since January.  I was planning to go on maternity leave in late March, but my little guy decided to surprise me 8 weeks early on January 29th instead!  He is doing great (thanks to everyone who has reached out).
Since I will be writing less frequently while on maternity leave, I will be integrating some wonderful guest posts on the blog.

Thank you to everyone who has volunteered their time to contribute to Pop Health over the next few months!

Friday, January 10, 2014

Beyond Communication: Social Media Can Help Pay Your Health Care Bills!

Just a few weeks ago, I recapped the "Top 3 Pop Health Trends in 2013".  Topping my list was the intersection between social media and public health.  I've written about using social media for everything in public health from advocacy to emergency response to surveillance.  So I was intrigued to see a recent story that highlighted another innovation:  allowing patients to use social media to pay for health care services.

The "Pay-With-A-Tweet" program was launched by Telecure as a way to market their telehealth services.  They link California residents with an urgent care provider within 15 minutes of their call.  Clinicians are made available to callers via phone or video as a way to reduce access to care barriers.

The "Pay-With-A-Tweet" program will waive the $25 consultation fee if patients share their experiences on Facebook or Twitter.  According to media reports on the program, the idea blossomed after Telecure officials noticed that patients were discussing their experiences on social media.  Creating a formal program allowed Telecure to (1) take advantage of social media marketing and (2) provide those short on cash with an alternate way to pay for care.

Telecure's CEO told mHealth News that the program's goals are currently to "stimulate awareness and growth".

I'd be interested to see how Telecure is evaluating this program and hope to see some follow-up press or research that documents the strengths and challenges of this strategy.

Some thoughts that come to mind for me:

  • To tweet or not to tweet?  How do patient concerns about privacy contribute to their decision to participate in this program?  Many patients may not want to share with their social networks that they've been consulting with a physician (regardless of the diagnosis)- is that a barrier to taking advantage of this program?
  • Is social media heavily utilized among their target populations (patients in remote locations and under served patients)?  What do those user patterns look like?
  • How are tweets/facebook posts about negative experiences being handled?  Are negative posts still being promoted along with positive posts?  How are Telecure officials monitoring posts for customer service problems that may have occurred?
  • How are tweets/facebook posts being promoted to the public?  For example, I searched several hashtags on twitter after seeing the media coverage (e.g., #telecure, #paywithatweet) but was not able to find any results that included reviews of their services.  If they are using social media to market services, they will want the patient posts to be easy to find! 

What Do You Think?

  • Is using social media for payment an effective strategy to engage these and other target populations?
  • What other evaluation questions/considerations should be raised in addition to those I've listed above?

Monday, December 30, 2013

Top 3 Pop Health Trends in 2013

Wrapping up 2013 has given me a great opportunity to reflect on what I have been writing about over the past year.  Looking back over 35+ posts, here are the trends that caught my eye:

1.  Social Media & Public Health:  The intersection of these two topics continues to intrigue us in the public health field and the application of social media is being explored in everything from preparedness to health education.

Pop Health Favorites From 2013:

2.  Celebrities & Public Health:  This is not a new topic by any means.  For decades, celebrities have been health advocates and/or the topic of discussion for a number of public health issues.  However, I highlight it as a trend in 2013 for two reasons.  (1) With the help of social media, celebrities are weighing in constantly on health issues and current events in real time. These opinions can come quickly and casually through Twitter or Facebook...they no longer speak exclusively through publicists and press releases.  (2) Public health is putting an emphasis on evaluating the impact of celebrities on health issues.  *I hope we see more of this in 2014!!

Pop Health Favorites From 2013:

3.  Crowdsourcing & Public Health:  While I haven't written about it as much as I would like, I have been fascinated by the creative use of crowdsourcing in 2013 that has helped advance public health dialogue.  [For those not familiar with the term, "crowdsourcing" is the act of obtaining ideas, content, etc. by soliciting contributions from a large group of people- like Twitter users!]  Specifically I'd like to acknowledge Slate for utilizing this strategy in the #NotDeadYet story I link to below and more recently in their analysis of gun death data.  I think we in public health can learn a lot from the crowdsourcing strategies that Slate has used to engage readers.

Pop Health Favorite From 2013:

2014:  I anticipate that each of these three topics will continue to grow and appear in many Pop Health posts in 2014.  I hope that we see more and more evaluation studies of social media/celebrities/crowdsourcing and their impact on public health initiatives.  I hope these studies are widely disseminated and made accessible to many of us- even if we lack comprehensive access to peer reviewed journals.  If you see such studies, pass them along!  I am hoping to expand my "Research Notes" posts in the upcoming year and would love to highlight such studies on the blog.

What Do You Think?

  • What other 2013 trends in health communication/social media/public health did you see in your work?
  • What new/expanding trends do you anticipate in 2014?

Monday, December 23, 2013

Research Notes: The Angelina Effect

The second most popular Pop Health post of 2013 was "Angelina Jolie's 'Medical Choice' Dominates the Internet" (May 14, 2013).  In that post, I highlighted several public health implications of her op-ed that were being discussed in the media coverage-

(1) Angelina as a "champion" for breast cancer prevention: would her celebrity status help or hurt the cause?
(2) Legal and policy issues with BRCA genetic testing.
(3) Health communication (specifically regarding risk perception).
(4) Reviewing the evidence base for recommending BRCA testing or preventative mastectomies.

When celebrity health stories such as this are publicized, I always keep my eyes peeled to see if any evaluation research or subsequent stories follow.  So I was thrilled to see a peer-reviewed paper released last week that examined the impact of her op-ed.  Authors of "The Angelina Effect: Immediate Reach, Grasp, and Impact of Going Public", conducted a survey which asked participants to report their understanding, reactions, perceptions, and subsequent activities related to the story.  The researchers were especially interested in the public's ability to distinguish the genetic context of Angelina's risk of Breast Cancer from the lower risk that characterizes the vast majority of women who do not carry a BRCA mutation.

Some key findings:

  • Approximately 75% of sampled adults were aware of Angelina's choice to undergo a double mastectomy to reduce her risk of developing Breast Cancer.
  • Of those aware of her story, only 3.4% indicated that they had read her op-ed originally posted in the New York Times.  Instead, most became aware of the story through the national/local news (61.2%) or entertainment news (21.5%).
  • Among respondents that correctly reported Angelina's risk of developing Breast Cancer, fewer than 10% had the information necessary to interpret her risk relative to a woman unaffected by the BRCA gene mutation.
  • The majority of respondents (80%) did not report any health-related actions (e.g., speaking with a doctor or genetic counselor) in the 3 weeks between the op-ed's publication and survey completion.
The authors' conclusions have important implications for those of us that lead health communication efforts- especially those efforts that intersect with the popular media:

"While celebrities can bring heightened awareness to health issues, there is a need for these messages to be accompanied by more purposeful communication efforts to assist the public in understanding and using the complex diagnostic and treatment information that these stories convey."

What Do You Think?
  • Are you surprised that Angelina's op-ed did not result in significant knowledge or behavior change among readers?
  • Should we retire "awareness" as a public health goal since it often does not lead to knowledge or behavior change?
  • Since most respondents were not able to distinguish Angelina's cancer risk from women who do not carry the BRCA gene mutation, could the op-ed do more harm than good?
  • This survey was conducted within 3 weeks of the op-ed publication; are there questions you would like to see asked in a longer-term follow-up survey?

Tuesday, November 26, 2013

What Public Health Can Learn About Branding From "Parks and Recreation": Fluoride, TDAZZLE, and H2Flow

"All I have on my side is facts and science...and people hate facts and science".
-Leslie Knope

On the November 21, 2013 episode of Parks and Recreation called "Fluoride", the gang once again tackled an important public health issue.  Since the towns of Pawnee and Eagleton have recently been combined, the City Council embarks on a vote regarding the merger of the towns' water reservoirs.  The Eagleton reservoir contains Fluoride and a merger would mean Pawnee residents would drink water with Fluoride for the first time in their history.

The pro-Fluoride contingent (led by Councilwoman Leslie Knope) quickly learns that Fluoride, despite all its public health benefits, faces a serious image problem!  Fellow Council members scare the public by describing Fluoride as everything from a dangerous chemical to a mind-control tool used by Communists.  When Councilman Jeremy Jamm proposes a Pawnee Clean Water Bill that would prohibit adding anything to the water supply (forever), Leslie's Parks and Recreation Administrator Tom Haverford proposes a solution:

"Jamm's already ruined Fluoride.  Everyone's scared of it.  What if we called it something else?  We re-brand."
-Tom Haverford

"What are you saying?  We need to sex-up Fluoride?"
-Leslie Knope

"You got to give people something to get excited about."
-Tom Haverford

The result:  TDAZZLE.  Leslie and Tom describe it as "not a chemical; it is an aquatic-based social media oral experience".  Their presentation on TDAZZLE engages the residents with video, social media, and a free give-away.

When Jamm fights #TDAZZLE with an idea that would actually fill the drinking water with sugar, they re-brand again.

The result: H2Flow.  Tom encourages Pawnee residents to think about H2Flow as an app for your teeth.  The more flow you take in, the more sparkle points you get.  If you get enough sparkle points, then you're on your way to your first Aqua Badge.  If you get enough Aqua Badges, they'll welcome you to the H2Flow Platinum Club.

By the time the episode ends, the re-branding has been successful.  Every Pawnee resident will have H2Flow (a.k.a. Fluoride) in their drinking water.

While this episode and the re-branding campaigns are over the top and ridiculous, they offer some important lessons to public health:

(1)  Science, facts, and reason are not always enough to change public attitudes and behaviors.  
If they were, everyone would stop smoking and get a flu shot.  Leslie and Tom acknowledged this and threw out their dry presentation of chemistry/statistics.

(2)  Language matters
One of the biggest challenges for Fluoride's image in Pawnee was its association with the term "chemical".  Chemicals are considered dangerous and toxic- so why would anyone want them in the drinking water?  Leslie and Tom had to change the way that Fluoride was being described.

(3) Get creative
Integrate advertising principles to get people on board with public health initiatives. Engage audiences by utilizing trends and aligning the "product" with what the public wants/values.  Leslie and Tom used catchy names, social media, and games to connect with residents.

(4) Keep trying
Public health problems/interventions often need to be re-framed in order to make mid-course corrections and keep up with new trends/data/challenges.  When TDAZZLE was defeated by Jamm's "Drink-ems", Leslie and Tom quickly re-branded as H2Flow.

This "image" battle is playing out across the country every day and impacts many public health issues (e.g., vaccinations).  The Fluoride battle even played out this year in Portland, Oregon. In a smart Scientific American article about the Fluoride vote in Portland, the writer Kyle Hill highlights the importance of language, communication, and framing:

"Yesterday’s vote was a failure of science communication, and it falls on public health officials to rectify that, to take back the word “chemical.” Perhaps re-framing the conversation in terms of dental health or water fluoridation as regulation, not just addition, could help. Until political questions are seriously informed by scientific answers, fear and freedom beats facts."

What Do You Think?
  • Parks & Recreation Fans:  What other lessons for public health did you find in the episode?
  • What examples can you share that highlight a public health issue/intervention that has been successfully re-branded or re-framed in recent years?
  • How can we better train public health professionals in health communication/advertising strategies that are so crucial to the success of their work?