- Healthcare professionals are no longer the sole sources of health information as 83% of people with chronic conditions search for information online. - Only 1% of people create online content, 9% share it, and 90% primarily consume information. It is important for healthcare marketers to understand how to engage the 10% who influence information spread. - Patients search online not just for basic information but to learn more about managing their conditions. They find interactive sources on disease sites and social media more useful than static one-way information sources. - As patients connect with each other online through communities and hashtags, analyzing online conversations can help healthcare organizations understand patients and effectively engage them.

1. One of the biggest changes as a result
of an Internet-enabled world is that
healthcare professionals are no longer
the sole sources of health information.
Research from Pew suggests that
83 percent of people online who have
chronic conditions will use the Internet
to search for health information—and
there is a lot out there.
Keep in mind, though, that there is a
“1-9-90” rule: 1 percent of people are
creating content, 9 percent share and
repackage content, and 90 percent
primarily listen and learn. So how do
you get your content into the hands of
the 10 percent who will spread it to the
other 90 percent? (See figure 1.)
Health Information vs. Health
Engagement Resources
First, realize this: patients aren’t often
merely seeking basic health education
information. They’re usually looking
to “level up” on their knowledge of
self-management, especially for chronic
conditions where they’re constantly
Online ConversationsFrom Understanding (Through Analysis) to Action and Success
Where do patients turn for information when they’re not
in front of their healthcare providers? Online, of course.
Knowing where and how people access and share information
can be of tremendous benefit for healthcare marketing and
communication executives looking to reach and engage
audiences with legitimate and valuable content.
experimenting with what works for
them and their lifestyles. These ideas
and this information—and any resulting
action—may come from two very
different places.
The first area is how we traditionally think
about online health information—often
static information that is pushed out to
a patient in a one-way format. It is often
presented by a credentialed organization
(or healthcare provider) and not
frequently updated. As a result, it is
often fairly generic.
The other category is what we would
consider online health engagement
resources: those that promote the
sharing of information and two-way
conversations. These resources may
be shared on a disease-specific site
or forum, but they are also likely to
be shared and discussed in more
“mainstream” platforms, such as Twitter
and Facebook. These resources aren’t
always vetted for accuracy, so they must
be taken with a grain of salt, but often
patients after their initial diagnosis and
adjustment will become savvy at finding
the right place to seek information or
discussion in a more interactive forum.
The Reality of
Connected Patients
As a result, patients are increasingly
connecting with each other online. As
Susannah Fox, Chief Technology Officer
for the U.S. Department of Health &
Human Services, recently said, “Patients
and caregivers know things—about
themselves, about each other, about
treatments—and they want to share
what they know to help other people.
Technology helps to surface and organize
that knowledge to make it useful for as
many people as possible.”
Sometimes this is done through
online patient communities—social
networks or forums specific to a certain
disease type. But these conversations
also happen in the midst of other
mainstream social media channels. So
patients, like the rest of us, use hashtags
to flag tweets and to connect with
others directly during specific times
for chats. Analyzing hashtags can help
identify the 1 percent who create
the most content in addition to the
(Continued on page 6)
BY Dana M. Lewis
Director, MDigitalLife
for W2O Group
She can be reached at
dlewis@w2ogroup.com and
@danamlewis.
© This article originally appeared in Healthcare Strategy Alert!, Issue 1 2016, published by the Forum for Healthcare Strategists.
All rights reserved.

2. 9 percent who are likely to share and
repackage content to distribute to the
rest of their communities.
Deeper Data Diving Is Possible
For marketing or communication
professionals (or even clinical
professionals), it’s important to
understand the hashtags being used
by these audiences. The first reason is
the same reason we’d share with our
colleagues when explaining how to
engage in social media: you don’t walk
into a crowded party and shout about
yourself. Yet that seems to happen more
often than not in the healthcare space:
hashtags are added to tweets without
a lot of consideration, or a campaign
is marked as a success because of the
“potential reach” of using the hashtag.
The second reason is simple: how to
know that a particular hashtag is the
right one, let alone the most effective
one, to use.
It’s no longer necessary to rely solely on
“potential reach” or other one-dimensional
metrics (number of followers, number
of tweets) to understand hashtags.
Now there is a plethora of metrics to
better understand hashtags and the
dynamic engagement of online patient
communities, and as a result, if and how
to best engage and with whom.
To illustrate this, a basic analysis was
performed over a three-month period
(June 1–Aug. 31, 2015) to compare
engagement levels by stakeholder
audience (patients, healthcare providers,
and media) from the MDigitalLife Health
Ecosystem database across a variety of
diabetes-specific hashtags. The hashtags
ranged from generic hashtags (#diabetes,
#t1d, #type2diabetes) to hashtags that
flag posts (#dblog, #WeAreNotWaiting,
#doc), in addition to scheduled
community hashtag chats (#DSMA,
#DCDE, #ourD) and conference hashtags
(#2015ADA, #ADA2015, #AADE15).
During that period, there were
46,321 tweets using those hashtags from
3,387 individuals in the database.
All Hashtags Are Not
Created Equal
Before reading this analysis, one might
assume that it’s a good idea to add
“#diabetes” to a diabetes-related tweet. It
catches the eye, right? But depending on
the intended audience, that may not be
very effective for search purposes. There’s
a high volume of usage around #diabetes,
so the tweet won’t necessarily stand out.
(And just because a tweet is tagged with
a hashtag doesn’t ensure that it’ll be seen
more than an untagged tweet.) More
realistically, if patients are the intended
audience, the numbers suggest joining a
more targeted conversation where they
are conversing in a lower-volume (but still
effective) space.
As figure 2 shows, members of the
health ecosystem (patients and other
individuals in the healthcare space who
are not medical providers, accounting
for 93 percent of the tweets analyzed)
are congregating around hashtags like
#doc (“diabetes online community”) and
#dblog (for “diabetes blog”). Additionally,
patients are frequently posting to
#DSMA, the weekly (Wednesday)
diabetes and social media chat, and
even post with the hashtag when the
chat is not live to share information with
the community.
Understanding Is No Longer
Out of Reach
Comparing the links and correlated
web domains that patients, healthcare
◆ ◆ Reflects what people read, search, and discover online every day. What do they learn? Where are they? How can you connect?
◆ ◆ Important to listen, educate, share, and provide unique experiences
The 1-9-90 Rule
◆ ◆ Top opinion leaders­—1% or
fewer—who drive the ideas
that fuel conversation share
◆ ◆ Important to focus content
and relationships here
1% of People Create Content
INFLUENCERS
◆ ◆ The people who carry the
message and where top
influencers source ideas
◆ ◆ Important to surround-sound
with paid and earned media
9% Share and Repackage
ADVOCATES
90% Listen and Learn
ENTHUSIASTS
(Continued from page 5)
Patients, like the rest of us, use hashtags to flag tweets and to
connect with others directly during specific times for chats.
FIGURE 1
© This article originally appeared in Healthcare Strategy Alert!, Issue 1 2016, published by the Forum for Healthcare Strategists.
All rights reserved.

3. Hashtag Usage Differs: Patients Are Having Different
Conversations Than Media and Healthcare Providers
providers, and members of the media
are sharing reinforces the fact that these
groups each use Twitter differently.
Those who fall into the media category
(journalists as well as healthcare
professionals and patients who also
write for healthcare publications)
are more likely to share science and
research-related information through
domains such as medicalnewstoday.com,
medscape.com, and others. Contrast
this with patients, who are instead
more often sharing from Instagram and
YouTube as well as diabetes-specific
sites. While there are fewer healthcare
professionals in this analysis overall, they
are even more likely than patients to
post links and choose to blend posts
between diabetes-specific news and
general resource information being
shared by healthcare brands.
Knowing this, the content strategy for
reaching healthcare providers, members
of the media, and patients should be
different—one size will not fit all. In fact,
trying to reach everyone with the same
message will often miss the mark for
all groups.
Finding Your 10 Percent
The analysis into link sharing (and
hashtag usage) provides additional
metrics for going beyond “potential
reach.” In many cases, a hashtag looks
like it has a high volume or a link or
domain appears to have been shared
many times. Yet a deeper dive shows
that often a single individual handle
is doing most of the posting, which
looks more like spam than meaningful
engagement. This helps paint a clearer
picture about whether that piece of
content is really so popular and whether
that hashtag is really reaching the
right audience.
Similarly, these types of analyses can
help assess who might be worthwhile
partners for an organization to reach out
to, whether through sharing relevant
content or a more formal partnership.
By analyzing individuals’ hashtag usage,
it is clear who uses hashtags the most
frequently, and it can be determined
whether someone is a frequent poster to
a single hashtag or multiple hashtags to
further assess what their influence may
be in those areas.
The same approach
can be used to
track @mentions
of other people and
organizations, to better
gauge conversationality and influence
on varying topics, and to help determine
if someone is in the 10 percent (the
combination of content creators, sharers,
and repackagers).
Such analyses may reveal that influence
is not purely determined by number
of followers; identifying the impact a
community participant has on his or
her network (regardless of size) may
be even more meaningful. By studying
the content being shared across
conversations and by different segments
of the healthcare ecosystem, the
channels (and hashtags) being
used to distribute and flag content,
and the deeper dynamics of
conversationality among community
members, healthcare marketing and
communication executives will find that
they are able to develop more effective
strategies for reaching and engaging
online audiences.
10%
FIGURE 2
Note: This data set from the “health ecosystem” includes patients
(93% of the group’s tweets) in addition to other individuals who
work in healthcare and healthcare organizations, whether these
are advocacy groups, medical and professional societies, or
health systems.
NumberofConversations
#diabetes
#2015ADA
#AADE15
#DSMA
#DCDE
#WeAreNotWaiting
#dblog
#doc
25,000
20,000
15,000
10,000
5,000
0
Hashtags Used
Healthcare Providers Health Ecosystem Media
© This article originally appeared in Healthcare Strategy Alert!, Issue 1 2016, published by the Forum for Healthcare Strategists.
All rights reserved.