Social media has been widely criticized for its role in spreading viral misinformation during the pandemic. But it can be a force for good as well, says Bertha Hidalgo, Ph.D., associate professor in the Department of Epidemiology. "Social media can provide new and innovative ways to move the public health needle," Hidalgo said. In his 1989 bestseller, "The 7 Habits of Highly Effective People," management guru Stephen R. Covey captured a key lesson of the COVID-19 pandemic. "When the trust account is high, communication is easy, instant and effective," Covey wrote. And when the trust account is low, confusion and mistrust run wild.
Social media has been widely criticized for its role in spreading viral misinformation during the pandemic. But it can be a force for good as well, says Bertha Hidalgo, Ph.D., associate professor in the Department of Epidemiology. "Social media can provide new and innovative ways to move the public health needle," Hidalgo said. She is leading studies of COVID-19 and heart disease that use social media for recruitment and education and is a prolific social media user in her personal life.
"My own personal experience has inspired a lot of the work I'm doing in social media," Hidalgo said. "In public health we often see engagement with communities as needing to be face-to-face, and that is still really important. But there are also communities we can reach digitally that can also benefit from what we say. It's just another way to be able to have an impact."
There are great examples of social accounts that shined during the COVID-19 pandemic, Hidalgo says. "One that comes to mind is Dear Pandemic,” which is run by a team of interdisciplinary researchers with backgrounds in nursing, health policy, economics, mental health and epidemiology, she said. "They started on Facebook and amassed a huge following because of their focus on putting out evidence-based information. They would write posts that would break down science and tell people what they needed to know in lay language. In some ways people needed that, because some people lost confidence in the information the CDC and other government agencies were putting out.”
Here are three ways that Hidalgo sees social media contributing to public health research and practice — and three points researchers should keep in mind if they plan to use social media in their studies.
1. Using social to tell the whole story
"On social media, you have the opportunity to have a conversation that continues over time," Hidalgo said. "You can share videos with Instagram Stories or write long, detailed posts on a blog where you can explain, 'Yes, these guidelines or recommendations are changing, but this is why. This is the science behind why these changes are happening. Here are the research studies that got us where we are today.' You can tell the story. Social media really lends itself to being able to engage with people in that way and provide the background they may not have otherwise."
2. Making the pandemic personal
“Messages that were coming out at the national level were too ambiguous at times,” Hidalgo said. “People had a lot of questions about what they themselves needed to do in their specific situations. Offering an interpretation of the guidance that was coming out was a big reason for my engaging with individuals on social media over the past year and more. Some of it was reassurance and some of it was leading by example, sharing what I was personally doing in the pandemic."
3. Reaching new communities
As the pandemic swept across Alabama this past spring, Hidalgo wanted to learn more about the experience of Latinx people in the state: if they had had symptoms, had been tested for COVID-19, had experienced job loss, had access to child care. But what was the best way to reach people and the right way to ask the questions she wanted to answer?
To find out, Hidalgo applied for a Back of the Envelope Award from the School of Public Health. The annual program provides pilot funds to enable faculty to explore new ideas. "At the onset of the COVID-19 pandemic there was very little accurate information — even any information — that was disseminated to the Latinx population here in Alabama," Hidalgo said. "Websites with information on testing and prevention were all centered on the English language. We were seeing such high rates of COVID-19 in this population, and I wanted to know, was it a lack of understanding, a lack of communication a lack of perceived risk or something else?"
| "In order to launch a successful social media messaging campaign or intervention or survey, you have to have established trust with the community you are trying to reach.... It's the same thing we say about engaging with people in community-based participatory research: You have to have trust before you can ask people to do things." |
Instead of posting flyers or sending emails, typical recruitment strategies, Hidalgo wanted to “demonstrate the feasibility of recruitment using social media," she said. Facebook was one option, but preliminary research showed that this would target a relatively homogenous population. Working with data from marketing research firms, "what we found is that WhatsApp is the most popular platform, with a 52% usage rate in the Latinx population compared with 34% for Instagram and 21% for Twitter," Hidalgo said. "If we wanted to reach this community in Alabama, WhatsApp seemed the most reasonable platform. And it has proven to be a great social media platform to use, as opposed to having to come up with email lists or post flyers in stores and wait for people to engage."
The average response time for messages sent to participants through WhatsApp is about 90 seconds, Hidalgo said. "If you are able to disseminate a message or a call to recruitment using established networks, like HICA [the Hispanic Interest Coalition of Alabama], and established individuals that have large networks that already communicate on WhatsApp, people know these aren't messages that are being randomly sent to them — they are a more engaged audience and people tend to respond.
"In some segments in the Latinx population there is a lot of mobility,” Hidalgo said. “Expecting people to come in to a university setting or go to a clinic and fill out survey is not always realistic. I felt this was a way to be able to reach and also engage people.”
The right social media channel to target depends on the audience a researcher wants to reach, Hidalgo points out. In November 2020, she received a two-year, $300,000 grant from the American Heart Association's Institute for Precision Cardiovascular Medicine to increase education and awareness in multiethnic millennial women about cardiovascular disease and stroke. "Because of the ages we are targeting, Facebook and Instagram proved to be the best platforms," Hidalgo said.
Engaging with a community on social media also is a great way for a researcher to establish visibility in their area of interest. "Through the Back of the Envelope award I could find and reach the populations that needed to be recruited," Hidalgo said. "Compare this with setting up to do a survey at a community center; by using social media, many more people have the awareness that Dr. Hidalgo at UAB is working on this issue of COVID-19's effects on the Latinx population in Alabama."
While she was developing her study of the Latinx population in Alabama, Hidalgo was selected as site principal investigator for a major study by the Robert Wood Johnson Foundation, known as RESOURCE, which will survey multiethnic populations nationwide about their experiences during the pandemic. “I deliberately timed the questions and contacts from the Back of the Envelope study so that we will be able to compare them with the results from RESOURCE,” Hidalgo said.
Getting started
Researchers should keep a few points in mind when engaging with social media, Hidalgo says.
1. Credibility must be cultivated
"In order to launch a successful social media messaging campaign or intervention or survey, you have to have established trust with the community you are trying to reach,” Hidalgo said. “If you as an individual researcher suddenly open an account and try to launch something with no network, no history, you will have no trust. It's the same thing we say about engaging with people in community-based participatory research: You have to have trust before you can ask people to do things."
2. Language matters
"One of the points of understanding that has emerged from the pandemic is that we need to pay close attention to the words we are using when we are communicating," Hidalgo said. As a part of her Back of the Envelope award, Hidalgo worked carefully to make sure that the words she chose for her survey questions would be clear to all members of the diverse Latinx population in Alabama.
“The other really important thing that came out of my preliminary research was that it was important to understand the backgrounds of the Latinx population of Alabama,” Hidalgo said. “While it is predominantly Mexican, there are also a large number of Guatemalans, Puerto Ricans, Colombians, Brazilians, Salvadorians and Panamanians. And anyone who speaks Spanish knows that the connotations of words and the types of words that are used to describe certain things can vary depending on where people come from.”
As just one example, there are several common words for face covering or mask in Spanish — máscara, mascarilla and tapabocas. "Those are three words that all say the same thing but understanding which was most common across all background groups is important," Hidalgo said. Hidalgo and colleagues would watch news segments from across the country to see which words were most commonly used. "Then we tested those words in local social media groups," Hidalgo said. "We would ask, 'Do you prefer this word over that word? Do you understand what that word means?' We did this informal pilot testing to make sure that they made sense."
3. It takes a team to succeed
Studies using social media are "really the embodiment of team science and multidisciplinary research," Hidalgo said. One of the collaborators on her American Heart Association study is Alex Krallman, Ph.D., formerly a faculty member in the Department of Marketing, Industrial Distribution and Economics in the Collat School of Business who now is at the University of North Carolina-Wilmington. "She helped us better understand how to leverage social media for a public health intervention and campaign," Hidalgo said.
"There are already great examples of using social media in research, but this is still a nascent field, and we have a lot to learn," Hidalgo said. "Working with people who have done this in business and marketing for a decade now is a great way to build bridges and better understand how to leverage fast-paced social media for good."