"Social Media as Marketing tool for E-Health solutions promotion"

The present study has several important limitations which must be taking into account when interpreting the findings.
First, the sample included only 20 e-health organizations. The qualitative data obtained in the research is insufficient to make generalizations for the whole industry and to perform statistical analyses which could be used to study correlations between variables and impact of various moderating factors. Further researches can focus on broadening the scope of analysis and possible influence of mediating factors on social media activity. Among the most promising moderating factors are:
firm’s size;
type of organization;
regional presence;
business profile, i.e. types of e-health products and their importance for перу company’s business.
The second limitation is the focu ...

Table of figures 3
List of tables 4
List of abbreviations 5
1. Introduction 6
1.1 Problem Formulation 6
1.2 Objectives of the Study 7
2. E-Health solutions: An Industry Overview 8
2.1. Definitions of E-Health 8
2.2 E-Health Technologies 9
2.3 E-Health Advantages and Barriers 11
2.4 E-Health Policy and Regulatory Framework in EU 14
2.5 Global and European E-Health Markets: Size, Segmentation, Key trends 16
3. Social Media Marketing of E-Health Solutions 18
3.1 Social Media as a Tool for Marketing Promotion 18
3.2 Social Media Channels 20
3.3 Social Media Marketing of E-Health Solutions: A Literature Review 23
4. The Study of Social Media Use in E-Health Solution Promotion 25
4.1 Overview of the Study 25
4.2 Method 26
4.3 Results: Quantitative Analysis 27
4.4 Results: Case studies 36
5. Discussion 42
5.1 Using Social Media to Promote E-Health Solutions 42
5.2 Key Benefits and Challenges in Social Media Use for E-Health Solutions Promotion 48
5.3 Limitations and Further Research 51
References 54
Appendix A 58
Appendix B 59
 
Table of figures
Figure 1 Social media most frequently used by health app vendors (N20) 28
Figure 2 Facebook publication activity and social networking intensity 30
Figure 3 App vendors’ activity in Twitter 31
Figure 4 Comparison of Facebook and Twitter activity 32
Figure 5 Values of Cfb reflecting relative effectiveness of Facebook and Twitter promotional activity 34
Figure 6 SMM evaluational effectiveness of organizations using Twitter, likes per tweet 35
Figure 7 SMM networking effectiveness of organizations, followers per tweet 36

New social media providing tools for various forms of online communication and interaction have rapidly changed social life and business environment. For customers, social media provide access to information on products from various sources, opportunities to share their opinions and experiences thus affecting purchasing decisions of other people, and to directly communicate with companies throughout the world. For organizations, social media provide opportunities for fast dissemination of information, receiving feedback and monitoring market situation. As social media become more and more widespread, its significance for marketers increases enormously. In Europe, almost half of the population are active social media users and their share is constantly growing (Kemp, 2016).
In this situati on, companies cannot ignore social media in their marketing strategies and activities. Even if the company have no Facebook or Twitter account or its YouTube channel, social media affect its performance. Customers exchange information and discuss companies and products even when they are nor present and not distribute products electronically. Increasing interest of commercial firms, non-for-profit organizations, and governmental bodies is thus an inevitable step in developing their marketing systems.
Although increasing importance of social media marketing (SMM) is now widely recognized by both marketers and academic researchers, little is known of how social media are actually used by companies in different industries and sectors, and how effective these new tools are for promotional and other marketing purposes. A relevant task for a better understanding of the new channels of marketing communications is thus to study actual SMM practices in particular industries and market conditions.
One of new industries for which social media seem to be a natural choice for marketing is e-health, internally diverse industry developing new IT solutions for medical and healthcare tasks. Although e-health is by definition closely related to new information and communication technologies, and is deeply embedded in the virtual environment of the Internet, surprisingly little is known of how SMM is implemented by the companies working in this industry. The current study addresses this lack of evidence.

Virtual worlds and virtual games provide technological basis for telepresence and allow users to directly interact and communicate with each other and with the environment is a simulated 3D space. Although virtual world applications such as Second Life offer new and promising opportunities for both marketing and internal management (Kaplan and Haenlein, 2010), it is still used infrequently. It can be concluded that the current technological market provides many new channels for communication, including customers’ peer-to-peer communications which can be targeted by the marketing activities. The multitude and diversity of existing social media make it crucial to choose appropriate strategies and tactics which can succeed in particular industry such as e-health.3.3 Social Media Marketing ofE-Health Solutions: A Literature ReviewThe widespread use of social media leads to its penetration to healthcare as well as other spheres of modern life. Healthcare professionals have rapidly recognized potential of social media throughout the healthcare industry (Thakeray et al., 2008; Hawn, 2009; Chou et al., 2009). However, given that social media is still in its early stage, no surprise that empirical evidence regarding its use for promotional purposes in particular industries such as e-health is scarce. Most publications on the use of social media in healthcare do not specify its use in different subsectors (see, for example, Moorhead et al., 2013; Grajales III et al., 2014; Denecke, 2015). Besides, social media use in healthcare and medicine goes far beyond promotional activities and pursue such purposes as knowledge management, health monitoring, health-related data mining, or e-health activities as such, e.g. online consulting and telemedicine (Denecke, 2015).On the other hand, it can be difficult to differentiate SMM for e-health from a more general issue of SMM in healthcare and medicine as the broad understanding of e-health can treat any IT-mediated communication involving patients and healthcare professionals as a kind of e-health activity. As social media is one of such communication tools, any use of them by relevant actors can be targeted by SMM activities. A survey-based study by M.Antheunis et al. (2013) showed that social media are widely used by both patients and professionals. Patients prefer Twitter and Facebook and their primary motivations are receiving information, sharing advice, and getting social support. Professionals, in turn, use LinkedIn and Twitter for communication with colleagues and marketing. Participants in this study were professionals in obstetrics and gynecology and cannot be treated as providers of e-health solutions.Another survey conducted by Thaker et al. (2011) showed that hospitals actively use social media to reach general public (97%), provide information about the hospital (93%), inform about their news and events (91%), public relations (89%) and health promotion (90%). At the same time, effectiveness of active social media used by healthcare organization was questioned by A.Miller and C.Tucker who found that firms postings are primarily generated by employees and this leads to a less client-focused approach (Miller and Tucker, 2012).Although providers of e-health solutions include some of the most technologically advanced and influential companies, and use SMM tools quite successfully, surprisingly little is known about the use of these tools for specific e-health market. To the date, there is no clear empirical evidence of how providers of e-health solutions use various social media tools to promote their products. Even the enormously growing market of health-related mobile apps is not appropriately studied within academic literature. Several available publications are rather exploratory and are provide a basis for discussions and further research (e.g. Van Velsen et al., 2013; Bourdreaux et al., 2014). 4. The Study of Social Media Use in E-Health Solution Promotion4.1 Overview of the StudyAnalysis of existing literature showed that although social media marketing is a well-established practice in contemporary business, little is known how it is actually used in particular markets and industries. The current study aims at partially bridging the gap in relation to e-health industry. As has been showed in chapter 2, e-health industry includes different subsectors. It is reasonable to suppose that marketing strategies and technologies should vary among these subsectors which range from high-end IoT solutions to mobile apps. For this reason, the current study is limited to one particular subsector: health mobile apps. Health mobile apps is a fast-growing industry which is estimated to exceed 8 billion US dollars by 2018 (Peterson, 2012), including devices and services. This market is chosen because of its highly competitive nature. Barriers to enter this market are very low: any individual and qualified expert can develop and app for mobile devices. The market is open and globalized: developers from any country can sell their products via AppStore, GooglePlay or other channels. For apps developers, social media seem to be a natural choice for marketing promotions as they sell their products electronically and the products themselves are digital ones developed for the virtual world. Apps developers are IT-professionals for whom Internet is the natural business environment. It is reasonable to suppose that SMM is actively used by them to promote their apps. Taking into account lack of empirical data on social media use in health apps promotion, the current study is an exploratory one. The main research questions underlying the study are:1. How intensively health apps developers use social media for promotional purposes?2. Which social media channels do they prefer to use?3. How effective is their promotional activity in social media?Three particular hypotheses corresponding to these questions can be postulated basing on the existing literature and specific nature of the market.Hypothesis 1: All app developers use social media on a regular manner. Rationale: the nature of the product and of the business makes SMM a natural choice for promotion.Hypothesis 2: Facebook, Twitter and LinkedIn are the most popular social media channels among European apps developers. Rationale: These social media are the most popular in the Western World and were found to be most actively used in health industry in the previous studies.Hypothesis 3: App developers use different SMM strategies which result in varying frequency and efficiency of particular channels. Rationale: Medical and health apps are very different in terms of their target audiences and companies may develop different strategies according to their marketing goals and specific features of their audiences.4.2 MethodA combination of quantitative and qualitative methods is used to understand approaches to the use of social media adopted by health apps developers.20 organizations developing health apps and available in European market have been selected basing primarily on European Directory of Health Apps 2012-2013 provided by PatentView. The list of app developers contains information on European and other-country (primarily US-based) health applications recommended by patient groups or empowered consumers. The list was used as a basis for further research. In some cases, organizations mentioned in 2012 Directory were reorganized or liquidated – they were not included in the final list. Only organization corresponding to the following criteria were included:they are health-focused organizations (i.e. companies providing a wide range of solutions in many fields were excluded);they develop apps by themselves (not in collaboration or via outsourcing);they are not individual developers;they have website which can be used to find necessary information;they are still active in 2016.Initial screening and search showed that in Europe, about half of all corporate developers are non for profit organizations. As the use of SMM is a relevant task for NFP organizations as well as for firms, they were included in the list. Finally, although the main focus is on European market, due to high level of globalization of the industry, it was unreasonable to exclude US-based companies from the analysis. Thus, the final list of organizations consisted of 10 EU-based, and 10 US-based app developers. Among the European developers, 50% were NFP organizations. See Appendix 1 for the information on app developers.Using publicly available information from the relevant web-sources, the following information was obtained for each developer:business profile of organization;the list of third-party social media where developer has its own account;existence of on-site-blog;duration of presence on each media;basic metrics for the most actively used social media. For Facebook, the following information was extracted:a number of publications for the last two months (as the data extraction dates were slightly different, the exact time frame can vary) – used to measure social networking activity;average number of comments for this 2-month period of time – used to measure effectiveness of social networking and community-building efforts;a total number of ‘likes’ – used to measure overall perception of the organization.For Twitter, the following information was measured:a total number of tweets;a number of followers;number of Twitter ‘likes’.All data was gathered in November, 2016. Taking into account exploratory type of the study and relatively small sample, descriptive statistic is the main type of analysis. In addition, to better understand the strategies used by organizations and differences between them, a qualitative analysis of the companies based on case-study approach have been used. This analysis is used for a more reliable interpretation of results.4.3 Results: Quantitative AnalysisThe study showed that 100% of organizations developing health apps use social media. At a formal level, Hypothesis 1 is supported. At the same time, some organizations having social media accounts de facto abandon them and do not use them in present. Examples of such companies include Maxwell Software and Better QQL. That’s why Hypothesis 1 should be considered as only partially supported.Figure 1 shows the relative use of different social media by 20 organizations included in the sample.Figure 1 Social media most frequently used by health app developers (N=20)As can be seen, three media channels, namely Twitter, Facebook and LinkedIn are much more frequently used by app developers than others. Twitter and Facebook are almost absolute must-haves for e-health organizations. At the same time, the proportion of organizations using these media is less than 100%. This is somewhat surprising as all the companies included in the study are from EU or US, where these channels are dominating. In one case (Visible Health, Inc.) the company’s website contains FB button but its account is not active anymore. In all cases when Facebook and Twitter accounts were not found, the companies were commercial ones. LinkedIn is the third most frequently used social media: 75% of organizations have account on this professional network. In sum, the results of the study are consistent with hypothesis 2 although the fact that not all the organizations use such popular social networks as Facebook and Twitter worth attention. App developers differ in the number of social media channels they use. Average number of social media channels used is 4.35 and ranges from 1 to 7. All organizations except Montuno Software use more than 1 social media channel.SMM activity was studied using data on Facebook and Twitter usage.Average duration of the two most popular networks, Twitter and Facebook is almost the same and is equal to 72.2 and 75.6 months correspondingly. This means that, on average, app developers use this channel for more than 6 years. This is enough to find their way in SMM and understand how can it be used to promote their productions.Table 2 summarized data on organizations’ Facebook and Twitter activity.Table 2 Social networking activity of organizations on Facebook and TwitterOrganizationFacebookTwitterNo of publications for two last monthsAverage No of comments per publicationTweetsFollowersAIC303.849745446Fraunhofer Portugal160271163Lifesum169183664982BodymapApps1030742MedipalN.A.N.A.N.A.N.A.DisabledGo1648.61320018200Doctot00563442AssistiveWare280.736723152TrygFonden400.75701317Cancer Research UK8299.945600281000Azumio40116009658Epocrates (Athenahealth)0014736912WebMD59021.9229001360000MySleepBot006001761Montuno SoftwareN.A.N.A.N.A.N.A.Maxwell Software00219HealthTap670.22640030200Better QOL0018188Lingraphica260.226792167Visible Health, Inc.N.A.N.A.9961037Figure 2 depicts both actual publication activity of those companies which use Facebook, and activity of their community represented by an average amount of comments posted for any recent publication.Figure 2 Facebook publication activity and social networking intensityIt can be seen that companies differ significantly in their own activity of FB usage although most companies have less than 50 publications for the last two months. Four organizations have no publications in this period of time at all. On average, community’s activity in Facebook is low (median is 0.2). It can be seen that there are two remarkable examples of FB usage. One US-based company, WebMD, is an absolute leader of publication activity. It publishes almost 10 units of content every day. It is also second most frequently cited company in the sample. Another interesting example is UK-based NFP organization, Cancer Research UK which has succeeded in creating the most active online community which intensively communicate both within and externally, with the company.Two more companies, Lifesum and DisabledGo can also be classified as active publishers. Yet social media presence of Lifesum doesn’t result in active involvement of users.Companies' activity in Twitter is depicted on a chart on figure 3. Here, total number of tweets is used to measure activity of the organizations, and number of followers is used to analyze their success in social networking. Figure 3 App developers’ activity in TwitterThe situation in Twitter is very similar to that of Facebook. Again, most companies have a relatively small number of tweets (median is 2076) and followers (median is 2660) as compared to the ‘leaders’. Cancer Research UK and WebMD are as active in Twitter as in Facebook. However, their networking situation is reverse. Cancer Research UK is the most active in publishing tweets – more than 45 thousand for almost 8 years. WebMD is less active for roughly the same period of time but is leading in attracting followers. Its social network is significantly larger than anyone else’s and consists of more than 1.3 million followers. The third most active company is US-based HealthTap. Its social network is third and consists of slightly more than 30 thousand followers. Two companies have less than 100 tweets, and two companies have less than 100 followers. Maxwell Software has a Twitter account but doesn’t use it since the beginning. Figure 4 helps to compare relative importance of Facebook and Twitter activity plotting both FB recent publications and number of tweets.Figure 4 Comparison of Facebook and Twitter activityAlthough differences in promotional activity in two social networks exist and point to potentially different approaches to the social media use, the trend can also be identified: if a company is active in social media, it is active in all the media it uses. Indeed, computed Pearson correlation for these two variables was found to be r=0.45. This indicates moderate correlation between two variables. At the same time, given a relatively small sample and existing outliers, correlational analysis should not be taken too seriously.The next measures used in the analysis involved perceived value of content provided by e-health organizations by users. For this purpose, a total number of ‘likes’ for Facebook and Twitter was used. To correct for varying duration of the media channels usage, this number was divided by a number of months of social media usage, to get average ‘likes per month’ variable. The results are given in Table 3.Table 3 Facebook and Twitter ‘likes per month’ statisticsCompanyFB likes per monthTwitter likes per monthAIC1329.025.6Fraunhofer Portugal23.340.0Lifesum546.968.2BodymapApps0.62.4MedipalN.A.N.A.DisabledGo151.536.0Doctot1.80.8AssistiveWare32.61.9TrygFonden124.30.3Cancer Research UK14572.086.1Azumio131.495.2Epocrates (Athenahealth)449.54.7WebMD11775.245.0MySleepBot0.01.4Montuno SoftwareN.A.N.A.Maxwell Software1.50.0HealthTap332.542.6Better QOL12.60.0Lingraphica80.317.9Visible Health, Inc.N.A.1.5In most cases, Facebook promotional activities receive significantly more evaluation feedback than Twitter. It also can be seen that companies significantly differ in their ability to attract ‘likes’. Again, WebMD and Cancer Research UK are the leader of public opinion in Facebook. At the same time, Azumio, a US-based health app developer, is leading in Twitter, together with Cancer Research UK and Lifesum.To measure relative effectiveness of Facebook and Twitter activity in terms of attracting public positive evaluations, a simple new variable Сfb was computed: Cfb = √FB likes per month – √Twitter likes per month(1)The larger Cfb is, the more effective is Facebook activity as compared to Twitter. If a coefficient is less than 0, this means the company is more successful in Twitter. Results are shown in a chart on figure 5. Organizations without available relevant data are excluded.Figure 5 Values of Cfb reflecting relative effectiveness of Facebook and Twitter promotional activityThe data in the diagram can be used to roughly estimate a company’s relative promotional success in different social media use, i.e., to compare promotional effectiveness of the two channels. See the next chapter for further discussions of this issue.Using statistics available for Twitter, two direct measures of SMM effectiveness for this channel have been computed: an average number of likes per tweet, and an average number of followers per tweet. Due to functional limitations of Facebook services, these statistics are only available for Twitter. Figures 6 and 7 depict the results.Figure 6 SMM evaluational effectiveness of organizations using Twitter, likes per tweetLifesum, Azumio and Lingraphica were found to be the most effective in using this communication channel to attract positive evaluations of their customers. Maxwell Software doesn’t support the channel and has no feedback at all. Fraunhofer Portugal and especially AssistiveWare are regularly publishing tweets but their activity is useless in terms of attracting customers’ attention and interest.Figure 7 SMM networking effectiveness of organizations, followers per tweetThe situation differs significantly when networking effectiveness is measured. The previous leaders, namely Azumio, Lingraphica, and Lifesum, seem to be unable to invoke long-term interest in their information. Better QQL and Maxwell Software should not be treated as true leaders as they have just a few tweets. On the other head, the leading positions of WebMD and Cancer Research UK is not surprising as they were found to be effective in social networking before.In sum, it is possible to conclude that the distinction between the two kinds of effectiveness, evaluational and networking ones, is a useful construct which can be used for identifying different SMM strategies. LinkedIn is the third most popular social network used by e-health organizations. The leading organizations using this channel are Cancer Research UK and WebMD which have 34.9 and 20.3 thousand followers, correspondingly.