Social Media as Marketing tool for E-Health solutions promotion

A s has been shown, its SMM activity is declined and this is definitely a rational choice. A possible explanation is that social media proved to be not effective promotional channel and the company shifted to other tools. A zumio is another example demonstrating disappointment in SMM. G iven that the company successfully develop and promote a number of apps, it is possible to conclude that this was a rational choice.

W hereas in some cases lack of SMM activity is a strategic choice, in other cases this can be treated as inability to set SMM goals and to find a way how to use social media for promoting their products. On the opposite site of the continuity are organizations and companies publishing news and updating their accounts on daily basis. S uch frequency is only possible if a company has rationally chosen social media as an important marketing communication channel. T.

o maintain such an activity (e.g. up to 10 Facebook publications every day plus other media in case of WebMD) at least one job position must be created within a company. A s in case with low-activity pole, it is impossible to describe SMM-active organizations as pursuing one particular strategy. S.

ome companies use social media primarily as a one-sided communication tool, delivering relevant information to customers. T his can be termed as a strategy of ‘feeding': the company strives to generate a stable flow of content which will be consumed by customers on a regular manner. I f a person accepts it a source of information, either special or entertaining, the established communication channel can further be used to promote particular products such as mobile apps or information services. H ealthTap and Lifesum provide examples of such feeding strategies. Another strategy is used by such organizations as Cancer Research UK, DisabledGo and, to a lesser extent, WebMD and AIC.

I t can be defined as ‘community' strategy. I t is focused on creating and maintaining online community organized around a company and its social media channels.

S uccessful implementation of such a strategy leads to emergence of self-sustained social network, in a non-technical sense of this word. P articipants perceive such community as their social circle, and readily participate in its life. A company’s posts and reposts are used as motive for further communication within the community, information and opinion exchanges.

C ommunication in such communities is a value in its own right, and customers' loyalty becomes organizations' the main resource. T his type of strategies is successfully exploited by both commercial and NFP organizations. O ne important success factor which can be identified for this type of strategy is existence of social basis for emergence of a community.

I n health industry, specific diseases or other health-related problems (e.g. body weight problems, disabilities, etc.) can be a natural basis of this kind. W ithin the sample, only the 4 mentioned organizations can be defined as successfully pursuing the ‘community-based' strategy. W hereas creating such a community is a valuable marketing goal, the fact that only 20% of the sample managed to achieve it indicates the complexity of the task. A.

comparison of this group of organizations with other FB active publishers (as FB is more suitable for the creation and maintenance of online community than Twitter) such as Lifesum, TrygFonden, HealthTap, AssistiveWare and Lingraphica shows that often such attempts are not successful. T he in-depth content analysis is necessary to conclude about effective tools of content management in the industry, as on the first glance organizations active in FB use similar approaches to content and try to publish ‘useful' and ‘interesting' information for their customers. O ne possible explanation may by that companies differ in their ability to reach their target audience at the initial stage of AIDA complex, i.e. target audience is simply unaware of their existence. T.

he companies, despite their activity, could not generate the ‘critical mass' of users who’s own self-interested activity (probably motivated by self-relevance of the content) will support horizontal communication and content generation. I f this explanation is true, a practical recommendation to responsible persons in such companies is that their attention should be directed toward identification of their target audience, dissemination of information about their FB or Twitter channels, and evoking initial interest. SEO optimization and communicating with relevant users on third-party social media channels might be useful to increase their visibility and informing their potential customers. There is also a difference in relative use and effectiveness of Facebook and Twitter (as well as other media). I n general, Facebook is primarily used for communication and networking purposes, whereas Twitter — for informational ones.

F acebook provides more opportunities to provide various types of content and to invoke customers' interest and positive evaluations. T his leads to a generally more likes per month for Facebook content than for Twitter. H.

owever, companies differ enormously in their ability to generate likes for Facebook and Twitter content. T he fact that several companies have more positive feedback in Twitter than in Facebook (e.g. BodymapsApps). T his may indicate preference for ‘fast information' which can be more valued in some contexts, e.g. when target audience in less engaged in community activities and is more pragmatic in its information-seeking behavior. A n important result of the study is the distinction between evaluational and networking effectiveness of social media found for Twitter use. T.

he study showed that companies can significantly differ in their ability to attract ‘likes' which measures immediate response to a particular piece of content, and ability to attract long-term interest manifested in the number of followers. I n fact, preliminary data indicates that these can be the opposite goals: to receive positive feedback from casual visitors, or to guarantee re-visits and make the visitors interested in further content. F.

or marketing purposes, networking effectiveness seems to be more promising as it increases life-time value of customers. I t also should be noted that it is easier to artificially generate ‘likes' than followers — see next paragraph for details. A possible variety of SMM strategies used by organizations could be explained by important differences between applications and vendors' businesses. I ndeed, even the small sample of 20 organizations showed that they can be classified in many ways.

F irst of all, the sample consists of both firms and non-for-profit organizations. A s has been shown already, there’s no significant differences between the two groups of organizations in terms of social media activity and strategies adopted. T he variety of strategies to SMM can be observed within each of the group. A lthough it might be reasonable to suppose that companies have more resources to maintain high-quality content management and intense generation of own content, example of Cancer Research UK and AIC show that highly motivated and interested members of NFP organizations can initiate and maintain high-quality communication with the public.

A nother factor potentially influencing the choice and success of social media strategies is medical/health specialization of the companies. V arious health-related problems have different scope and importance for relevant audiences and society in general, and this can affect users' motivations related to social media. C ancer is a widespread fatal disease with important social consequences, and related content can be of higher value and importance for relevant audiences as compared to headache or sleep disorder. S imilarly, issues of healthy way of living, diet, etc may be of interest for many people but there are lots of relevant sources of information for them, and they are not life-or-death topics triggering specific needs for social support.

T he organizations included in the sample can be classified into several groups according to this criterion. F irst, there are organizations specialized on one particular medical or health-related problem. C ancer Research UK, AIC, Lingrahpica, MySleepBot, or BetterQQL are examples of such companies. A.

nother group consists of organizations covering a wider range of health-related issues. T his group includes, inter alia, WebMD, Azumio, Epocrates, HealthTapor Maxwell Software. B oth groups have examples of high and low levels of social media activity, and more or less success of SMM strategies and tactics.

T his might indicate that the degree of medical specialization is not directly related to social media effectiveness. H owever, preliminary analysis of the cases included in the sample, shows that, for specialized medical companies, a possible success factor is identification of specific needs of their customers, and providing content satisfying these needs. T ypically, such needs include the need for expert knowledge on one particular disease, but can also include the need for psychological and social support (as illustrated by Cancer Research UK). I n both cases, active interaction with customers is essential.

F or companies specializing in fitness, diet, or other beauty-related issues, a more important success factor is providing entertaining content and multimedia content not necessarily involving communication with customers — as best illustrated by Lifesum. F or more diversified companies, the success factors include ability to provide referential information (rather than expert knowledge) and not highly specialized health-related and entertaining content. T he community support may be included in SMM strategy but not necessarily, as shown by HealthTap. T he success of community-focused strategy is based on entertaining and general topics discussions and not on exchange of specific expert knowledge, as illustrated by WebMD. The third possible classification of app vendors is related to the role of app development in their business models.

I ndeed, the sample includes organizations with significantly varying interest in app development. O n one hand, such organizations as Maxwell Software, Epocrates, Azumio, MySleepBot, Doctot, or Lifesum, are specialized companies for which app development is the core business, On the other hand, the sample include such organizations as Cancer Research UK, DisabledGo, AIC, for which app development is a secondary and minor activity.

W ebMD, HealthTap, TrygFonden, and Fraunhofer are somewhere in between. I t can be seen that the second group consist of organizations especially successful in community-focused social media strategies.

T his can indicate their business model implies more efforts investing in information services rather that software development. A s a rule, such organizations provide informational support for its customers, and mobile apps are just a part of such support. Of a special interest is comparison of DisabledGo and AssistiveWare. B oth companies are focused on people with disabilities but the second one is specialized in app development.

T he fact that DisabledGo is visibly more successful in all aspects of social media marketing probably means that for health app developers applications themselves should be considered as only one of several core business processes and must be amplified with relevant information services. F or customers, a health app can seldom be the complete solution of their problem, and product extension should be considered as an important success factor for companies developing solutions for end-users, both healthcare professionals and patients. In the first group of app-focused vendors, those ones which develop and maintain only one or a small number of health apps with the focus on one health problem (e.g. MySleepBot and BetterQQL) have almost no chances to be successful in social media. S mall social base and the lack of supporting information servicesmake them incapable of generating value for customers. T he success is possible when the (only) application is not related to one particular disease and is integrated with other information services (as in case of Epocrates).For commercial firms, the in-between group is probably illustrating the most promising strategic choice.

W ebMD and HealthTap can both be classified as successful in SMM although adopting different approaches. T he first one is adopted the ‘community-focused' strategy, whereas the second adopts the ‘feeding' strategy of SMM. I n both cases however, social networking is essential. I n case of WebMD, it is realized through social media marketing.

I n case of HealthTap, networking functions are embedded in the application itself. I n both cases, app development is only a part of core business processes and are amplified by referencing and other important information services. 5.2 Key Benefits and Challenges inSocial Media Use for E-Health Solutions PromotionSMM is still a relatively new approach to branding and products promotion, and there is no clear understanding of how to use the new channels in the best way. M any companies are still experimenting in using social networks, social sharing platforms and other tools for their marketing purposes. A.

company deciding to use social media should take into account that they are horizontally-oriented communication networks in which customers become ‘pivotal authors of brand stories' (Gensler et al., 2013). SMM literature identifies many potential benefits of using social media, such as wider access to their customers, fast dissemination of information, receiving fast feedback and opportunity to rapidly correct their decisions, exploiting potential of social rewards and gamification of company-to-customer relations, benefiting from ‘word-of-mouth' and customer-to-customer networking for increasing brand awareness, and so on (Charlesworth, 2015, Kaplan and Haenlein, 2010). In light of the present study, taking account its objective limitations (see below) the following benefits can be identified:

1. Supporting online communities. E ffective networking SMM strategies exemplified by Cancer Research UK, WebMD, or DisabledGo, lead to creating the whole social community around the company. S.

uch communities guarantee brand loyalty and increased life-time value of the customers. T hey are also an important social resource which can be mobilized to further disseminate information in a ‘word-of-mouth' mode. 2. F ast dissemination of information.

C ustomers can timely receive information on new products, updates, or relevant news. This increases the perceived value of the company.

3. Delivery of valuable web content. U sing social media, e-health companies provide wide and convenient access to important content which is of a special interest and importance for their customers, e.g. information on diseases and new medications, etc. G ood content management also increases the perceived value of a company. Social media provide new opportunities for e-health solutions providers but also new challenges and risks. A.

gain, SMM literature names a number of important challenges associated with social media use. F or example, a survey of 777 marketing executives from different countries revealed three main concerns associated with SMM: lack of professional marketers with necessary analytical skills necessary to leverage customer insights;maintaining brand reputation in a situation when social media plays an important role even if a company doesn’t use its own channels;assess the effectiveness of SMM activities (Leeflang et al., 2014).In healthcare industry, Moorhead et al. (2013) identified 12 limitations of social media in health communication, relevant for various stakeholders. A.

mong them, lack of reliability, quality concerns, and lack of confidentiality and privacy are the most common and important. The present study highlighted several challenges for health app vendors in their use of social media:

1. Maintaining activity. To keep active in social media is crucial to maintain a company’s reputation and its SMM effectiveness. Without a stable information flow social media channels become useless and may lead to an opposite result and customers' disappointment. This is consistent with previous findings (e.g. Kaplan and Haenlein, 2010, pp.66), although examples of Athenahealth and Azumio raise the following question needing further research: does intentional decline in social media activity necessarily lead to reputational loss when SMM is considered as ineffective?2. Providing useful content. Even high level of social media activity is useless or even harmful if it is of low quality and relevance for customers.

3. Managing feedback. Customers' communication generated by SMM must be constantly monitored and timely moderated. Without it, a company can lose its connection with customers and decrease its ability manage potentially harmful and negative information.

4. Security risks and fake information management. A lthough the current study was not focused on content analysis, the fact that social media are currently overflown with fake information is potentially damaging a company’s communication. I ndeed, the problem of reliability of information circulating in social media becomes of increasing importance. F.

or example, a recent investigation of the US President 2016 elections published by BuzzFeed News showed that fake news published and disseminated via social media (Facebook) significantly outperformed mainstream news: 8.7 million shares, responses and comments for a piece of fake FB content against 7.3 million for mainstream news (Silverman, 2016). A lthough this is not an academic publication, it shows that concerns regarding reliability of current social media are recognized by both professionals and lay people (Charleswoth, 2015, p.8).Health industry is especially sensitive to such damages as false medical and health-related information (be that information on drugs effectiveness, patient data, or something else) can be of high risk for both patients and professionals.С. Lee Ventola lists a number of dangers of social media use by health care professionals: low quality of information associated with anonymity and lack of responsibility, damage to professional reputation, breaches of professional privacy, legal and licensing concerns, and other (Ventola, 2014). A.

lthough the current study doesn’t consider social media as way of delivering health-related services, these concerns are of relevance for vendors' marketing purposes. I f a company uses social media for both products promotion and professional services as such (e.g. consulting), then the risks are essential. S ome companies' decreasing interest in SMM may indicate intentional response to such concerns and be a sign of a new trend.

T he companies identified as passive and/or ineffective in social media might choose this approach to decrease risks. H owever, further research is needed to understand the role of legal and professional risks for vendors' SMM decisions. To sum up the results of the study and analysis, it is possible to conclude that currently, the sector of health app is highly heterogeneous and is characterized by variability in using social media. T he nature of company’s products and applications as well as the scope and specific needs of the target audiences vary significantly and are important determinants of SMM applicability and success factors. T he degree of specialization and the role of app development in business models are also important factors contributing to the choice and success of SMM approaches.

In practical sense, a number of recommendations for social media marketing in e-health companies focused on app development, can be formulated:

1.For companies specialized in particular disease, SMM should be based on providing specific expert information and/or social support responding to specific (medical) needs of their customers, and active social networking on the basis of these specific needs, — this strategy however should be chosen when the company is ready to take responsibility for the content;2.For companies specialized in fitness and other similar health-related issues, SMM should be based on providing entertaining content;3. For more diversified companies, SMM should be focused on providing referential information and information of general interest, as well as on entertaining content; the support of online communities is essential but can be avoided if networking functions are realized by other means, e.g. the application itself;4. Successful SMM can be significantly affected by the company’s ability to extend their business model and amplify their software development activities with relevant information services which make apps only a part of their product. In this case, risks associated with the use of social media as a tool for medical and health care services delivery should be carefully analyzed. When such risks (recovering personal data, violation of professional ethics, poor information content, illegal publishing of other’s intellectual property, etc.) are considered as essential, SMM should not include expert knowledge as media content and the priority should be given to the content of low responsibility. 5. For companies focusing on development and support of one particular app (or a small number of apps) related to specific medical problems, social media marketing is not effective and should be substituted by other marketing tools.

5.3 Limitations and Further ResearchThe present study has several important limitations which must be taking into account when interpreting the findings. F irst, the sample included only 20 e-health organizations. T he 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. F.

urther researches can focus on broadening the scope of analysis and possible influence of mediating factors on social media activity. A mong 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 focus on social media marketing activities on media channels controlled by organizations. A nalysis of social media activity on companies' official social media channels is just a part of SMM.

I ndeed, to maintain brand health and reputation, it is not sufficient to track and manage its perception on a company’s official Facebook or Twitter account. S ocial networks provide opportunities for customers to communicate with each other directly, using media channels which are not under organizational control. T.

o manage brand-relevant information outside official channels is a much more difficult task needing significant efforts and skills. T his part of SMM is a new important focus for further research. T he third limitation is a direct consequence of the methods used in the study. S imple qualitative statistics doesn’t provide detailed information on communication strategies used in each social media channel and the communicated content.

A lthough elements of case study methodology helped to better understand SMM activity of e-health organizations, a deeper analysis of web-communication is needed to better understand promotional strategies and tactics used by organizations as well as customers' behaviors and attitudes. S uch methods as interviews with managers and customers' surveys would help to better understand firms' rationale for key SMM decisions and customers' motivations and attitudes underlying their participation (or non-participation) in vendors' social media activities. Finally, the study was limited by the data gathered and analyzed. T.

o better understand effectiveness of SMM, future research can include additional data, first of all, on firms' financial and commercial performance. D espite these important limitations, the present study provides first evidence on SMM promotional strategies actually used in one particular sector of e-health industry, health mobile apps. I t showed that companies and organizations working in one industry take very different accounts on how to use social media to promote their products. A lthough social media is a must-have for marketers in current business environment, and especially in high-tech industries, its effective use is anything but a trivial thing.

B oth small and big organizations face difficulties in maintaining their presence in social media, and just a few can be treated as effective in dealing with them. T he very notion of SMM effectiveness should be threated carefully: the present study showed preliminary evidence that there can be at least two distinct forms of social media effectiveness: evaluational and networking, the first being related to generating fast and positive feedback, and the second with establishing long-term relations. Taking into account lack of evidence in this rapidly changing industry, the study can be considered as a first step toward a better understanding of e-health organizations' use of social media for the promotion of their solutions. R.

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Pharmacy & Therapeutics, 39: 491−499.AppendixAList of companies and organizations included in the studyOrganizationOrganization typeCountryWebsiteAIC (Associazione Iraliana Celiachia) NFPItalywww.celiachia.itFraunhofer PortugalNFPPortugalwww.fraunhofer.pt/en/fraunhofer_aicos/home.htmlLifesumCommercialSweeden.

https://lifesum.comBodymapAppsNFPUK.

http://bodymapapps.comMedipalCommercialSweeden.

http://medipal.seDisabledGoCommercialUKwww.disabledgo.comDoctotCommercialIrelandwww.doctot.comAssistiveWareCommercialNetherlandwww.assistiveware.comTrygFondenNFPDenmarkwww.trygfonden.dkCancer Research UKNFPUKwww.cancerresearchuk.orgAzumioCommercialUS.

http://www.azumio.comEpocrates (Athenahealth)CommercialUS.

http://www.epocrates.comWebMDCommercialUSwww.webmd.comMySleepBotCommercialUSwww.mysleepbot.comMontuno SoftwareCommercialUSwww.montunosoftware.comMaxwell SoftwareCommercialUSwww.maxwellapps.comHealthTapCommercialUSwww.healthtap.comBetter QOLCommercialUS.

http://iheadache.comLingraphicaCommercialUS.

https://aacdevice.aphasia.comVisible Health, Inc.CommercialUS.

http://visiblehealth.comAppendixBExamples of e-health applications (screenshots from vendors' websites) AiC Mobile (AIC)Mover (Fraunhofer Portugal) LifesumFibromapp (Bodymap Apps) Medipal DisabledGoDiabetes (Doctot)Proloquo2Go (AssisitveWare)TrygFonden HjertestartTumour Takedown (Cancer Research UK) Instant Heart Rate (Azumio)SleepBot (MySleepBot)Epocrates (Athenahealth)WebMD appDosecast (Montuno Software) Glucose Companion (Montuno Software) HealthTapDrawMD (Visible Health) iHeadAche (Better QQL) SmallTalk Aphasia (Lingraphica).