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Spamming for Public Health

Spamming for Public Health

Picture of R. Jan Gurley

Spam, public health, Doc Gurley, Reporting on Health, health journalism

I have decided to spam for public health.

Phone calls, text messaging, and even apps have been shown to help improve health and sustain behavior change, even in people suffering from profound mental illness. But when it comes to using these tools for public health, there are two problems. The first is that each message (whether via phone call or text) costs money. The second is that it's quite hard to use those platforms for blasting messages to a whole population.

That's how I ended up in what is probably a community of spammers. I registered at Black Hat World in order to get access to its forum on uploading bulk tweets, and didn't realize what company I was keeping until I saw user names like popzzz and images of a neon green skull and crossbones and rolling lines of HTML.

I am now poised at the unique intersection of spamming and homelessness. Suffice it to say, there aren't a lot of people stampeding to spam the homeless.

So how did I, a suburban soccer mom, former Shoney's-waitress-turned-Harvard-trained-doc, end up in this precarious position?

A lot of people are wondering if Twitter, or other similar Web-based messaging applications, could be a way to deliver health improvement messages. One big advantage of messaging systems like Twitter is that messages can be delivered either to the public at large or one-to-one. The classic example is when a celebrity direct-messages a fan ("OMG!!! Ashton just DM-ed me!!")

So could Twitter work for public health? Some examples are already emerging in developing countries. Crowdsourcing platform Ushahidi is being used to track services to poor areas, as well as report on the funds that supposedly were allocated to creating and sustaining those same services. Some of America's more disadvantaged urban and rural areas could probably benefit from taking the Ushahidi approach to local health care access. 

And in terms of free messaging, Africa also has platforms that might be useful in the States. The free mobile chat service Mxit was recently named as one of Africa's best tech companies. Mxit offers free instant messaging, making it a potentially highly useful platform for free population-based health prompts.

And then there's the potential use of Twitter to help keep yourself motivated to make sustained changes for your health. How exactly might that work? Tweet_fit is a new app that "blows up" Twitter - the device helps you track (and publish!) your workout start and end times. If you want to see what it looks like, go here. How's that for keeping you honest? You could be sending your exercise results to your trainer. And those trainers could be anywhere on the globe. Are we now going to be outsourcing trainers?

Food diaries (Tweet What You Eat) are already a big hit on Twitter - another example of a tweet-based tool for behavior change.

AskCH took public health one step further. It was a Twitter-based experiment to see if simple health questions could be asked, and answered, by tweets.  For a glimpse of how the system tried to do this, go here. The beta testing has concluded, and, as far as results go, as the site says, "This has been a great experiment, and thanks for the testing and feedback! We will use the data collected from this test to make the change:healthcare cost savings tool better."

The British Medical Journal (BMJ) blog recently discussed whether or not doctors could "tweach" patients about diabetes. Since the newest approach to diabetic teaching is through group classes, David Kerr, a BMJ blogger who is the managing editor of the Journal of Diabetes Science and Technology, pondered whether:

Twitter (or an equivalent) could be used to support patient education? This would have the advantage that information can be shared at two levels and providing a two-way format – between the group being taught and the wider audience outside." He also adds that "The other advantage of T(w)eaching is the opportunity for standardizing the content of an education program.

Challenges would include working within a 140-character limit and the ever-present threat of obtuse medical abbreviations. But the larger challenge to tweaching may be the fact that "the content of a live stream of ‘tweets' will need to be policed by the health care provider at regular intervals." Since doctors are unlikely to get paid for this type of work, a public health sector might be more willing, or able, to take on tweaching as a way to reach a large audience.

But could Twitter ever be used for person-specific feedback? Science Roll spotlighted Kickbee and the youngest Twitter user, ever. Corey Menscher designed an elastic band that went around his pregnant wife's belly and sent a tweet every time the fetus kicked. As the article pointed out, the health management potential from this kind of device includes:

  • "A diabetic patient monitors his/her blood sugar, and whenever there is a serious difference from normal values, the doctor receives a twit (tweet) about it.
  • "An old patient with high blood pressure measures his/her blood pressure several times a day with an automatic device. When the value is too high, the doctor receives a twit (tweet) about it.
  • "Pregnant women who are at risk for some reasons, can wear such sensors, and any time the heart beat of the fetus decreases, the doctor receives a twit (tweet) about it."

What do you think? Does your community need Ushahidi? Are you interested in getting prompts on Twitter? Do you know another innovative health use that's breaking ground? Share in the comments below.

Disclaimer: Identifiable patients mentioned in this post were not served by R. Jan Gurley in her capacity as a physician at the San Francisco Department of Public Health, nor were they encountered through her position there. The views and opinions expressed by R. Jan Gurley are her own and do not necessarily reflect the official policies of the City and County of San Francisco; nor does mention of the San Francisco Department of Public Health imply its endorsement.

Photo credit: Arnold Gatilao via Flickr


Picture of Angilee Shah

This is really interesting, but are there also HIPAA concerns?

Picture of

Thanks for the great question, Angilee. There definitely are HIPAA concerns. Twitter allows people to reply (which is public), or DM (direct message) which is relatively private. But neither option fits HIPAA-levels of security for patient information. One of the questions anyone trying to "spam" for public health must ask themselves, is whether the prompts you send out are going to be patient-specific, or more general. They should always be more general -- and the good news is that studies show that works! It may sound simplistic, but basically, ask yourself prior to any post, reply or DM: are you giving out non-specific, general education on a health topic, or are you giving out personalized medical advice? Is that difference clear to the recipient? Certainly, no one should be getting medical advice from Twitter, and no one should be discussing anyone's patient-level information on Twitter (or Facebook), as the recent Twitter "meltdown" revealed. Here are some decent general tips on avoiding HIPPA violations in any type of social media: 7 Tips To Avoid HIPAA Violations In Social Media. - Doc Gurley

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