At the Australian Pain Society’s 43rd Annual Scientific Meeting in April, I was honoured to present at the ‘Pain in the Media’ plenary about the value and potential of social media in research and clinical practice.

I think it is important to begin by saying that the talk was not about social media; it was about people—how to understand, reach and support people.

Social media is one tool that can help us to do these things.

Focusing on people with low back pain, I spoke about three areas where social media could enhance clinical or research practice—understanding patients, reaching patients and supporting behaviour change.

Data from qualitative research suggests that people with low back pain can be dissatisfied with the care they receive (Toye & Barker 2012, Penn et al 2020).

They may feel marginalised or dismissed and may take a long time to build sufficient trust to engage with a clinician’s recommendations (Fleming et al 2017). This is at odds with patient-centred care.

Ideally, patients should feel comfortable about sharing their concerns, beliefs and expectations in clinical consultations in order to nurture shared decision-making.

There is evidence that people are more comfortable speaking to a computer than to a clinician. For example, Lucas and colleagues (2014) conducted an experiment in which 200 participants completed a preoccupation mental health screening with a virtual human interviewer.

Participants were randomly assigned to two groups—one group was led to believe that the virtual interviewer was controlled by a human and the other group believed that it was automated.

Those in the automated group reported less fear of self-disclosure, were less concerned about what impression they made, displayed more intense expressions (were more likely to express sadness) and reported feeling more willing to disclose than those randomised to believe they were talking to a human.

Edel O'Hagan.

This is an early example but there are others.

A large survey of university undergraduate students highlighted the respondents’ tendency to prefer to discuss sensitive topics with a computer-generated avatar interviewer rather than human interviewers, citing that they felt less judged by a computer (Pickard et al 2016).

Social media provides the advantage of anonymity, allowing people to communicate their views and experiences independent of healthcare professionals. It may create a comfortable space for people to share their feelings and ideas about low back pain.

Back in 2018, my colleagues and I were working with a media company whose access to data scraping tools allowed us to identify posts on public social media platforms that included certain key words.

I chose key words that people might use to talk to their friends and social network about back pain. At the time, I wondered if people sought advice on management from their social network and if a person’s social network reinforced unhelpful beliefs about low back pain.

Over two months, I identified more than 700 posts that included the words ‘back pain’.

I conducted an inductive content analysis to interpret the posts and the responses to them.

Rather than seeking advice or recommendations for management, in most of the posts the original poster seemed to be seeking validation and rather than providing unhelpful advice, most responses offered sympathy (O’Hagan et al 2021).

This suggests that validation, which is perhaps absent from clinical encounters, is important to people with low back pain.

It is difficult to infer too much from brief social media interactions, but they can offer us useful insights.

Patients may not divulge all elements of the personal impact of low back pain in a clinical encounter.

Exploring the information that people with low back pain disclose to non-healthcare professionals on social media could supplement the potentially incomplete information obtained by healthcare professionals.

The second advantage of social media is reach.

We all know that back pain is a big problem—it has been the leading cause of disability worldwide for the past four decades—and a large-scale solution is warranted.

One example of such a solution is the ‘Back Pain: Don’t Take It Lying Down’ mass media campaign that ran in Victoria in 1997–1999.

Medical experts and Australian sporting and television personalities delivered the campaign via TV advertisements, supported by radio and printed advertisements, outdoor billboards, posters, seminars, workplace visits and publicity articles.

It was a successful campaign.

In comparison with New South Wales, which was the control state, there was a shift in population beliefs in Victoria irrespective of age, sex, education level, occupation, employment status, type of work (manual or non-manual), income, country of birth (Australia or other), residence (metropolitan or rural), previous back pain experience and reported awareness of back pain advertising (Buchbinder et al 2001).

These belief changes were accompanied by a decline in the number of workers’ compensation claims for back pain and in healthcare use over the duration of the campaign.

However, similar campaigns in Norway, Scotland, Ireland and Canada had no impact on health costs related to low back pain (Suman et al 2020).

One factor that was evident in the successful Australian campaign was its broad reach.

The campaign reached 86 per cent of the target population and cost US$7.6 million over three years (about $15 million now).

The unsuccessful campaigns either had a significantly lower budget or reached less than 50 per cent of the target audience.

The value of a large budget lies in its ability to achieve maximum reach.

We know that there are four billion active social media users worldwide and that makes social media a potentially cost-effective alternative to traditionally delivered public health campaigns.

Again working with a media agency, we developed a video to be disseminated on social media to reassure people that it’s safe to move.

Over three months, we used social media advertising to recruit 1900 participants, more than 1200 of whom had low back pain.

We spent just over $4000 and had almost 400,000 impressions, which means either that our content was delivered to someone’s social media feed almost 400,000 times or that there were 400,000 exposures to this content (O’Hagan et al 2022).

The third advantage of social media is that it supports behaviour change.

In the US, a campaign was launched on Facebook in December 2020 to encourage people to stay at home for the Christmas and Thanksgiving holidays.

The messages were geo-targeted at people in certain American states and not others. In the states where the messages were delivered, there was a noticeable drop in travel in the three days before each holiday and a corresponding reduction in subsequent COVID-19 infections (Breza et al 2021).

In an online randomised controlled trial (n=508,689), people searching for health-related terms were randomised to receive one of several professionally developed campaign advertisements or the ‘status quo’ (ads that would otherwise have been delivered).

For one month pre-intervention and post-intervention, their searches for health-promoting goods or services were recorded.

The results showed that after the intervention, there was a 50 per cent increase in the number of people who searched for assistance with helpful health behaviours such as weight loss in the exposed group compared with the control group.

These studies provide some evidence of the value of using social media to initiate behaviour change on a large scale (Yom-Tov et al 2018).

Overall, there is emerging value in the ability of social media to enhance clinical consultations and research.

This was a very brief snapshot of how I have used social media in my own research—there are many other options and the possibilities are endless.

References

1.  Toye F, Barker K. Persistent non-specific low back pain and patients’ experience of general practice: a qualitative study. Prim Health Care Res Dev 2012;13:72–84. doi:10.1017/S1463423611000387
2. Penn TM, Overstreet DS, Aroke EN, et al. Perceived injustice helps explain the association between chronic pain stigma and movement-evoked pain in adults with nonspecific chronic low back pain. Pain Med (United States) 2020;21:3161–71. doi:10.1093/PM/PNAA095
3. Fleming MD, Shim JK, Yen I, et al. Patient Engagement at the Margins: Health Care Providers’ Assessments of Engagement and the Structural Determinants of Health in the Safety-net. Soc Sci Med 2017;183:11–8.
4. Lucas GM, Gratch J, King A, et al. It’s only a computer: Virtual humans increase willingness to disclose. Comput Human Behav 2014;37:94–100. doi:10.1016/j.chb.2014.04.043
5. Pickard MD, Roster CA, Chen Y. Revealing sensitive information in personal interviews: Is self-disclosure easier with humans or avatars and under what conditions? Comput Human Behav 2016;65:23–30. doi:10.1016/j.chb.2016.08.004
6. O’Hagan ET, Traeger AC, Bunzli S, et al. What do people post on social media relative to low back pain? A content analysis of Australian data. Musculoskelet Sci Pract 2021;54:102402. doi:10.1016/j.msksp.2021.102402
7. Buchbinder R, Jolley D, Wyatt M. 2001 Volvo Award Winner in Clinical Studies: Effects of a media campaign on back pain beliefs and its potential influence on management of low back pain in general practice. Spine (Phila Pa 1976) 2001;26:2535–42. doi:10.1097/00007632-200112010-00005
8. Suman A, Armijo-olivo S, Deshpande S, et al. A systematic review of the effectiveness of mass media campaigns for the management of low back pain. Disabil Rehabil 2020;:1–29. doi:10.1080/09638288.2020.1743777
9. O’Hagan, E. et al. It’s safe to move! A protocol for a randomised controlled trial investigating the effect of a video designed to increase people’s confidence becoming more active despite back pain. BMJ Open 12, e063250 (2022).
10.Breza E, Stanford FC, Alsan M, et al. Effects of a large-scale social media advertising campaign on holiday travel and COVID-19 infections: a cluster randomized controlled trial. Nat Med 2021;27:1622–8. doi:10.1038/s41591-021-01487-3
11. Yom-Tov E, Shembekar J, Barclay S, et al. The effectiveness of public health advertisements to promote health: a randomized-controlled trial on 794,000 participants. npj Digit Med 2018;1. doi:10.1038/s41746-018-0031-7