Author:  Silvio Waisbord, March 18 2015, cross-posted from the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) website: In this guest post, Silvio Waisbord, Ph.D. of the George Washington University’s School of Media and Public Affairs explores how social media can influence public health behaviors, especially in resource-limited settings.

The popularity of social media (Facebook, Twitter, blogs, etc.) in Western culture has driven interest and enthusiasm about the possibilities of their uses in global health programs. The reason is obvious: if we are hooked on social media and numbers keep growing, why wouldn't it work elsewhere too? Recently, when global health confronts major challenges - from Ebola to HIV testing to multidrug-resistance tuberculosis, social media is inevitably seen as part of the solution.

However, years after global health programs incorporated social media, we should not exaggerate its impact nor should we underestimate its contributions.

Social media is not the answer to all of our deep-seated, tough communication problems. Social media channels contribute to improving health systems and the performance of health workers, if they are used correctly and appropriately. More data is needed prove that social media can truly help overcome traditional communication problems such as reach, persuasion, understanding, credibility, participation, and motivation to action across communities. Social media does not miraculously resolve old communication challenges nor address the social determinants of health.

These results should come to no surprise. Two-thirds of the world’s population still has no access to the Internet, creating a "digital divide." Access is still sparse and unreliable, particularly among low-income families. The rapid expansion of mobile telephones, praised as another remarkable opportunity for improved health communication, doesn't necessarily translate into digital connectivity or major changes in the way people consume, exchange, trust, or act upon information.

Also, it is not obvious that even if more people had digital access, social media would effectively reach, persuade, remind, or change attitudes related to health care. My sense is that the rush to invest considerable funding on digital communication was based on hopes and hunches rather than solid evidence about impact.

But we can’t underestimate the significance of social media in global health either. Social media can be extremely useful tools for advocacy, news-making, information dissemination, scholarly research, and other activities. Examples where social media might have limited impact are to promote dialogue, participation, and change in certain communities, but it can be effectively used to reach specific populations - policy-makers, journalists, experts, academics, and other groups who play important roles in global health.

The opportunities and limitations of social media remind us that we should not praise or dismiss information technologies in abstract. For decades, global health has been predisposed to recurrent bouts of techno-optimism, that are followed by moderate, nuanced assessments about the impact of technologies on behavior and social change. Past programs also placed big hopes on “old” technologies - radio, television, portable video, and computer tele-centers. Subsequent evidence showed a more mixed picture, with hits and misses contingent on numerous conditions. 

The problem is that the question “what the media does for global health” does not lend itself to straightforward answers. We cannot produce succinct yet comprehensive answers about a range of health issues, behaviors and conditions across communities. Too many variables affect the uses of communication and media in support of health programs. It would be handy to produce programmatic recommendations based on evidence from the field, like we do with HIV/AIDS programs now, but communication cannot always deliver similar conclusions.

Yes, complex explanations with multiple clauses and conditionals lack memorable punch and clear take-home message. They are not suitable to elevator speeches with donors and technical experts. Once you introduce "as long as" "only if" and other references, audiences are likely to get lost in a fog of data.  

This is why communication practitioners and researchers need to improve how we convey what communication and media contribute to global health. It is not a problem of insufficient evidence. We do have plenty of data, insights, and experiences, as shown by recent meta-analysis of the literature. The challenge is making persuasive pitches to non-communication experts without falling into reductionist arguments and long-winded explanations.

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Image caption/credit: Research nurses in Rwanda now collect data on electronic tablets. Laura Elizabeth Pohl/EGPAF