SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Jerome P.

Triona1

Abstract The birth of Internet Social Networking, characterized by the use of the popular site Facebook has given more users the platform to quickly spread information to bigger networks. Facebook has gone beyond personal use and has opened more opportunities for people and organization to provide all kinds of information, such as technologies, fashion, economy and even health. This study on mediated communication has used online survey and focus group discussions to ascertain the TB knowledge gained and retained by Facebook users. 50 respondents were able to provide a glimpse of how viral marketing schemes can make effective TB information retention and sharing. Results indicated that Facebook can indeed be used effectively to disseminate information due to its large user-base and quick information exchange mechanisms. The study has emphasized that the effectiveness of the campaign is dependent on the success in factors such as awareness of the needs and interests of a target user/audience base, a recognizable and relatable brand, and development of messages that are clear and concise, enabling quick retention and sharing without degradation. The study acknowledged that while Facebook is a vital information tool, it is best used to support bigger awareness activities and campaigns.

KEYWORDS: Social Networks, Online Health Awareness, TB Education

Graduate student of MDC, University of the Philippines Open University, (email address: Jerome.trinona@gmail.com)

SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK INTRODUCTION The Web, social networking, FB, and viral marketing Web 2.0 refers to the second generation of the Web, which enables people with no specialized technical knowledge to create their own websites, to self-publish, create and upload audio and video files, share photos and information and complete a variety of other tasks (Capilanou University, 2010). Social network sites as web-based services that allow individuals to (1) construct a public or semi-public profile within a bounded system, (2) articulate a list of other users with whom they share a connection, and (3) view and traverse their list of connections and those made by others within the system. (Boyd, 2007) Social networking has been around the internet space for a couple of years now, the earliest of which was the website SixDegrees.com established in 1997 (Boyd). But just recently, we have seen the surge in popularity of networking site Facebook (http://www.facebook.com) boasting with a user base or 500 million as of July, 2010 (Facebook, 2010). Such popularity even spawned a full-length film chronicling its early years and struggles. The World Health Organization, however cautions users of social media (WHO,2009) , especially those in the health profession to be wary of the quality of information taken through social networking sites such as Facebook. While social networking has become a great information equalizer that has radically transformed the way people communicate around the world and elevating electronic communication to a level that is near face to face, health professionals should ensure that information is correct and accessible. A study conducted by the pharmacy health care provider CVS indicated the potential of social networking to disseminate and acquire information on health, such as diabetes (PR
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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Newswire, 2010). However, like the WHO article, CVS warns of possible risks such as inaccurate information, distribution of information only for profit and promotion purposes and privacy concerns. The popular social networking site Facebook ( http://www.facebook.com) is a prime example of the success of Web 2.0, taking the internet by storm with a user base or 500 million as of July, 2010 (Facebook, 2010). With the success of Facebook came the virtual explosion in information exchange, with concepts and ideas ranging from the mundane to the philosophical, from personal feelings to even the political arena. Social networking has been a vital web tool for the last few years that it would help change even the political landscape of the most powerful country in the world. Facebook has been successful for use in both personal and enterprise purposes because: It is convenient a few mouse clicks and a page is already online Cost effective it is practically zero cost to set-up. Anyone with a computer and internet access can setup an account in minutes. Time efficient it can be accessed anytime and anywhere (with mobile applications) Large networks it can utilize the personal and professional networks of members

Because of this, Facebook and Social Networking sites are at the forefront of a new breed of marketing campaigns, and are now used as vital tools by tech savvy marketing individuals and groups. Undeniably, Facebook goes beyond the social networking platform, as it has been used beyond the personal space. It has also been used, with certain degrees of effectiveness, for enterprise purposes because it is convenient to set up, is virtually cost free, and can be accessed anywhere (with available internet connection). With its continuously growing user base,
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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Facebook has become a viable audience base to sell ideas, products and services, even spawning viral marketing campaigns that hope to attract the attention of greater audiences with greater impact. Viral Marketing Campaigns: The new Word-of-Mouth in Social Media Viral marketing is a technique that is based on the assumption that people will share interesting and entertaining content. Blogs and seemingly amateur videos are often used to create word-of-mouth buzz for a new product or service, generating exposure that is often much more valuable than traditional advertising. The spread of viral marketing is related to the spread of concepts such as the meme, an idea that self-reproduces like a virus; a catchphrase or concept (Oskui, 2010) The popularity of Facebook has given viral marketing campaigns a new media to use. Facebook relies heavily on networking and its ease of use enables users to immediately share interesting photos, videos and text. The goal of viral marketing is to utilize the Internet to pass on subtle messages or information about a product or service, and/or to enlist customers to pass on something about a product or service to their network of friends through the Internet. (Scott Public Relations, 2001). Viral marketing can be a very effective tool to disseminate information on health, and to influence people to improve their health seeking behavior. Similar to the warnings of the WHO, there are also implications on using viral marketing, social networks and the internet for health information dissemination: a) Violation of privacy. Individuals are concerned about the privacy of their health information for a variety of very good reasons and the internet can be suspected as a means by which privacy can be violated.
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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK b) Healthcare delivery is local. Generally speaking, the provision of healthcare services is a local phenomenon. Information and health messages can be relevant to users within a specific user area or group, thus other users outside this group may not be interested in this information. c) Internet penetration and access. Despite its rapid adoption, there are still millions of people who do not use the Internet. Target audiences of the health messages may belong to communities without access to the internet. d) People hate spam. To be successful, viral marketing must be personalized, valuable, and perceived as coming from a reliable source that the recipient knows and respects. Otherwise, the information will just be sent to the trash bin.

Statement of the Problem Tuberculosis (TB) is a contagious disease that spreads through the air like the common cold. Only people who are sick with TB in their lungs are infectious and when they cough, sneeze, talk or spit, they propel TB bacilli, into the air. A person needs only to inhale a small number of these to be infected. If left untreated each person with active TB disease will infect on average between 10 and 15 people every year (WHO, 2010). The Philippines is 9th among the 22 countries with the high burden of TB. Internet penetration is steadily growing in the country. Information and health messages on tuberculosis have already been done using the static web and even social networking sites. Web cafes with their affordable internet connection rates and prepaid internet cards have given

SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK even the poor access to information that is available online. Health information is just a mouse click away. Despite the reach of social networks, there have been little or extensive assessment and studies on this internet phenomenon and its use for health. Also, while the country has taken great leaps in terms of treatment and care, with the increase in internet access to health information, knowledge and misconceptions about the tuberculosis still remains. This research would like to answer: How effective is Facebook in spreading health information, particularly TB? Can social networking sites be used effectively in affecting knowledge, attitudes and behaviors on tuberculosis? Objectives of the Study This study aims to determine the effectiveness of Facebook in increasing awareness of users on Tuberculosis, transmission, prevention, and control. Specifically, this study aims to: 1. Describe the profile of the respondents; 2. Describe the communication profile of the respondents; 3. Determine TB-related information acquired and retained by the respondents from Facebook; 4. Determine the information TB-related information shared by the respondents to others via Facebook; and 5. Give recommendations on how to improve the strategies (e.g., messages development and content delivery) of information on TB in Facebook.
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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Importance of the Study This study hopefully will contribute to the initial body of knowledge that will further assess the impact of social networking for health and other relevant purposes, particularly in: a) Improving health message development this study hopes to be able to provide insights on how health messages should be crafted for use in a social networking platform. Unlike the static, unmoving pages of basic websites, Facebook and twitter rely on continuous stream of information. Thus, this study may be able to provide information on the appropriate crafting and dissemination of health messages to a network of users. Given that internet viral marketing and memes passes through the consciousness of users in a faster pace than the usual website, achieving maximum impact in the delivery and retention of messages is vital. b) Audiences targeting this study can be valuable for content developers as it may give focus to them in targeting potential audiences for product, services and social development causes and programs. c) Expanding reach development programs will be able to expand their reach and increase networking and even gather additional funding support.

SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Conceptual Framework Study The basic communication model shows the relationship of the different elements of communication: message, channel, audience, feedback, environment and barriers, harmonized into a continuous cycle of information exchange.

Fig. 1: A Communication Model for the Study

Applying a similar model in the study, the use Facebook (and other internet social networking site) acts as the channel from which the exchange of information takes hold. Messages come in the form of health information catalyzed by the use of viral marketing techniques thereby speeding up knowledge acquisition and retention. The facility for comments and feedback mechanism improves knowledge sharing and facilitates the increase and improvement of the knowledge pool, which goes back into the message acquisition and sharing cycle.

SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK
Knowledg e retention

Knowledg e retention Knowled

Viral Marketing Schemes Health Messages and Information via Social Networking

ge Sharing

Knowled ge retention

Knowledge acquisition
Viral Marketing Schemes Knowledg e Sharing

Comments, sharing and feedback mechanism

Fig. 2: Viral Marketing in Social Networks for Knowledge Acquisition,

The use of viral marketing in Facebook is effective in disseminating health information and enhances knowledge acquisition, retention and sharing. Thus, the active delivery of health information sent through social network and delivered using viral marketing schemes (pushing of messages) will be acquired, retained and shared by more users/audiences as compared to the passive acquisition of information via static internet websites (pulling of messages).

SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK METHODOLOGY Design The study used a one-shot case study design, as the study intends to be exploratory and was only able to get a limited snapshot of the respondents activity and behavior. Respondents and sampling This study also used purposive sampling to determine its respondents. Due to the nature of Facebooks user base, of which users are spread all over the world, it is not possible to limit participation of respondents to a particular area or location. The study acquired its respondents from the Global Fund TB Grant Facebook Page (http://www.facebook.com/pages/PBSP.GF.TB). As of this writing, this page has 165 user likes. Through regular posts and reminders on the page, these individuals were requested to participate in study. The researcher also sent email and notification to these users, as well as sought the participation of other users in his own Facebook Network. A post on this page also encouraged users to invite friends to like the page and participate. Research Instruments 1) Survey - This study collected data using an online survey questionnaire form which was self-administered by the Facebook user. The link of the survey form was posted in the FB page. The survey was able to gather 50 respondents, representing 30.3 % of the total user base of the page. The survey was conducted on January 23 and ended on February 10, 2012. The online survey utilized contains the following variables:

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK General Information Facebook Usage Knowledge on TB Use of FB for Sharing information on TB

2) Focus Group Discussion (FGD) The online FGD which separately conducted through Yahoo chat was aimed at getting a deeper insight on the opinions and ideas of respondents on the contents of TB health messages on Facebook and its development for TB information dissemination. The FGD was done on February 10, 2011, at around 8pm. The schedule was determined to be the best schedule since it was a Friday and all of the participants are already home. Data analysis The study used descriptive analysis using frequencies and percentages.

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK RESULTS AND DISCUSSION Objective 1: Respondents Demographic Profile Location of Respondents 45 of the survey respondents came from the Philippines, 3 respondents were from Saudi Arabia, 1 respondent came from the USA and 1 respondent was from Singapore. For the FGD, all of the participants were from the Philippines

Figure 3. Location of survey respondents

Age, Sex and Civil Status Of the total 50 respondents in the survey, 48% of which were aged between 21- 40 years old and 40% were aged between 31-40 yo. Mean age is at 31. 92 years old. 28 respondents (56%) are males while 22 (44%) are males. Shown below (Table 1) are the ages of the suvrey respondents.

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK
Table 1. Respondents Age

Age Bracket 11-20 21-30 31-40 41-50 51-60 Total

No. of respondents 1 24 20 4 1 50

Percent 2.0% 48.0% 40.0% 8.0% 2.0% 100.0%

31 (63.3%) of respondents are single, and 14 (28.6 %) are married. 3 (6.4%) are engaged/living in, and 1 respondent (2.1%) is separated. In the online Focus Group Discussion, of the 15 individuals invited through email to participate, only 8 were able to join. 5 of the participants are males, and 3 are males. Participants are aged 16-35 years old. Education and Occupation 26 survey respondents (54.2%) are college level, 18 (37.5%) have masters degrees (or are currently taking their MAs, 4 (8.3) are taking other post-graduate degrees. 26 or 54.2% are private sector employees, 6 (12.5%) are OFWs, 5 (10.4%) are government employees, 4 (8.3%) are NGO workers. Meanwhile for the FGD participants, 5 are employees, while 3 are students.

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Objective 2: Respondents Communication Profile Facebook Usage 30 survey respondents (63.6%) have been using Facebook for 3-4 years, 11 (25%) responded with 5 years and above, and 5 (11.4%). 4 have no answers.

Figure 4. Length of Facebook Usage

Meanwhile for the FGD, all of the participants are Facebook users, and have been for at least 5 years. All are accessing the internet in their homes, using personal computers. All of the participants use their Facebook every day. Locations where Facebook is accessed The home is the main location where Facebook is accessed, followed by the office, mobile phone and internet cafs.
Table 2. Locations where Facebook is accessed

Location

Home Office School Internet Mobile Phone Others

Number of Responses 43 33 6 16 29 1

Percentage of Responses 98% 75% 14% 36% 66% 2%

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Time of Access 17 of the survey respondents (37%) access Facebook between 6 pm 12 midnight, 15 (32.6%) are online the whole day, 12 (26.1%) access between 12 noon to 6pm, and 2 (4.3%) responded accessing between 12 midnight 6 am.

Time of Access
15, 33% 2, 4% 0, 0% 12 midnight - 6 am 6 am -12 noon 12 noon 6 pm 12, 26% 6pm 12 midnight Im online t he whole day

17, 37%

Figure 5. Time of Access

Number of Facebook Friends 17 (39.5%) of respondents have 301-600 FB friends as of this survey, 9 (20.9%) have 101-300 friends, and 7 (16.3%) have 100 friends below.

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Figure 6. Number of Facebook Friends

SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Facebook Activity The survey respondents were asked to rank their Facebook activities in order of importance, with 5 being the most important, and 1 being the least. 24 respondents (52.2%) answered Read and comment on posts as 1 st on what they usually do on Facebook, 17 (38.6%) answered Post and View Pictures as 2nd, 15 (35.7%) answered Post and share links as 3 rd, 14 (34.1%) answered Post and view videos as 4 th, and 24 (55.8%) answered Play games as the 5th.

Figure 7. Respondents Facebook Activities

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK

Objective 3: TB-related Information Acquired through Facebook

Information searched on Facebook Individuals, Organizations and Health were the top 3 when responses when asked for information being searched by the respondents on Facebook.
Table 3. Information Searched on Facebook
Rank 1 2 3 4 5 6 7 8 9 10 Information Searched Responses Individuals Organizations Health Education Beauty Fashion Research Studies Science Arts Others 39 28 27 25 25 17 17 13 12 3 Percent 87% 62% 60% 56% 56% 38% 38% 29% 27% 7%

Health Topics on Facebook When asked for health topics that respondents are interested in finding in Facebook, top 3 responses were Basic Information, New Discoveries and Cures and Remedies.

Table 4. Health Topics searched on Facebook

Rank 1 2 3 4 5 6 7

Health Topic New Discoveries Cures and Remedies Signs and Symptoms Medical Procedures Medical Anomalies Others

Responses 29 25 24 13 13 1

% 76% 64% 56% 53% 29% 29% 2%

Basic information on Health 34

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK

Meanwhile in the FGD, most respondents agree that when they see and read information on health, they usually ignore the posts if the information is not relatable. One respondent answered that she is a bit sensitive if the topic involves children, as she has a child of her own, so whenever information on diseases in children is posted by her friends, she usually reads them. Awareness on TB When asked if they are aware of Tuberculosis, 44 (88%) of respondents surveyed answered in Yes, while 5 (10%) have no answer. Only 1 (2%) is not aware of TB.

Figure 8. Use of Facebook for Sharing TB Information

Knowledge on TB When asked as to what information on TB the respondent know, top 3 responses were: TB is curable, TB is transferred through coughing/sneezing and TB is deadly.

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Figure 9. Knowledge on TB

SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK

When asked how did the survey respondents learn about TB, 16 (36%) responded that TB was taught in school, 8 (18%) got the information through health educators and 5 (11%) got the information through rumors.

Figure 10. How respondents learned about TB

When respondents where asked where did they learn about TB, 21 (48%) answered School, 12 (27%) answered Home, and 5 (11%) answered Work.

Figure 11. Where the respondents learned about TB

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK

23 (31%) of respondents answered NO, when asked if they Liked an FB post on TB, 15 (21%) answered YES, while 10 (21%) had no answer.

Figure 12. On Liking FB Posts on TB

The number 1 information remembered for the posts on TB is DOTS/TB Care with 13 responses, followed by Prevention with 10 responses, and Symptoms and Mode of transmission both with 9 responses.

Figure 14. TB information retained

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK In the FGD, Only 3 were able to read information on TB on Facebook, but all have seen one or more type of health information on Facebook. Two mentioned that they usually see information about HIV/AIDS, and lately, appeals from other friends about children with certain type of diseases, either hydrocephalus, or cleft palates or lips. Of the 3 who were able to see information on TB, one noted that the information is very technical in nature, and not pertaining to information on the disease. The two did not remember the information that they read. Information retention When respondents were asked why they remembered the information, 8 respondents (50%) answered that the information was important and 2 (13%) answered that the post was emotionally touching.

Figure 15. Reasons for remembering information

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Objective 4: TB-related information shared through Facebook Information Shared on TB Asked as to what information the survey respondents shared on Facebook about TB, number 1 response was TB Prevention, followed by TB Care, and Modes of Transmission and symptoms.

Figure 16. TB Information Shared

Factors for sharing The survey also asked respondents what triggered them to share the information on TB, 13 (93%) answered that the information is important, and 1 (7%) answered that this was required in school.

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Figure 17. Reasons for sharing

SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Effectiveness of FB for TB Information 36 survey respondents (84%) think that Facebook is an effective source on TB Information, while 7 (16%) answered No.

Figure 18. Is Facebook an effective source of TB information?

When asked why, respondents enumerated the following reasons: a. Facebooks number of users and network b. Facebook easily connects people with each other c. Information gets more interesting once posted on Facebook d. Almost everyone is in Facebook When the NO respondents were asked why they think Facebook is not an effective source of information on TB, the respondents answered the following: a. TB is an index of poverty, most people affected by the disease are poor at do not have access to Facebook. b. Not all Facebook posts are credible. c. Most are just sharing personal information. d. TB is a depressing topic.
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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Meanwhile in the FGD, the participants were asked if Facebook can be used for sharing health information, 5 participants said yes, while 3 said no. The yes participants agreed that Facebooks network can be utilized to spread information on health. Probed further if Facebook can be used to spread information on TB, the yes participants still agreed, but two participants mentioned that TB is still seen as a disease of the poor, and they think most patients are still poor so the information will not reach them. They still agree that for prevention measures, the information can still be spread to Facebook users. The No respondents agreed that FB can be ineffective for health information dissemination because of the speed of the updates. If a user would not log in for some time, any information on TB or any health information posted by a friend can be buried below all the new information. Also, TB is not a hip disease like HIV/AIDS. When probed further, a participant mentioned that some of the faces of HIV/AIDS are popular like Magic Johnson, and most awareness campaigns are supported by popular celebrities. He has not seen a public figure admitting to having TB. They think this is because TB is not a very popular disease. All of the respondents agreed when one mentioned that users should always be careful when seeing information on Facebook. She has seen some of her friends click on videos that turned out to be viruses, or hoaxes. One agreed, that the internet in itself is already filled with false information, and that by putting it in Facebook, some would think that it is the truth. When probed further, the participants think this is because of the naivet of Facebook users, and lack of experience in using the internet. While most websites would have to be setup by professionals, setting up a Facebook account or page is relatively easier, and they think that this can be abused. The participants were asked as to how Facebook can be used for TB information dissemination and what features would be the best way to do this. One participant suggested that
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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK the posts first should be accurate, and that all information should be backed up with data. Another participant agreed, and that the information should always be fresh and updated. She said that she has been following blogs on fashion and beauty and what keeps her visiting the blog is the constant update. If a Facebook page fails to update the posts regularly, they might lose the readers. The other suggested that the page should still maintain a separate website, where the complete information on TB is stored. The problem that he sees for Facebook is that although it is easy for pictures and videos to be saved, long articles are not easily found, and the short status messages are easily buried among other updates. They could not also upload documents and PDF files. One participant is doubtful of Facebooks technology to spread information on health, in general. He thinks that the site was made for social interaction and that the ordinary websites are still the best information on TB. He mentioned that even sites like Wikipedia are doubted as credible information sources, how much more with social networking sites such as Facebook. Objective 5: TB Information and Message Development In the FGD, participants were asked how the messages should be crafted to be noticeable on Facebook. Most of the participants suggested to post heart-warming messages, the type that appeals to parents. A participant mentioned that the effect of TB on children would be effective since most mothers like her share information on child care with her friends. Most agree that the posts should not be technical but should be concise. Messages should also be regularly updated and relatable. There should also be consideration in the language. All agree that since Facebook is an international page, the posts should be mostly in English to be able to reach a broader audience. One suggested that if the post is targeted for Filipino audiences, to consider translating it to Tagalog and other major dialects.
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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK Most of the participants suggested taking advantage of the photo and video features when crafting the information, but be careful with explicit images like body parts, open wounds and the like as most are in agreement that it is turning them off, and they would just ignore it. One participant also suggested being careful with the rights on confidentiality in posting of information on persons with diseases. A participant suggested that an interactive game can also be used so that children who are also Facebook users can learn about TB while having fun. Most of the participants agreed that the photo and video upload features are very useful, as they have seen in other health information posts. One suggested that maybe for photo postings, there should be an accompanying human interest story about TB, since like her, she is not into the scientific explanation of the disease, but she is more interested in the human aspect of how the diseases affect the lives of the patients and the families. A participant noticed that even the DOH has no recent or updated information campaign on the disease, unlike the other health campaigns like dengue.

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK CONCLUSIONS AND RECOMMENDATIONS Conclusion Results of this study indicate that indeed, Facebook can be used effectively to disseminate information on TB, however, FB as a medium could be in support of a bigger TBawareness and information campaign. Results of the survey indicate that spreading awareness on TB can be effectively made through Facebook due to its large user-base and quick information exchange mechanisms, such as video and photo sharing, and immediate feedback through comments. . However, the effectiveness of the campaign will depend on factors such as greater awareness of the needs and interests of a target user/audience base, establishment of a recognizable and relatable brand, and development of messages that are clear and concise. Results from both the survey and FGD indicate that messages are shared faster if the user can relate to the messages being sent. Information first and foremost needed to be factual, but the effectiveness of sharing the information to other users can be catalyzed if these can also tug at the users emotions. Recommendations Facebook can be used for short and quick information dissemination Facebook is very effective in linking up a users network of friends using the constant updates of status messages, video and photo posts. A users newsfeed is regularly updated with new information within minutes, even seconds. Utilizing this feature of Facebook for TB information dissemination would be effective via the use of short and easily digestible snippets of information.

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK TB campaigns over Facebook should be able to provide for effortless transfer of the information from the source to the audience Using simple and concise messaging is better for information transfer and retention of knowledge. TB is bacteria that are easily transferrable. This message is just as true in spreading awareness on the disease. Information spread when it is easy to transmit. The medium that carries the TB message must be easy to transfer and replicate, therefore the transfer of these messages via Facebook networks should be generally pain-free for users. Viral marketing works on Facebook because instant communication has become so easy and inexpensive, messages should be simpler so it can be transmitted easily and without degradation. Common motivations and behaviors can help increase sharing of information Clever viral marketing plans take advantage of common human motivations. So does the hunger to be popular, loved, and understood. The resulting urge to communicate produces thousands of shared photos, videos, and statuses over Facebook and other popular social networking sites. Knowing audiences common motivations and behaviors, couple with clear and concise messaging, will enable messages to be quickly transferred and shared.

Utilizing Networks is effective, but audience segmentation is key. Most people are social. An individuals network may consist of hundreds, even thousands of people, depending upon her position in society. Health educators embarking on utilizing social networks should understand the power of these human networks, both the strong, close networks as well as the weaker networked relationships. People on the Internet develop networks of relationships, too. Within these networks are segmented audiences with difference information

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK needs and motivations. TB messages need to be crafted to address the information needs of individuals within these networks. Awareness of user habits Facebook is very interactive and therefore message developers should be aware of user habits of target audiences. As indicated by the FGD results, adults are more inclined to share information on health, as these may affect their children (for parents). Timing of messages are also important, while static websites can retain the information longer, information on Facebook is immediately updated and replaced. Well timed information update may play a key in the sharing of messages (posting in the morning vs. evenings). Brand recognition TB is not a popular or hip topic. Health educators should be able to position TB as a brand that is easily recognizable, much like the HIV, Dengue, and Smoking Campaigns of the Department of Health, a strong brand presence will allow for a quicker retention and wider sharing of information. Facebook can be used to support a bigger IEC campaign While an effective medium, TB awareness campaigns would still need a bigger strategy where the use of Facebook can be used as one of the tools. Information posted on Facebook should serve as a portal for complete information available through other IEC materials and websites. An in-depth analysis is also needed, particularly in Facebook user behaviors and attitudes, as well as factorial analysis of elements that contribute or hinder effective information transfer, retention and sharing.

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SOCIAL NETWORKS FOR HEALTH INFORMATION: INCREASED AWARENESS ON TUBERCULOSIS THROUGH VIRAL MARKETING SCHEMES IN FACEBOOK References Capilanou University. (2010). A Social Media Glossary. Retrieved December 8, 2010, from http://www.capilanou.ca/help/login-page/active-cms/glossary.html#Web%202.0 Facebook. (2010) Company Timeline. Retrieved December 10, 2010, from http://www.facebook.com/press/info.php?timeline Oskoui. (2010). Glossary. Retrieved December 11,2010 from http://www.oskouioskoui.com/glossary/M World Health Organization. (2010). What is Tuberculosis? Retrieved December 10, 2010 from http://www.who.int/topics/tuberculosis/en/ Boyd D. M., & Ellison, N. B. (March, 2007). Social network sites: Definition, history, and scholarship. Journal of Computer-Mediated Communication, 13(1), article 11. Retrieved December 29, 2010 from http://jcmc.indiana.edu/vol13/issue1/boyd.ellison.html World Health Organization. (October 2009). What social media offers to health professionals and citizens. Bulletin of the World Health Organization. Retrieved January 4, 2011 from http://www.who.int/bulletin/volumes/87/8/09-066712/en/ PRN News Wire (December 2010) Study of Diabetes Information Shared on Facebook Identifies Patient Benefits, Potential Risks of Health 2.0, News Releases. Retrieved January 11, 2010 from http://www.prnewswire.com/news-releases/study-of-diabetesinformation-shared-on-facebook-identifies-patient-benefits-potential-risks-of-health-20106512043.html Scott Public Relations (2010). The New Generation of guerilla marketing : can viral marketing work for health care? Health Leaders Information to Lead. Retrieved December 28, 2010 from http://bit.ly/fErSZc (shortened URL)
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