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ACSM'S Health & Fitness Journal:
doi: 10.1249/FIT.0b013e31826f8c9d
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LEVERAGING SOCIAL MEDIA TECHNOLOGIES TO HELP CLIENTS ACHIEVE BEHAVIOR CHANGE GOALS

Torgan, Carol E. Ph.D., FACSM; Cousineau, Tara M. Ph.D.

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Author Information

Carol E. Torgan, Ph.D., FACSM, is a scientist based in Bethesda, MD. Her research interests focus on the adaptability of skeletal muscle, spanning from cellular biology to human performance. She is the principal at Kinetics Consulting, where she consults on the intersection of health, science, and technology.

Tara M. Cousineau, Ph.D., is a clinical psychologist and a research scientist, with a focus on mind-body medicine and positive psychology. She is the founder of BodiMojo, Inc., which develops technology-based health behavior change tools for adolescents. She has received grants from the National Institutes of Health, Small Business Innovative Research program.

Disclosure: The authors declare no conflicts of interest.

Tara Cousineau, Ph.D., is a recipient of a grant (NIH 1R43DK085748-01A1) from the National Institutes of Health. Carol Torgan, Ph.D., serves as a consultant on this grant.

Products and tools mentioned in this article are for illustrative purposes only and do not imply endorsement by the authors.

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Abstract

LEARNING OBJECTIVES: • Understand key considerations in matching clients with social media technologies to support health and behavior change goals.

• Become familiar with the four-step “POST” (people, objectives, strategy, technology) approach.

• Become aware of the risks and benefits of using social media technologies.

Facebook, Twitter, YouTube, and Pinterest. Gadgets, trackers, and apps. The fast-moving participatory world of social media is embraced by professional athletes, celebrities, and major corporations, as well as by the White House and Mayo Clinic. An ever-expanding array of tools and technologies gives health and fitness professionals the power to reach and connect the right person with the right information in the right place at the right time.

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“Social media” is defined as “forms of electronic communication through which users create online communities to share information, ideas, personal messages, and other content (as videos)” according to Merriam-Webster (6). Social media may include Web-based tools and mobile technologies that foster information creation and exchange.

As a result of new technologies, new virtual communities are rapidly forming. There are more than 900 million active users on Facebook (3). On YouTube, more than 72 hours of video are uploaded every minute (10). There are thousands of health and fitness smartphone applications (apps) that range from Abs to Zzzs (1). With all these tools and technologies available, however, it can be tricky to know what will work best to engage, educate, and motivate clients and how best to incorporate the tools.

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BEHAVIOR CHANGE

One of the hardest things for people to do is to change behavior. Often, this is because a person’s goal is too extreme, too difficult, or just too unrealistic. Motivation can waiver, and people may just give up or give in to their vices.

What is typically missing is a simple plan where people can focus on small actionable steps or achievable goals. People who set specific manageable goals tend to achieve their goals at much higher rates than people who do not. Success is built on previous successes. An individual who sets a goal to run a marathon will need to train in small incremental steps or will otherwise fail. In essence, goals need to be SMART: specific, measurable, attainable, relevant, and time bound.

How can practitioners help people achieve success in reaching their goals? Three elements need to converge at the same time: motivation, ability, and a trigger, according to social scientist B.J. Fogg (4). A person may have a high motivation to change a behavior but a low ability to achieve it. Or they may have a high ability to change a behavior but a low motivation to do so. Finding the right methods to boost motivation and teach a skill is key, and may vary with individual needs and circumstances.

The third element, an appropriate trigger, serves as the cue. It can be external — like an alarm, an email reminder, or an exercise buddy one is obligated to meet (virtually or in real life). A trigger also can be internal or environmental — something in one’s daily routine like coming home from work and entering the kitchen or seeing your dog eagerly awaiting a jaunt.

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These cues are calls to action. Environmental cues at home, at work, at social events, or even in a restaurant are often subtle, may go unnoticed, and greatly influence behaviors, such as eating, as shown by Brian Wansink, Ph.D., director of Cornell University’s Food and Brand Lab (9). Simple changes in routine and setting up new triggers can be used for positive changes. For example, instead of entering the house through a kitchen door and automatically opening the fridge, a person may use the front entrance, where a pair of running shoes or a yoga mat has been placed as a trigger to be active. Or a person may put a bowl of fresh fruit or nut mix on a table as a cue rather than filling up a snack drawer with cookies and chips.

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THE “POST” APPROACH

The extensive range of social media technologies and gadgets now available provides a tool kit to help clients set specific goals, get and stay motivated, and set appropriate triggers that lead to behavior change. There are apps to track physical activity, follow a diet, save money, manage stress, and more. Such technologies can provide “nudges,” or electronic calls to action, to help clients achieve their health goals. Many of these technologies connect people to online communities or offer a person the ability to invite friends to join in a health challenge of choice. In this case, social accountability (another kind of trigger) can be quite persuasive.

But how and where do you start when new social media tools are constantly popping up, along with thousands of health and fitness apps? A good strategy is to follow the four-step “POST” approach. This stands for people, objectives, strategy, and technology and was created by Forrester Research, Inc. (2). The key to remember is that people always come first and technology always comes last.

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People

Know who your audience is. Consider what social media tools your clients are using (or not using). For example, someone who only uses a social networking site once a month or who is not allowed to access one in the workplace may not benefit from a health program delivered in this manner. Someone else may prefer simple email or text reminders. It is important to identify what types of technologies and tools are already a part of a person’s daily routine.

Extensive data from the Pew Research Center’s Internet & American Life Project underscore the significant demographic variations in social networking and mobile phone usage patterns. For example, of the 35% of American adults who currently own a smartphone, most are financially well-off, well educated, and younger than 45 years (8). And of the more than 70% of online adults who use video-sharing sites, such as YouTube or Vimeo, more parents (81%) than nonparents (61%) use them (7). Overall, 65% of adult Internet users say that they access a social networking site like Facebook or LinkedIn. This includes 8 in 10 Internet users aged 18 to 29 years and a third of individuals aged 65 years or older (5).

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Objectives

Consider your clients’ key objectives. What goals do they have or what specific behaviors do they want or need to change? Also consider your own objectives as a health or service provider. In addition to helping your clients, do you want to extend your professional brand to include technology tools? Do you want to engage and foster a supportive online community for your clients who share similar goals?

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Strategy

Assess what your resources are with respect to health content, skills, technology, time, and money. Then take time to think about how you plan to help your clients reach their objectives. What are the client service end points and what is most important to track or measure along the way? Consider how you plan to reach your own professional goals and how you can maintain the oversight needed to administer or promote the use of technology.

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Technology

Once you have the people, objectives, and strategy nailed down, then you can choose the most appropriate tools and technologies (or tool kit) to help your clients achieve their goals. Determine what tools will work best for you, what will work best for your clients, and then match these. Given a person’s health goals and lifestyle, what tools might function as a persuasive trigger to help him or her achieve his or her goals? For a list of questions to consider when selecting social media tools, see Table 1.

TABLE 1: Questions t...
TABLE 1: Questions t...
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CASE SCENARIOS: PUTTING IT TOGETHER

The following three case scenarios serve as illustrations of how individuals might benefit from technology-based tools in large part based on their personality, preferences, lifestyle patterns, and motivation.

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Case 1

Susan is a young mother with a full-time retail manager job. She considered herself to be in great shape during college until she settled down and had children. Now that she has gone back to work, she finds it difficult to get to the gym or to use home fitness equipment. She is now moderately overweight and increasingly self-conscious. She would like to lose some weight and “get in shape.” Like many of her girlfriends, she takes a backseat to self-care while managing home and work life. Yet, she generally is optimistic and sociable and stays in touch with her friends through social networks, which she often accesses through her smartphone; this experience has been very affirming for her. For her birthday, she received a gift certificate from her family to a local women’s fitness center and complementary sessions with a certified personal trainer.

The trainer talked to Susan about her background, goals, and use of technology. Based on Susan’s lifestyle and potential triggers, the trainer mapped out a fitness plan at the gym and also discussed some technology applications that might provide the right triggers for Susan during her busy day. The trainer suggested that Susan try some social health apps that she might find fun to do with her online friends and recommended some that are easy to use, inspirational, and focus on small daily challenges or life goals beyond fitness and nutrition like donating clothes or being kind. The trainer connected with Susan through her online social networking site of choice, using it to encourage her, notify her of upcoming events, and invite her to bring her friends along to try new classes. The trainer sends Susan text reminders about training sessions and positive feedback after the sessions. Susan has found that inviting her friends to set goals with her and exercise with her not only amplifies her social support but also makes the experience of setting goals and achieving them more fun.

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Case 2
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Bob is a middle-aged sales executive who spends more than half of his time traveling. He is prediabetic and has high blood pressure. During a regular checkup, his physician recommends that he exercise regularly and watch what he eats. Bob is concerned about his high blood pressure but has a hard time maintaining healthy habits on the road.

Bob’s company initiates a new corporate wellness challenge. Bob is intrigued by challenges, especially when there are rewards, so he enrolls in the program. The wellness program offers employees an online platform to log healthy behaviors, such as physical activity and eating, earn points, and get rewards. Bob likes the fact that he can engage in the online platform via his tablet or smartphone; he can quickly check his status during downtime at airports and in cabs, and he can get credit for the exercise he does on the road. He also can engage in competitions with his sales colleagues who are located in other regions around the country. For Bob, the online competition is a motivating factor and a trigger. Although Bob has no patience to log his dietary intake, he’s found an app that lets him use his smartphone to take pictures of his food and rate it. The act of photographing his meals is making him more aware of his food choices on the road.

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Case 3

Polly is a retired senior who recently had hip replacement surgery. She lives alone with her dog Darcy and visits her daughter and grandchildren on weekends. Her recovery is going slower than she would like, and this is making her somewhat depressed. She is not technology savvy other than using email and Internet video calling via Skype, which her grandchildren taught her how to do on her home computer. She loves being able to stay in touch with her family this way, and it makes her feel safe.

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Polly has been going to physical therapy at a clinic for her hip replacement but lately feels she’s not making much progress. Her therapist senses Polly’s frustration and talks to her about her goals and home life. Polly wants to be able to walk Darcy around the neighborhood without difficulty. Darcy serves as a trigger that Polly can use to progress. The therapist gives Polly two pedometers to use, one for her and one for Darcy, so she can track steps and note progress. When the therapist notes that Polly is having difficulty learning her new rehab exercises, he does follow-up Internet video calls to demonstrate the exercises and check on her progress.

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SOCIAL MEDIA BEST PRACTICES

As you explore social media tools, make sure you have clear policies and guidelines in place. Consider browsing a database of social media policies, such as the one at http://socialmediagovernance.com/policies.php#axzz1lBDZyeGu, which includes policies from The American Red Cross, The Cleveland Clinic, Coca-Cola, Kaiser Permanente, Pfizer, and the U.S. Navy. Although transparency and open dialog are hallmarks of social media, you need to ensure that privacy and safety are not compromised. Give careful consideration to the separation of your professional and personal identities (it may be most appropriate to have two online profiles). Also have plans in place to address issues such as negative feedback and privacy breeches.

New social media tools, apps, and Web sites are popping up regularly. Currently, there is no Good Housekeeping “seal of approval” or consumer guide as to quality, safety, and value. In addition, the terms of service guidelines for many sites change on a regular basis. As you explore the range of social media tools and technologies available (see Table 2 for examples), keep in mind that just because a new app or site exists, it does not mean you should use it, or that it will work for your purposes. Do your homework. Explore a variety of tools and online communities before recommending them. Guide your clients to take a buyer beware approach when deciding on what health apps to download or whether to join an online community. As with finding a fitness trainer, life coach, or nutritionist, finding the “right match” with a community, an app, or other social media tool is key and may take several tries. Fun and experimentation can be part of the mix.

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TABLE 2: Examples of...
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FUTURE TRENDS

The world of social media is rapidly changing and evolving. As smartphone ownership increases, more communication is moving mobile. In addition, the growing number of health and fitness apps gives people unprecedented on-the-go access to trackers and communities. The integration of game-like design features, such as challenges that offer rewards (known as gamification), will make apps and communities more entertaining and fun for many and provide more tools that can be used by health professionals to motivate clients to achieve healthy behaviors. In addition, new generations of consumer-friendly gadgets that monitor physiological variables are replacing standard measurement tools, such as heart rate monitors and pedometers. These sensors, which may be attached to the body or be embedded in clothing, will empower people to track multiple measurements and to share them in real time. This will increase the need for health professionals to help interpret the data and guide individuals to set and achieve appropriate goals through the adoption of healthy habits.

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CONDENSED VERSION AND BOTTOM LINE

There is an expanding array of social media technologies available to professionals to help clients achieve their personal health goals. Practitioners should consider a client’s goals, behavioral triggers, and preferred social media tools, as well as assess their own use of social media, and then match what will work best. A four-step POST (people, objectives, strategy, technology) approach provides a framework for determining why and how to integrate social media tools to help clients. Potential risks and benefits of these tools should be considered.

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References

1. Apple Web site [Internet]. Cupertino (CA): Apple App Store, Health & Fitness; [cited 2012 July 14]. Available from: http://itunes.apple.com/us/genre/ios-health-fitness/id6013?mt=8.

2. Bernoff J. The POST method: A systematic approach to social strategy. Forrester Research Empowered blog [Internet]. 2007 [cited 2012 July 14]. Available from: http://forrester.typepad.com/groundswell/2007/12/the-post-method.html.

3. Facebook Web site [Internet]. Menlo Park (CA): Facebook Fact Sheet; [cited 2012 July 14]. Available from: http://newsroom.fb.com/content/default.aspx?NewsAreaId=22.

4. Fogg BJ. A behavior model for persuasive design. Persuasive ’09 [Internet]. 2009 [cited 2012 July 14]. Available from: http://bjfogg.com/fbm_files/page4_1.pdf.

5. Madden M, Zichuhr K. 65% of online adults use social networking sites. Pew Internet & American Life Project [Internet]. 2011 [cited 2012 July 14]. Available from: http://www.pewinternet.org/Reports/2011/Social-Networking-Sites.aspx.

6. Merriam-Webster Web site [Internet]. Springfield (MA): Merriam-Webster definition of social media; [cited 2012 July 14]. Available from: http://www.merriam-webster.com/dictionary/social%20media.

7. Moore K. 71% of online adults now use video-sharing sites. Pew Internet & American Life Project [Internet]. 2011 [cited 2012 July 14]. Available from: http://www.pewinternet.org/Reports/2011/Video-sharing-sites.aspx.

8. Smith A. Smartphone adoption and usage. Pew Internet & American Life Project [Internet]. 2011 [cited 2012 July 14]. Available from: http://www.pewinternet.org/Reports/2011/Smartphones.aspx.

9. Wansink B. Mindless Eating: Why We Eat More Than We Think. New York (NY): Bantam-Dell; 2006. 288 p.

10. YouTube Web site [Internet]. San Bruno (CA): YouTube Statistics; [cited 2012 July 14]. Available from: http://www.youtube.com/t/press_statistics.

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Recommended Resources
AIDS.gov. How to use new media. Available from: http://www.aids.gov/using-new-media/.

Centers for Disease Control and Prevention (CDC) Social Media Tools. Guidelines and Best Practices. Available from: http://www.cdc.gov/socialmedia/Tools/guidelines/.

Mayo Clinic Center for Social Media. Available from: http://socialmedia.mayoclinic.org/.

Social Media Governance, Policy Database. Available from: http://socialmediagovernance.com/policies.php#axzz1lBDZyeGu.

United States Surgeon General’s Healthy Apps Challenge winners. Available from: http://sghealthyapps.challenge.gov.

USA.gov mobile apps. Available from: http://apps.usa.gov/.

U.S. Department of Health and Human Services (HHS) Center for New Media, Standards and Policies. Available from: http://newmedia.hhs.gov/standards/.

Keywords:

Online; Community; Fitness; New Media; Apps

© 2012 American College of Sports Medicine

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