Author : Hugo Yim (MPH candidate 2022)
This public health strategic plan aims to propose a scalable and effective strategy to promote Drug Icon CC to the young people in Hong Kong. It is proposed that active promotion through Instagram would be a feasible approach to deliver health-related messages to the younger generation. Details of the promotional strategy and performance indicators for evaluating the intervention would be clearly explained in the strategic plan.
Background and Context of the Target Population (Young People)
According to the World Health Organization, ‘Young People’ are individuals in the age range between 10 to 24 years, which covers both the ‘adolescents’ and the ‘youth’1. In Hong Kong, there are a total of 893.2 thousand young people, which accounts for 12% of the total population2. In fact, the penetration rate of mobile devices has been increased sharply in the past decades. Studies from the government revealed that there were 77.9% of people aged 10-14 and 99.3% of people aged 15-24 possess a mobile device3, showing that the high-speed development of information technology has been affecting the community greatly under the information era. Regarding social media and health, studies revealed that there were 619,000 Instagram users in Hong Kong who are aged 13-244, showing a large portion of the target population are active social media users. Moreover, a survey conducted by the government found that people aged 15-24 were the heaviest users among all age groups, which are spending 17.7 hours on social media per week5. Therefore, it is expected that increasing exposure on social media would facilitate young people to know more about Drug Icons. In fact, young people are greatly believed in health information presented on the internet and social media. A local study found that compared to other countries, such as the United States and South Korea, young people in Hong Kong have the highest level of trust towards health information on social media6. Additionally, they are more willing to self-disclose their health issues through online platforms6, which indicates that it is greatly possible to dissipate health information and promote Drug Icons through social media. While the company has operated a Facebook account and recently set up a health knowledge page to deliver health messages to the general public, it is proposed that Acesobee can also consider using Instagram as a major communication media to deliver health information to the young people, which aids to promote Drug Icon in the community. It is noted that young people have been losing interest in Facebook in recent years, the percentage of teenage Facebook users was declined steadily from 94% in 2012 to 27% in 20217, which worried that the published post and information might not be able to reach the younger generation. Therefore, it is suggested to maximize the use of Instagram to deliver and promote health information to the youngsters
Studies and Research related to Instagram-based Health Promotion/ Intervention
Various countries and transnational organizations, including the World Health Organization (WHO) and Pan American Health Organization, have operated an Instagram profile to disseminate visually rich health promotional information to the general public8. In fact, there are plenty of studies that have analyzed the effectiveness of Instagram promotion and offered suggestions/ recommendations to increase the reach of the profiles. For instance, an exploratory study has been conducted to evaluate the official Instagram accounts set up by the National Health Services in Portugal as well as the Ministry of Health in Brazil8. By assessing all the post contents and user interactions, it was discovered that creating dialogues with users and covering topics of interest are the most important key to achieving success in health promotion8. It is noted that there was no interaction with the users on Portugal’s Instagram, resulting in sender-centred, vertical communication and received lots of complaints from the users, showing that replying to users’ comments and inviting them for interaction is necessary. In fact, they have concluded with suggestions of good practices which can facilitate Instagram operation, which includes: answering the user’s comments when there are enquiries and encouraging social participation; utilising the information given in the comment to improve communication strategies; presenting content with topic of interests and have a good planning of post content with regular and frequent publications8. It is suggested that these comments can facilitate the company to reach Instagram users more effectively. Actually, lots of public health studies have highlighted the importance of interaction and engagement with social media users9,10. In fact, a study was conducted to compare the engagement between Twitter and Instagram through evaluating the number of likes, comments, or shares. It was discovered that Instagram elicits more engagement and is able to disseminate information relating to infectious disease outbreaks (Ebola) more effectively than Twitter11, indicating that Instagram is ultimately useful in health education and promotion.
While it is mentioned that presenting the topic of interest is essential to facilitate engagement and increase the reach to the target population, it is critical to publish Instagram posts that are popular and commonly discussed among the younger generation. In fact, studies have shown that young people are more comfortable when discussing hard-to-discuss issues (e.g. Sexual health, drugs) on online platforms, compared to face-to-face communication13. Besides, it is noted that topics related to sex, dieting and nutrition are being commonly discussed among youngsters on social media14. Therefore, it is suggested that the company can design the post content based on the interests of the young people as well as the current hot topics in society. In fact, it is acceptable to discuss those relatively hard-to-discuss topics in a healthy and proper way (such as educating people about contraceptive pills/ instructions of self-administering rectal and vaginal medications etc.).
Proposed Approaches/ Topics to promote Drug Icon on Instagram
(i) Promote Drug Icon through current hot news related to medication
While one of the major aims of Drug Icon is to enhance peoples’ knowledge and adherence to medication, it is suggested to collaborate the medication pictogram with current hot issues in order to address Drug Icon to the young people. For example, while pharmacies in Hong Kong are currently running out of Panadol since people are stockpiling essential supplies14, young people, in fact, may not know much about the medication. It is suggested to educate people about the basic medical knowledge related to Panadol (paracetamol). Actually, this knowledge can be addressed through Drug Icon by using it as an education tool. For instance, we can place the icon “Avoid Alcohol” (figure 1) when we educate people about the precaution of taking paracetamol. It is because doctors and pharmacists have strongly advised not to drink alcohol as it may increase the risk of hepatotoxicity with ingesting together with Panadol15. Besides, we can remind people to take the medication as needed by placing the Icon “As needed” (figure 2) on the Instagram post. By applying the Drug Icon to real-life examples/ current hot issues, it not only helps to promote Drug Icon in social media but also to facilitate people in receiving health advice and information.
(ii) Promote Drug Icon through common health issues/ problems among young people
As mentioned above, presenting topics which are interested to the youngsters is the most important key to achieving success in health promotion8. In order to attract young people to be interested in the post content, it is recommended to introduce Drug Icon by discussing the common health issues among the youngsters. For instance, it was found that the number of adolescent psychiatric patients has increased by 50% from 2011/12 to 2015/1616. Meanwhile, the youth suicide rate has doubled from 2014 to 201716, showing that there are an increasing number of young people suffering from mental health diseases. While people are getting more concerned about positive mental health17, especially under the pandemic, it is recommended that the company can design posts related to mental health-related/ psychiatric medications, such as the indications and precautions of taking sleeping pills. While there are various over-the-counter (OTC) sleeping pills available in Hong Kong18, it is critical to educate young people to take the medication in an appropriate manner through the application of alcohol. For instance, we can apply the icon “Avoid Alcohol” to highlight the harmful effects of combining alcohol and tranquillizers. It is noted that taking the sleep pills together with alcohol would induce dangerous and deadly side effects, such as slowed or laboured breathing due to suppression of the central nervous system19, which is life-threatening. Therefore, it is suggested to promote Drug Icon through the common health issues among youngsters to cater for their concerns.
Besides, as mentioned that topics related to sex, dieting and nutrition are being commonly being discussed among youngsters on social media as people are more comfortable when discussing these issues through the online platform13,14. Therefore, it is proposed that Instagram would be a good online platform to promote Drug Icon and educate sexual health knowledge among young people by introducing sexual medicine (e.g contraceptive pills). In fact, recent studies revealed that Hong Kong young people are having deficient knowledge about contraception, especially on condoms and contraceptive use20, showing that more education should be given regarding the use of contraceptive medications. Therefore, it is suggested to promote Drug Icon by applying the icons when educating young people about contraceptive pills (e.g “Complete the whole course” (figure 4) and “May cause drowsiness” (figure 5)). Example was given in figure 6 for reference.
(iii) Promote Drug Icon through trivia
Trivia has been used for teaching and learning for many decades since it was found to be effective in educating health-related knowledge to students. For instance, studies revealed that students are having significant improvement in sickle cell disease knowledge after receiving a trivia-based education21, which indicates that trivia is an effective tool to engage young people. Therefore, it is suggested to introduce Drug Icon to young people through trivia. For example, there is a common misconception for Chinese people to take medication after meals in order to prevent ‘harming’ the stomach. Yet, the actual reason is that ingestion of food would alter the stomach acidity, which may affect the action of the medication22. It is noted that some medicines such as azithromycin, isoniazid and erythromycin would compromise when exposed to the acidic environment22. As a result, such medications should be taken on an empty stomach. On the other hand, there are also drugs that require an acidic environment to facilitate absorption (e.g itraconazole and ketoconazole)22. Therefore, such medicines should be taken after food. By promoting the drug icon through trivia, this may help to engage young people through various fun facts, which is a feasible and effective approach to increase their attention. In fact, trivia can also be used by asking users to guess which celebrities have been suffered from medical diseases and introducing the disease-related medication through Drug Icon. For instance, by introducing celebrities who had suffered from depression (e.g Lady Gaga)23, it is possible to introduce the precautions of taking antidepressants through the use of Drug Icon (e.g explain the reason why patients may need to take plenty of water when taking the medications/ why antidepressants would cause drowsiness etc.). This allows young people to receive health knowledge in a more interesting way.
(iv) Promote Drug Icon by asking followers for any interesting topic
As mentioned that interaction and engagement with Instagram users are critical to effectively disseminating health information through social media9,10. In fact, there are numerous diseases and medications that can be discussed and promoted through the Drug Icon. However, it is more important to cater for the needs and concerns of young people by offering an online platform to ask medication-related questions. It is suggested to utilize the interactive functions on Instagram to facilitate communication with the users. By reading their questions, it could be an inspiration for the company to create posts for answering their concerns, which creates a positive feedback loop.
Measures to facilitate interaction with users
(i) Creating Instagram Augmented Reality (AR) games/ filters to promote Drug Icon
It is highlighted that gamification is commonly used in health education since it increases learners’ engagement and motivation by incorporating game elements in the educational environment24. For example, Finland has created a mobile health game “Fume” to promote adolescents’ tobacco health literacy and support tobacco-free life. Although it only contains several mini-games and textual information related to tobacco, studies revealed that embedded game elements are more effective to increase health literacy than the non-gamified intervention (website) due to the raised of interest, showing that gamification is an effective approach to promote health among young people. In fact, the Singapore government has also adopted gamification in health promotion. For instance, the official Instagram of the Health Promotion Board (@hpbsg) has created Instagram AR game filters (such as Bite for balance challenge) to promote healthy lifestyle as well as to facilitate interaction with users25. While these filters are permitted to repost and share with friends, it is expected to engage more Instagram users by sharing the filters and the players may learn health-related knowledge from playing the games. Therefore, it is proposed that creating AR filters is a feasible approach to promote Drug Icon on Instagram.
Regarding the feasibility, it is highlighted that the price of creating an Instagram filter is much lower than designing a gaming application. In fact, Facebook (the parent company of Instagram) has created the Spark AR Studio which allows users to design AR filters for free26. Since their aim is to make AR accessible for anyone27, the Studio offers templates and tutorials that aids to guide new users to create engaging filters26. Therefore, it is highly feasible for the company to create its own AR filter. It is highlighted lots of famous brands (e.g Starbucks, Coca-Cola, Uber-Eats) have already launched their custom Instagram filters to promote their brand and increase engagement with their followers28, it is proposed that creating AR filter would be a major trend to interact with young people on the social media. Therefore, using the company-designed mascot to create Instagram filters would be a feasible approach to promote Drug Icon and facilitate interaction with users.
(ii) Maximize the use of Q&A and Quiz function on Instagram
In order to increase engagement with the target audience, Instagram has created Story questions sticker (Figure 11 and 12) to allow followers to share their thoughts and tastes by typing on the Q&A boxes. All questions received can be answered publicly by creating an additional story. As stated that users’ comments and thoughts are effective tools to create inspiration for the company to design and create posts by answering their concerns, it is suggested that Q&A activity can be posted regularly to ask followers for any enquiries regarding currently taking medications or any health topics they would like to explore in order to facilitate interaction. In addition, interactions can also be achieved by using the Quiz sticker (Figure 13). Trivia-style multiple-choice questions can be created to test the followers about health or medication-related knowledge. This would bring more opportunities to engage with your audience and offers an interesting and relax way to educate young people. For instance, questions related to medication can be designed to test young people on their medical knowledge and application of Drug Icon. By educating the young people through an interactive approach, this may facilitate the promotion of Drug Icon on social media. In fact, Instagram is actively exploring and creating new features for users to interact with others (e.g created Photo sharing stickers and customized link stickers in early-2022)29, it is suggested that companies can utilize the new features to promote Drug Icon on Instagram.
(iii) Collaborate with other Instagram page/ Non-governmental organizations (NGO)
While Drug Icon has formed extensive collaborations with other NGOs such as Health In Action, Lok Sin Tong, Eldpathy etc. It is suggested to facilitate collaboration with these organizations to promote Drug Icon on social media. For instance, Instagram Live sessions can be organized by inviting members in Health In Action to share on medication safety and health-related information. Since the NGO has formed a transdisciplinary team (including pharmacists, nutritionists and nurses) to empower people to embrace healthy life30. Through the knowledge exchange and sharing by the healthcare professionals on Instagram live, it may help to answer the followers’ questions from professional perspectives. Additionally, exposure can be gained by co-organizing activities with other Instagram pages, which may help to attract followers from other channels to follow our pages. In fact, interaction can also be achieved by reposting, hashtagging and commenting on other Instagram pages, which are the common features to increase exposure on social media.
(iv) Responding promptly to followers’ comments
As mentioned, engagement is a critical component of running a successful Instagram account. While followers are the valuable asset of the Instagram page, it is important to interact with them by replying to their comments and concerns. In fact, the official Instagram created by the National Health Services in Portugal has offered a classic example of the consequences of not engaging with the followers’ comments (which received numerous complaints in the comment box)8. As a health promotor, it is necessary to reply to peoples’ questions in order to facilitate their understanding and learning as well as to establish a good image to the followers.
Strategies to evaluate the intervention
It is necessary to evaluate the effectiveness of Instagram-based health promotion on a regular basis in order to achieve continuous improvement. In fact, Neiger et al. have designed a set of key performance indicators (KPIs) for analyzing the performance of health promotion through social media31, which includes (1) Exposure, (2) Reach, (3) Insight and (4) Engagement. It is suggested that the company can be based be on these KPIs to evaluate whether the page has effectively promoted Drug Icon to young people. Indication of each KPI and their related metrics will be explained below.
Exposure refers to the number of times that the health promotion materials have been viewed on the social internet31. It is critical to analyze the number of views as increasing the exposure of Drug Icon is the major aim of creating social media channels for health promotion. In fact, the Centers for Disease Control and Prevention (CDC) have also stated that increasing exposure is one of the purposes for the use of social media in health promotion32, showing that it is important to evaluate the number of views that an Instagram post/ story has been received. It would be ideal that the health materials can be exposed to a large number of young people within a short period of time. There are various metrics that may facilitate assessing the degree of exposure, such as number of profile visits (accounts reached); website clicks; amount of views on each Instagram post and story; virality (growth rate of followers) etc. In fact, these data can be easily retrieved from ‘Instagram Insights’ if the Instagram page is a business account33. However, there are still a few analytics tools that are available to generate performance statistics for free33, which is easy for the company to generate these data. By evaluating the exposure, it aids the company to identify the strength and weaknesses of current promotional strategies. Therefore, it is suggested to evaluate the exposure of Instagram account regularly in order to analyze any particular posts/ published contents that have successfully increased the exposure. Besides, measures can be formulated to further increase exposure based on the performance statistics (e.g. adding extra hashtags on Instagram posts if it was found successful in increasing exposure).
Insight refers to the followers’ feedback from social media33. It is also highlighted by the CDC that communicating with consumers for market insights is critical when using social media for health promotion32. The study which analyzed the health promotion strategies in Portugal and Brazil have also reviewed the users’ comments to evaluate the performance of Instagram-based health promotion8, showing that feedback from the followers is indispensable in social media evaluation. Besides, as mentioned above, users’ comments could also be an inspiration for the company to create posts, which generates a positive feedback loop. Therefore, it is proposed that the company can record the numbers and types of comments and recommendations in order to evaluate the performance of the Instagram account. Based on the opinion given by the followers, solutions can be designed to improve the post content/ promotional strategies in order to attract more followers. In fact, there are some charged analytic tools that offer text analysis (e.g tagging, keywords, sentiment characterization etc.) to evaluate users’ comments. However, this can also be done easily by simply categorizing the common feedback given by the users (e.g classified comments into compliments, complaints, doubts etc.). An example was given below for reference.
Engagement refers to the extent of the followers engaged in social media33, which determines whether the users are actively participating in Drug Icon Instagram account. As mentioned that interaction with Instagram users is critical to effectively disseminate health information through social media, it is proposed that better engagement would help facilitate the promotion of Drug Icon in Hong Kong. In fact, one of the major advantages of using Instagram for promotion is that it offers various platforms for engagement (e.g votes and quizzes function, live, repost etc.). Therefore, evaluation of followers’ engagement is needed. Neiger et al. have classified the degree of engagement into three levels33. Low engagement assesses the extent to which followers have acknowledged a preference for the post content (whether the followers like the post content)33, which can be measured by the like rates and numbers of followers flagged/ saved the posts. Medium engagement measures the number of followers who are involved in sharing, creating and using the content to influence others33. This can be measured by comment and retreat rate, participation rate on Instagram stories (e.g quizzes, voting, Q&A etc.), direct message rate etc. High engagement refers to actual participation in offline activities which result from exposure to the social media application33. This can be measured by number of people who registered for activities organized by Drug Icon through the Instagram link, number of followers who attended offline events as participants/volunteers etc. It is highlighted that all the proposed metrics for low and medium engagement can be retrieved from Instagram Insights, while metrics for high engagement may need to ask the participants through questionnaires. It is suggested that the company can evaluate the level of engagement in order to decide any additional interactions on social media is needed.
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