A study on the effective use of social media in public health

education given by the government of Kerala

A dissertation submitted to Christ College (Autonomous), Irinjalakuda, Affiliated to the
University of Calicut in partial fulfillment of the Degree of

MASTER OF SOCIAL WORK

Specializing In
Medical and Psychiatric Social Work

Submitted by

ALISHA K S
(REG. NO: CCASMSW003)

Under the Guidance of

Mrs. DHANYA K
Asst. Professor in Social Work

DEPARTMENT OF SOCIAL WORK

CHRIST COLLEGE (AUTONOMOUS),

IRINJALAKUDA
MARCH 2021
 CERTIFICATE

This is to certify that the dissertation entitled “A study on the effective use
of social media in public health education given by the government of
Kerala", submitted to Christ College (Autonomous), Irinjalakuda, Affiliated to
the University of Calicut, in partial fulfillment of the requirements for the
award of the Degree in Master of Social Work is a record of original research
work done by Mrs. ALISHA K S (Reg.No.CCATMSW003) during the
period 2019-2021 under the supervision and guidance and that this dissertation
has not formed the basis for the award of any Degree / Diploma / Associate
ship / Fellowship and or similar title to any candidate of any University.

Ms. Dhanya K Rosemary T. George

Guide and Supervisor HOD, Dept. of Social Work

Signature of External Examiner

Name of External Examiner

 DECLARATION

I, Mrs. ALISHA K S hereby declare that the dissertation entitled “A study

on the effective use of social media in public health education given by the
government of Kerala" submitted to Christ College (Autonomous), Irinjalakuda,
Affiliated to the University of Calicut, in partial fulfillment of the requirements for
the award of the Degree in Master of Social Work is a record of original research
work done by Mrs. ALISHA K S (Reg.No. CCATMSW003) during the period
2019-2021 under the supervision and guidance of Ms. Dhanya K Assistant
Professor, Department of Social Work, Christ College (Autonomous), Irinjalakuda,
and has not formed the basis for the award of any Degree / Diploma / Associate
ship / Fellowship and or similar title to any candidate of any University.

Place: Irinjalakuda
Date: ALISHA K S
 ACKNOWLEDGEMENT

This project has been made successful by the sincere effort of a lot of people
without whom this venture would not have been possible. I would like to thank all
of them.
I would like to thank Rev. Fr. Jolly Andrews Principal, Christ College
(Autonomous), Irinjalakuda, for providing such a platform for executing and
approving the project proposal.
I wish to express my gratitude to the head of the department, Mrs.
Rosemary T. George for their valuable suggestions, support during the course of
the study.
I would like to thank my research guide, Ms. Dhanya K, who kindly
supervised and gave me excellent suggestions, guidance and encouragement all the
time during my project work which helped me in conceptualizing and completing
this endeavor.
I wish to express my sincere and humble gratitude to all respondents of the
study who had been kind enough to permit me to pursue this project.
Above all, I humbly solicit the God Almighty’s blessing and I am always
thankful for the strength and presence of mind showered upon me for completing
this work successfully.

ALISHA K S
 CONTENTS

SL.NO CHAPTER PAGE

NO.

1 1-14
INTRODUCTION

2 REVIEW OF 15-29
LITERATURE

30-34
3 RESEARCH
METHODOLOGY

35-45
4 DATA ANALYSIS AND
INTERPRETATIONS

FINDINGS, 46-49
5 SUGGESTIONS &
CONCLUSIONS

6 BIBLIOGRAPHY 50-52

7 APPENDIX 53-59
 LIST OF FIGURES

SL.No Figure Page

No.

1 Figure – 1 – Thematic analysis table 38

2 Figure – 2 – Respondents in Facebook 40

3 Figure -3- Special Training

for the usage of social 41
media to the officers

4 Figure -4- Availability of

infrastructure facilities in 41
DMO of Kerala for the use
of social media

5 Figure -5- Most shared 43

form of message in social
media

6 Figure -6- Usage of social 44

media by DMO in Kerala

7 Figure -7- Frequency of 45

sharing the message in
social media
 Chapter I

Introduction

Health has always been a cause of concern for human beings. Nothing is equivalent to
sound health. That’s why it is said that health is such a treasure which does not need any
coffer and is away from theft. Even when two person happen to meet together, their first
question is about health because our health brings longevity and ill health drives us towards
pangs, agony and sufferings. Consciousness about health is not a new phenomenon. It has
been in vogue since man started living a civilized life.

The task of sharing, imparting and spending of information is no more an uphill task.
This work is being accomplished by communication. It has its ranges that is from intra –
personal to mass communication. Interpersonal communication has its instant appeal and
high standard of satisfaction, faith and belief. There is only one sun in the world but now
Newspapers, Radio’s, Television’s and Internet’s are our four suns. The rays of these suns are
exactly like the rays of sun in real sense as these rays reach public speedily. These things
have brought new revolution and have created an upheaval. Besides education these things
give us information and entertainment and the matter of health is no exception to it.

Health communication denotes the process of sending and receiving information with
a predefined orientation and direction. Basically health communication deals with the
enhancement of health status at the individual and collective level as seamless and interactive
part of the total human development. Originally, health communication development was
along the lines of biomedical views of health and disease prevalent at that period. This view
had psycho-social factors having an impact on the health status of the community. Hence, the
major emphasis was on the transmission of appropriate health information to the community.
It is only recently that health education and health communication is given a short shift to the
understanding of health culture while planning for the developing health communication
strategies.

The augmentation of social media tools such as Facebook, YouTube, and Twitter etc.
is creating a new reality in health care by bringing social media to the forefront of health
information generation and dissemination. The rise of online communication has offered
many new possibilities to make health communication more attractive, especially for people
with low health literacy. Public are changing from consumers of Internet content to
generators of information using social media websites and web tools. Social media has
characteristics that enable communication, collaboration, consumption and creation in
entirely new ways. This study identifies the multiple ways in which awareness is created:
through educating and providing information.

Traditional media

The non-electronic medium which works as part of our culture and as vehicles of
transmitting tradition from one generation to another generation is called traditional media.
Traditional media comes in different forms and is known by different names in different
regions of the country. For instance, in Andhra Pradesh, ‘Janapadam’ indicates a village and
‘Janapadulu’ means villagers. The folk art forms of villages, on the whole are known as
‘Janapada Kalalu’. Similarly Lok Natya or Lok Geet means ‘people’s dance’ or ‘people’s
song’. There are many other forms of folk arts in other states of India. These are used as ‘Jan
Madhyamas’i.e ‘people’s media’. Traditional tools of communication are developed from the
beliefs, customs, and rituals practiced by the people. These are very old and deep-rooted.
Traditional media thus represents a form of communication employing vocal, verbal, musical
and visual folk art forms, transmitted to a society or group of societies from one generation to
another. They are indigenous modes and have served the society as tools/medium of
communication for ages.

Traditional media have been in existence in India for long and have been used as a
medium of communication in rural areas. Over the years, rural masses have been using the
folk media for expressing their social, ritual, moral and emotional needs. Traditional media
has a crucial role to perform in the process of socio-economic development in India. It helps
in convincing and influencing people in a very effective way.

Mass media

Mass media has changed the face of the common people in all walks of life and has
inoculated the common people by giving them immense health awareness. Mass media which
includes radio, television, newspaper, magazines and cinema are heavy tools available to the
innovator or promoter of new ideas. These mass channels of information can quickly and
effectively spread awareness and introduce behavioral changes. Health information which is
constantly being disseminated to the public, is still in its rudimentary form in India and is
oriented towards adult. Even when this information is available, there is disregard for balance
in both selecting the information to be disseminated. Today, youngsters are languishing under
bad practices such as smoking, alcoholism, drug abuse, and other practices that were socially
and morally alien to us. But no attention is being paid by the media to combat with such
issues which have created alarming proportions. Besides these issues that concern the
children’s well-being such as hygiene, nutrition, dental and eye care, first –aid other aspects
are not adequately covered in the media. Without the whole hearted backing of the media in
conveying health messages to the greatest number of people.

A desirable procedure in health education and communication programmed planning

can begin by studying the knowledge, opinions, attitudes, values and pattern of health
behavior of the children. Further, while designing health programmers it is essential to
consider media factors such as media distribution, reach and accessibility to the children. It is
not sufficient to make sure that children receive communication on health messages and have
properly understood their contents. Health communication research is still in its infancy in
India and has received little attention from communication scholars. Hence, an attempt is
made to unravel the role of media in disseminating health information.

The whole world is under the control of these things. The role of radio in the rural
areas cannot be ignored our attention can be diverted while watching T.V, poring over the
headlines of the Dailies but we pay rapt attention to radio. Both Radio and T.V have no
match and the importance of other media is equivalent to zero before these two things. The
Print media is confined to literate people only. People authenticate whatever they watch on
T.V and hear by listening to radio. Most of the people in India are orthodox. They lambast
T.V as it presents filthy, obscene and profane scenes but they like radio to the greatest extent.
The role of mass media in making the people health conscious is above the words. As a report
on the Second Press Commission notes, “a dishonest doctor can harm, at worst only a few
dozen or few score patients, while a dishonest journalist may poison the minds of hundreds of
thousands or millions of his fellowmen’’. In this light, the role played by media of
communication assumes special significance since preventive health care and health
education need an informed target community and to reach a vast number of people, both
healthy and sick. In general terms, mass communication system can help attaining better
health and to that extent it is clearly a edged weapon in the hands of planners as well
professionals.
 Mass media can contribute much to the promotion of health especially in certain
problematic areas such as family planning, communicable diseases by not only creating
awareness but bringing about changes in life style, attitudes and values of people. Mass
media can also act irresponsibly and negate all the good work that has been going on and
promote ill health. It is of common place experience that score of consumers products
advertised on television, on radio or in newspapers have proved bad for the health of the
public. Certain countries have banned advertising cigarettes and liquor on television, radio
and press etc. While in many developing countries such enlightened policies have not been
introduced as yet. In India, the situation is inexplicable because on one hand the government
invests a large sum of public money on the health care and treatment of sickness, while on the
other hand. It encourages marketing of such products through government controlled media
like radio and television which are of no use.

Social Media

Social media broadly refers to web sites and applications that are designed to allow
people to share content quickly, efficiently, and in real-time. While many people access
social media through smartphone apps, this communication tool started with computers, and
social media can refer to any internet communication tool that allows users to broadly share
content and engage with the public. The ability to share photos, opinions, and events in real-
time has transformed the way one lives.

Social media can be used for engaging the public and communicating key public
health interventions, while providing an important tool for public health surveillance. Social
media can provide timely, relevant and transparent information of public health importance;
such as tracking or predicting the spread or severity of influenza, COVID 19, west Nile virus
or meningitis as they propagate in the community, and, in identifying disease outbreaks or
clusters of chronic illnesses.

Social media is providing hope to answer some fundamental questions in the public
health arena, including the identification of non-cooperative disease carriers, adaptive
vaccination policies, augmenting public health surveillance for early disease detection and
creating disease situation awareness picture, updating or enhancing our understanding of the
emergence of global epidemics from day-to-day interpersonal interactions, while engaging
the public and communicating key public health messages.
 Social media platforms are widely deployed by the WHO, health care professionals,
and regulatory authorities worldwide to address key issues relating to public health. They can
be used to educated citizens and health care professionals on a broad range of themes, from
the challenges surrounding anti-microbial resistance to topics such as adverse reaction
reporting. The core focus of these initiatives is represented by awareness-building campaigns
that take advantage of the large scale, breadth of reach, and immediacy of social media
platforms to communicate quickly, effectively, and efficiently. Using social media to aid the
prevention and control of infectious diseases can be cost-effective. The health sector
represents a critical area of government responsibility in most countries; it accounts for a
large proportion of national spending, approximately equivalent to 9.9% of the global gross
domestic product in 2016. Like other segments of the public sector, government health
departments and national agencies are responsible for monitoring, protecting, and improving
the health of residents, and state-funded health care delivery institutions are under increasing
pressure to participate in electronic government (e-government) agendas. Many agencies will
likely use social media platforms individually to achieve this. Widespread public engagement
with social media platforms creates an effective ready-made path to their application in the
health care field.

Types of Social Media

There are many different types of social media, and many services could fit into
multiple categories. Here are a few of the major types, along with some examples.

Social Networks

Social networks specialize in connecting and exchanging thoughts, ideas, and content
with other users—often with users who share tastes and interests. Facebook and Twitter are
examples of social networks. Though more professional than others, LinkedIn may be
considered a social network, as Facebook.

Media Networks

As opposed to social networks, which specialize in letting users share and exchange
raw thoughts and ideas, media networks specialize in distributing content like photographs
and videos. Instagram and YouTube are examples of this. A YouTube user, for example, will
upload a video they've created, and other users can "like," "dislike," or comment on the video.
If they enjoy the video enough, a user may choose to "subscribe" to the creator, so that new
videos from that creator appear in their feed.

Discussion Networks

Discussion networks like Reddit are the ideal outlet for posts that can spark in-depth
discussion among users. Users can leave detailed responses in the comment section, and other
users can respond directly to those comments, allowing for conversations to grow and
develop organically. Blogging sites like WordPress may also be included in the discussion
network category, though some would consider blogging its own type of social media.

Review Networks

Review networks like Yelp and TripAdvisor add social media aspects to user reviews
of products and services. Users can interact directly with those leaving reviews, as can the
businesses being reviewed.

Social media platforms include a wide variety of networking sites (e.g., Facebook),
information-disseminating platforms (e.g., YouTube), and microblogging services (e.g.,
Twitter). These platforms and many others can be used to create and publish knowledge and
information about potential health and disease risks and interventions as well as healthy
lifestyles and effective health policies and strategies. In contrast to the campaigns
occasionally launched by traditional media, campaigns launched through social media
platforms often successfully convert knowledge and information on different health topics
into daily fruitful web-based discussions and conversations. Another key advantage of web-
based social media data, in addition to the availability of an increasingly large volume of
data, is that it is highly contextual and networked. For example, there will be robust
spatiotemporal sentiment toward a new vaccine, whether positive or negative. Risk factors
such as drug abuse, smoking, poor diet, and lack of exercise and their associated diseases are
often found to be clustered in a population. A better understanding of social media platforms
and their health data will help broaden the utility of social media in public health.

Social media platforms constitute a powerful means of communication that can be

used to elevate public awareness of infectious diseases, particularly new ones, in terms of
outbreak dates and spreading developments. Members of the public turn to both traditional
and social media to obtain information on emerging infectious diseases which represent
unprecedented risks to people. The public perceptions of these risks are shaped depending on
how information is communicated across social media platforms. This in turn affects people’s
behavior as well as the decisions they make. In addition to information dissemination through
social media platforms, the users of these platforms participate in discussions and
conversations by giving their own opinions and presenting their own experiences. However,
information disseminated through social media platforms often lacks credibility because it is
often generated by the users themselves rather than by medical specialists or professional
health care institutions; therefore, this information may lack reliability, accuracy, correctness,
or usefulness. As a result, the WHO has called for proactive and effective use of social media
platforms to disseminate information on health issues, explicitly on emerging infectious
diseases, to unspecialized persons and the general public.

Some are using character statements on Twitter, Facebook, Google and other social
networking platform. Some are writing lengthier expositions about their health in discussion
forums or blogs, and everyone is leaving a trail of health questions on Internet search
engines. Social data are made easily available through live maps (e.g. GoogleMaps), other
visualization techniques, Google Public Data Explorer or applications that can be plugged
into social networking sites.

The near-ubiquity of mobile phones worldwide and enhanced access to the Internet
over the past few years has allowed collaboration among broader cross section of the health
care and public health community and the public. With 70% of the world’s population
carrying mobile phones, individuals increasingly have the technological means to document
and publicize their health status. This rise in adoption of mobile phones and the Internet, in
both industrialized and developing countries, has provided additional opportunities in the
usage of social media to spread public health education.

Facebook

Facebook is the world's largest social network. With roughly 2.8 billion monthly active
users, Facebook is the most popular social network worldwide. Its mission is ‘Give people
the power to build community and bring the world closer together’. It is constantly iterating,
solving problems and working together to connect people all over the world. Mark
Zuckerberg is the Founder, Chairman and Chief Executive Officer of Facebook. The major
actions are Promoting Safety and Expression, Protecting Privacy and Security and Preparing
for Elections. Its major principles are
1. Give People a Voice
People deserve to be heard and to have a voice — even when that means defending the
right of people Facebook disagree with.
2. Build Connection and Community
Facebook’s services help people connect, and when they’re at their best, they bring
people closer together.
3. Serve Everyone
Facebook work to make technology accessible to everyone, and business model is ads so
Facebook services can be free.
4. Keep People Safe and Protect Privacy
Facebook have a responsibility to promote the best of what people can do together by
keeping people safe and preventing harm.
5. Promote Economic Opportunity
The tools of Facebook level the playing field so businesses grow, create jobs and
strengthen the economy.

Types of Facebook Posts

A perfect Facebook post is a link. A perfect Facebook post is short, as little 40
characters if at all possible. Posts at this length tend to receive a higher like rate and comment
rate and in other words, more engagement. It gets usually published at non-peak times and
follows other posts on a regular schedule timely. A perfect Facebook post includes a
newsworthy element. People are so overloaded with information these days that they
naturally gravitate toward things that are easy to consume and absorb. There are several types
of Facebook posts that attract the users to read. They are broadly listed down into eight types:
1. Images
2. Text
3. Videos
4. Memes
5. Cartoons
6. Animations
7. Website/Blog posts
8. Podcasts
 An eye-catching poster or flyer with strong visualisation does not necessarily need words
on it. Images can hence also reach illiterates or deaf. Information graphics or info-graphics
are graphic visual representations of information, data or knowledge intended to present
complex information quickly and clearly.

Text content relies on precise word choice, punctuation and visual features like emoticons
to establish the right tone. Written texts as a dialogue that takes place between reader and
writer require that characteristics and strategies that guide their reading. Generally, texts have
two kinds of information: content information (content schemata) and structural information
(formal schemata). Readers use content information to construct a meaningful mental
representation of a text; and they use structural information to help them organize the content
and thus facilitates the process of making meaning of a text.

Videos can extend even beyond verbal and nonverbal communication by including visual
aids like images and footage, which further strengthen the depth of understanding. The
simple matter of the speaker being visible makes video all the more accurate and effective.
Videos that have a hook, engaging content throughout, and a gripping final call-to-action are
bound to have success with keeping audiences interested. Videos are a great way for people
to express themselves and this is why many people find them so share worthy.

Video has the ability to include all other visual and auditory content. A video can consist
of a podcast and an article all in one and include limitless images, info graphics, and text. No
other medium has this ability. When a video takes advantage of this innate power, viewers
can better understand its message, meaning more people will be willing to share the video. It
is no secret that reading takes much longer than watching. Even podcasts take longer because
they lack visual aids. Visual content has always had a talent for condensing content. Visual
aesthetics combined with audio allows the information being provided to be delivered several
times as fast.

Memes extended and confined long in comparing to the cartoons. It elaborate on intricate
issues and situations by its uncommon visual texture and satirical text, hence it is the most
accessible to each common person who uses social media sites.
Memes also help us unwind, as we browse and procrastinate to distract ourselves from
troubling news.

A cartoon is a simple drawing of the things we see around us in an entertaining way with
lots of lively colours in it. Cartoons are a creative way of blending art, satire, caricature,
political messaging, humour and provocative imagery. Cartoons are now being used for
education and spreading awareness amongst the people in addition to fun and entertainment.
Cartoons are very eye-catching. The cartoon images seen by the children leave an impression
in their mind. They tend to remember what the saw in the form of cartoons, or what actions
were performed by the cartoons or anything else. If used in a correct way, cartoons can be
very benign. Cartoons and images that portray public health messages are now inclusive of
other cultures, reflecting the changing demographics of the country.

The simulation of movement created by a series of pictures is animation. A video presents

both visual and auditory information, which is assumed to improve information processing,
but people with low health literacy can also suffer from paying too much attention to
irrelevant details. Therefore, animations consisting of simple line drawings could be preferred
over realistic videos that often capture many details. As learning and understanding
encompasses the creation of an adequate mental representation, animations will be better able
to support this process compared to illustrations. This will apply particularly to audience
groups that have limited knowledge available to build such mental representations
themselves, such as people with low health literacy.

Animations require a higher level of awareness from the receiver due to the ongoing
changes in the visual information. This may increase the cognitive capacity that people need
to properly process the information. Receivers are expected to handle this increased cognitive
load better when they are able to listen to the text rather than reading it. Thus, to reduce
cognitive load, the textual information in animations has to be spoken and not written,
particularly for people with low health literacy, as they are more likely to experience
cognitive overload. Animation transmits messages to the brain 60,000 times faster than text,
so an animated video explaining a condition, process or device will allow the user to better
understand and recall the information.

Blogs are informal articles written for the purpose of showing thought leadership and
expertise on a topic. They are a great way to generate fresh content on a website and provide
a catalyst for email marketing, social media promotion to drive search traffic to your website.
By nature, blogs are supposed to be informal and conversational. The informal nature of the
blogs helps to build a natural connection with the target audience. It will offer more insights
to the users by educating those using facts and figures. This will help in bringing awareness
for your health and wellness website. Users like to consume blogs that give in-depth
information about a particular service. Some of the most successful blog posts from health
and wellness sites are the ones that give health and fitness advises and information to the
users in the form of case studies and pillar content. The blogs should be written for the target
audience and not the search engines.

Podcasts are downloadable, electronic audio files that may be listened to on portable
audio players (MP3 players) or computers. It can be shared on multiple social media
platforms such as Facebook, Twitter, or blogs. The process of creating a community topic
driven podcast afforded us the opportunity to design a dissemination tool to raise awareness
about health and biomedical research. It was a novel way to share health- and community-
related information using social media platforms to stimulate communication and maximize
audience reach.

Podcasts linked with other social media platforms are a feasible strategy for sharing and
stimulating communication about health and biomedical information to a wide audience
without barriers of time, geography, and weather.

Facebook have Community Standards that specify what’s allowed on Facebook apps, and
we remove anything that breaks these rules. For content that doesn’t violate Facebook rules
but has been rated false by independent fact-checkers, they reduce its distribution to help
prevent it from going viral. Facebook also provide context about what users see so they can
make Facebook own decisions on what to read, trust and share. Facebook work to limit the
spread of misinformation by the following activities:

 Third-Party Fact-Checking Program

Facebook work with more than 80 partners covering over 60 languages around the world

to review potentially false content.

 Labelling Misinformation
Facebook include warnings on posts that are rated false so that users can decide what to read
or share.

 Preventing Misinformation from Going Viral

When third-party fact-checkers label content false, Facebook significantly reduce its
distribution so fewer people see it.

Hence Facebook is the appropriate medium in the sharing of public health education.
Public Health Education

Public health is ‘the science and art of preventing disease, prolonging life and
promoting health through the organized efforts and informed choices of society,
organizations, public and private, communities and individuals’ (1920, C.E.A. Winslow).
Information is core to public health, and health data are a corner stone. The timeliness of
health data limits the availability of actionable public health information as the traditional
route for the data moves from patient self-report to a physician, through diagnostic
confirmations, and then from a physician or laboratory facility to a public health authority.
Health data found on social media circumvent the traditional route by removing the ‘middle
man’. However, the middle man plays a critical role. They validate and can tell authorities
something about the population they serve where generalizations of this information can be
made with a level of confidence. That confidence is crucial in triggering a governmental
action or intervention.

The extent to which we are able to improve the health of the public depends, in large
part, upon the quality and preparedness of the public health workforce, which is in turn
dependent upon the relevance and quality of its education and training. Public health
education for long has been expected to find solutions for multitude of public health problems
through building the capacity of public health workforce. The focus on public health
education came into consideration as early as the formation of the Bhore Committee, in the
1940s. The report of the Health Survey and Development Committee chaired by Sir Joseph
Bhore emphasized upon the inadequate teaching of preventive medicine and public health in
the medical student's undergraduate training, thereby highlighting the need and importance of
public health education. The contention of the report was to mainstream the art and science of
public health in medical education. This was deemed necessary for creating social physicians.

In 1999, World Health Organization convened a “Regional Conference on Public

Health Education and Practice in the South East Asia Region in the 21st Century” in Kolkata.
The main purpose of this conference was to critically review the public health situation
including public health education and practice in this region, and to identify effective ways
and means to improve and strengthen public health education and practice. It was discussed
that the best way to strengthen public health infrastructure and services is through
strengthening public health workforce. In order to generate skilled public health workforce, it
is extremely important to strengthen the public health education architecture in the country.
The main outcome of this regional conference was the “Calcutta Declaration on Public
Health.” This declaration provides a broad strategy and framework of action for
strengthening public health education in the South East Asia Region including India.
As rightly deliberated in Calcutta Declaration, development of public health
workforce is the necessary prerequisite for finding solutions to enormous public health
problems and challenges in this country. But what constitutes the public health workforce
(human resources in public health)? It comprises public health professionals (medical and
nonmedical), doctors, nursing professionals, paramedical workers, grass-root workers, and
allied health workers. Although staffing and resourcing remain serious problems in all the
categories of this workforce, the need and demand mismatch are more evident and visible for
the category of public health professionals trained in core and specialized areas of public
health. Hence, this manuscript will mainly focus on the significance of social media in the
public health education.

Government of Kerala

Kerala is the southernmost state of India. The state used innovative approaches and its
experience in disaster management planning came in handy to quickly deploy resources and
put up a timely and comprehensive response in collaboration with key stakeholders. A high-
level committee led by the Chief Minister, Health Minister, Chief Secretary and the Principal
Secretary (Health) has been set up to monitor, coordinate and guide actions in the field. The
State Control room led by the Principal Secretary, Mission Director, National Health
Mission, Directorate of Health Services, and Directorate of Medical Education; and its
various sub-committees are closely monitoring the various aspects of COVID-19 response.
Early release of technical guidelines on contact tracing, quarantine, isolation, hospitalization,
infection prevention and control, and extensive capacity-building for all cadres of health and
other interlinked departments played a critical role in managing the situation.

Kerala comprises of fourteen districts. Each district have district medical office. The
District Medical Office of Health has a crucial and effective role in health care system in the
District. The Official website named IEC wing by the Information Education and
Communication department under the District Medical Office of Health provides information
and awareness regarding Communicable and non-communicable diseases as well as
preventive and curative measures. The general public may utilize this site in benefitting
manner. Since this site will be updated periodically with latest news, events, information,
messages, important orders, etc. Under each district, there is one District Education and
Media Officer of DMO and two deputy officers in Kerala for carrying out these duties.

National Leprosy Eradication Programme (NLEP), India is a Centrally Sponsored

Scheme under the umbrella of National Health Mission (NHM). The primary goal of the
Programme is to detect the cases of leprosy at an early stage and to provide complete
treatment free of cost, in order to prevent the occurrence of disabilities in the persons affected
and stop the transmission of disease at the community level. The Programme also aims to
spread awareness about the disease and reduce stigma attached with the disease. The duty of
spreading awareness about the leprosy and its prevention through social media is manifested
by the officer designated with Senior Health Educator.

Even though the state of Kerala has advanced as compared to the other states of India
in terms of critical health indicators are concerned, the state is facing challenges that are
unique and specific. The people are now facing the problem of high morbidity both from re-
emergence of communicable diseases and the second generation problems like the ageing
population and non-communicable diseases. Moreover, there remains the challenge of
sustaining the privileged health indicators. Further, improving the quality of health care
where the health seeking behaviour is very high is of utmost importance. The resources of
National Rural Health Mission came in an opportune time when the state was finding it
difficult to find resources matching the demand. During the last three years the State has been
able to initiate many programs suiting to its specific requirements and considering its health
issues that need immediate intervention. These initiatives correspond to the Key Performance
areas outlined by NRHM like Institutional Strengthening, Improving access to better health
care and quality services and Accessibility of health care to the under privileged and
marginalized. These information are passed to the public through Junior Consultant officer.

There are total seventy officers involved in the sharing of health education through
social media in Kerala. Active and sincere involvement of the staff of the Health Services
Department is the backbone for the updating of events and data. District Education and
Media Officer of DMO in Kerala is selected as the sample for study. Because they are very
much active in spreading health education through social media. They will be responsible for
developing effective resources for all program stakeholders, and identifying visibility
opportunities, and for meeting with government authorities as well as partner agencies,
community leaders, keep them informed about successes & challenges. He/she is expected to
travel regularly and extensively to the field to collect information and stories and photograph
activities. These will be published on social media, as well as in a variety of communication
resource materials. These Officer will be a focal person at communication events. The
Officer will be supported by the National and International Communications Coordinator
who is responsible for the clearance of all work for publication.

This study explores the effective use of social media in public health education by the
government of Kerala. Since Kerala had made a great use of social media in spreading public
health education due to its high literacy rate and well infrastructure development.
 Chapter II

Review of Literature
Social media platforms have attracted the interest and attention of researchers and
practitioners in the health domain, who use them for different purposes. These include
professional training and development of clinicians; formation of health networks and
support groups; provision of funding for health institutions; facilitation of cooperation and
coordination among health professionals; monitoring of infectious diseases.

Even though social media platforms provide professionals in the public health domain
with numerous valuable opportunities and benefits, usage of social media platforms by
professionals is associated with several challenges, the most important of which are detecting
infectious disease outbreaks, monitoring emergencies, predicting disease trends, and
measuring the public’s awareness and responses. However, many studies have reviewed and
explored the potential applications of social media platforms for public health
communication.

Bandura (1977) cites visual media such as television as influential on the social
learning of adults as well as children. He explains that media has the power to transmit vast
behavioural messages to the masses simultaneously. The power of media is not limited to
spreading mass messages. Bandura states that due to humans’ exposure to a small select
environment, “their perceptions of social reality are heavily influenced by vicarious
experiences- what they see, hear, and read in the mass media”. Basically, people shape their
societal norms and conceptions around how they perceive the world, which is based off of
their observations.

Brian et.al (1980) in ‘Evaluation of Mass Media Programmes and Social Psychology
and Communication Research, Health Education and Behaviour’ study elucidates the impact
of media on people. It discusses at length the attitude and behaviour of people. This research
reviews and evaluates media sources like message, channel, receiver and destination affected
the knowledge, beliefs, attitude, intentions and behaviour of the target receivers.

Urgoiti (1991) discusses the audio cassettes as a part of primary health education. A
study was conducted in the Xhosa in speaking communities of the Western Cape as to the
acceptability and effectiveness of audiocassettes as communication medium. An
audiocassette containing a recorded audio message on neonatal jaundice was used in the
evaluation and it was found that, ‘there is a dramatic gain in knowledge of neonatal jaundice
after exposure to the tape. The study emphasis the potential of audiocassettes can be used
effectively in conjunction with other media,like community radio, as part of multi-media
health campaigns.

Backer, Rogers and Sopory (1992) express that communication campaigns attempt to
change or initiate attitudes and behaviours. Mass media messages often have significant
impact on personal and public health. According to the study, it is revealed that a health
communication campaigns for AIDS awareness resulted in an increase in the use of condoms.
Mass media have served as essential components in a number of important health
communication campaigns in recent years. The goal of the media health communication
campaign is to present specific messages, designed by health and communication experts,
which have intentional, positive health related effects on audiences. It has been found that
food and health commercials may have positive and negative effects, depending upon the
nutritional value of the food advertised.

Dorfman and Wallack (1993) argue that often public health communication
campaigns in the media themselves are simply a manifestation or a result of the
individualization and commercial culture promoted by the mass media in general. In public
health communication campaigns, the deep, complicated roots of problems are virtually
ignored in favour of messages that hold the individual person responsible. This is true in the
mass media as well. News, entertainment programming, and advertising all tend to hold
people responsible when they depict health problems. This may be a reflection of the strong
underlying ethic of individualism or it may be a consequence of storytelling conventions that
give preference to the "personal angle" over the more complex and less emotion inducing
institutional forces that contribute to health problems. The mass media routinely omit social
causal factors for problems.

Message framing is making some aspects of a social problem more salient by

emphasizing them in a message. Message frames define social problems, diagnose causes,
make moral judgments, and suggest remedies to solve these problems (Entman 1993).

Inga-Britt Lindblad (1994) in ‘Mass Communication and Health Promotion: The

Power of the Media and Public Opinion’ reveals that community-based preventive programs
in Sweden in the field of cardiovascular diseases and diabetes was greatly reported in the
news by the Swedish mass media. The study asserts that media focuses specifically to an
individual standpoint concerning health habits of people in Sweden.

Health education may therefore be concerned with developing people's awareness,

knowledge, motivation and skills using a whole range of approaches—from one-to-one
communication through large-scale community or nationwide interventions (Tones and
Tilford, 1994).

Joseph, (1997) in ‘Mass media and Rural Development’ points out that mass media
are suitable agencies for bringing about agricultural development and rural transformation.
This is especially true in case of radio. During the study, it was found that the rural people are
more exposed to this medium. Moreover, it is revealed that there is no relationship between
education and exposure to the radio. Hence, it is most suited for spreading information among
rural people who are lesser educated. In view of this fact the quality and coverage of
broadcast meant for rural people needs to be improved. The study suggests the usage of
simple words and local dialect for informing the rural under educated people in a better way.
It puts forward the opinion that excessive use of technical terms and very sophisticated
language should be avoided in the radio broadcasts. Formation of rural forums for conducting
discussions on development broadcast may help enormously to alleviate the difficulties
created by the lack of personal contacts between the communicator and the receiver.

While Hall ( 1999) argues that encoding/decoding theory has a strong influence in
behaviourism, this theory also represents a sense of media literacy in being able to not only
absorb media messages but to process these messages into social meaning. Without a proper
societal framework, codes such as television visuals, would not have such a universal or
naturalized nature. Yet, while some level of awareness is required in order to accurately
attribute these meanings to social frames, how aware are people of the impact of such media
messages.

Cline, et. al ( 2001) in ‘Consumer Health Information Seeking on the Internet: The
state of the art’ have considered that negative emotion and self-efficacy in health will interact
to determine cancer patients’ use of health–related information over the Internet.
Furthermore, they find out that the exercise of health-related information ensures increase in
the level of health consciousness among people. Such people would be better equipped to
cope with the illness. Various researches in this area have suggested that Internet plays an
important role of a virtual community in offering abundant and easily accessible information
support about diseases attracting a growing number of patients.

Green (2001) has defined health education as ‘any combination of learning methods
designed to facilitate voluntary adaptations of behaviour conducive to health’.

Gaur (2002) ‘Women’s Rights and Media Communication Today’ expresses that
media should address emphatically the issue of the rights of women regarding their health.
Health related issues demand greater attention to be taken up by the media .The study reveals
that the threat of HIV/AIDS is affecting women the hardest. Out of the 25% of infected
women 90% are monogamous housewives. The study is based on a survey conducted about
the level of awareness of women regarding AIDS which have suggested that knowledge
about the prevalence of AIDS is existent. But there is lack of adequate information about the
disease and its prevention. It is a challenging and enormous task for media to spread the
message of prevention from this dreaded disease and also the rehabilitation and counselling
of the affected women.

Ganguly et.al (2002) in their study entitled ‘AIDS Awareness among Undergraduate
Students in Maharashtra,’ has studied the AIDS awareness among the undergraduate students
in Maharashtra. The study suggested that there is a need to provide the health education to
these students. The respondents of the colleges of Nasik and Telgaon in Maharashtra have
been surveyed regarding awareness about AIDS. Some misconceptions regarding the modes
of transmission were observed among some students. These misconceptions include social
sharing of utensils & personal items, using common swimming pools and insect bite spread
infection. Attitude towards the HIV/AIDS patients was not found to be sympathetic among
respondents. Overall knowledge regarding HIV/AIDS among science students was found to
be better as compared to commerce and arts students. Confusion about modes of transmission
and prevention of the disease exists in the students’ minds.

Sorian and Baugh (2002) report from a survey of 292 US state government policy
makers found that the media of communication preferred by key decision makers varied by
age with younger respondents preferring electronic media and older respondents preferring
printed materials.

Dutta-Bergman, (2003), in the study ‘Health Communication on the Web: The Role
of Web Users Motivation and Information Completeness’ suggested in their study that
complete health information has stronger effect on attitude towards the information than
incomplete health information, regardless of participants’ motivation. The participants
receiving complete health information showed greater behavioural intention than those
receiving incomplete information. Information completeness is regarded as the most
important information criterion in patients’ decision making. Therefore, this study considers
the perceived completeness of information, that is, the degree to which users perceive
information obtained from different sources as complete, as potential mediator.

Metzer, M L et al (2003) in their research ‘Credibility for the 21st Century:

Integrating Perspectives on Source, Message, and Media Credibility in the Contemporary
Media Environment,’ published in communication yearbook do not find any significant
difference between college student’s perceived credibility of internet information and that of
a more general adult internet user population. However, they have found that college students
perceived information from other media channels to be more credible than other sources of
information. In general, age may be an important factor for consideration in future
replications for adult population.

Flanagin and Metzger & Slater, (2004) in ‘Operational Zing and Analyzing Exposure:
The Foundation of Media Effects Research,’ published in Journalism and Mass
Communication Quarterly, evaluated that virtual campaigns may also have important and
indirect effects from campaign-related news coverage. News coverage of a campaign
represents a possible source of indirect effects because news volume and content are not
under direct control of campaign planners. News coverage of health topics is associated with
population trends for a healthy behaviour.

Cotton and Gupta, (2004) in their study ‘Characteristics of Online and Offline health
Information Seekers and Factors that Discriminate Between Them’ published in Social
Science and Medicine Journal and the data collected from the people who have accessed the
web to acquire health information during the year prior to their study. They underline the fact
that there is significantly better general health and happiness among web users than those
who only gather information from offline sources. Furthermore, those without access to the
internet may benefit the most from web sources.

Whitehead (2004) mentions that health education relates to those activities informing
individuals about the cause and nature of health /sickness and the individual’s vulnerability
attached with their lifestyle and behaviour. Whitehead further explains that the main
objective of health education is to motivate individuals, groups, and communities to adapt to
a process of behavioural change by influencing their value system, attitude and beliefs.

Policymakers, opinion leaders, and voters should be the primary target audiences for
efforts to raise awareness of Social Determinants of Health and health disparities because
their views are most likely to ultimately shape health and social policy (Bartels et al. 2005).

Mediated interventions have been particularly effective, with past research showing
that electronic media can be used to deliver weight-loss interventions. Not surprisingly, the
Web has been employed in health behaviour interventions for weight loss, with several
studies showing that delivering interventions entirely through Web-based methodologies has
been a means of creating health behaviour changes (such as increasing physical activity or
assisting with weight loss maintenance) and increasing health-related knowledge. (Berkel,
Poston, Reeves, & Foreyt, 2005).

Kreps,(2005),in his study ‘Disseminating Relevant Health Information to

Underserved Audiences: Implications of the Digital Divide Pilot Projects’, published in
Journal of Medical Library Association, has asserted that information research on health
disparities and new communication technologies need great attention. The Internet offers as a
means to reduce health disparities by providing medical information and services to those
without insurance or who live in rural areas without close proximity to a health care
practitioner.

Surowiecki (2005) defined that social media is to make use of the “wisdom of the
crowd”. Group of people are better at problem solving, fostering decision making than the
individuals alone.

The term “Web 2.0” was generated by O’Reilly Media in 2004 (O’Reilly, 2005). It
refers to technologies that allow individuals to interactively participate with information and
with other individuals, and to build networks based on mutual personal or professional
interest.

Success of health communication campaigns has generally been determined by the

degree to which interventions have changed the overall level of a population's health or
health behaviour, with less emphasis on the interventions’ effects on the distribution of health
or effects within subpopulations (Hornik 2002; Hornik and Ramirez 2006).
 While public opinion and media practices present uphill battles to communicate these
population health messages, health communication science itself has also made it difficult to
effectively deliver them. First, most theories and research in health communication science
emphasize strategies to promote individual behaviour change rather than strategies to change
broader social factors (Viswanath and Emmons 2006).

Web 2.0 facilitates social networking therefore is also referred to as the social media.
These technologies - blogs (like Blogger), video sharing (like YouTube), presentation sharing
(like SlideShare), social networking service (like Facebook, LinkedIn), instant messaging
service (like Skype) and groupware (like Google Docs) - foster a more socially connected
platform (Anderson, 2007).

People are routinely exposed to a variety of competing message frames in the news
media (individual and societal responsibility; Chong and Druckman 2007), and they are
accustomed to seeing public health issues framed as individual problems (Kim and Willis
2007).

Corinne David-Ferdon (2007) The study has revealed that adolescents’ access to and
use of new media technology (e.g., cell phone, personal data assistant, computer for Internet
access) are on the rise, and this explosion of technology brings with it potential benefits and
risks. Attention is growing about the risk of adolescents to become victims of aggression
perpetrated by peers with new technology. In September 2006, the Centres for 40 Disease
Control and Prevention convened a panel of experts in technology and youth aggression to
examine this specific risk. Journal of Adolescent Health presents the data and
recommendations for future directions. It also support the argument that electronic aggression
is an emerging public health problem in need of additional prevalence and etiological
research to support the development and evaluation of effective prevention programs.

Flanagin, & Metzger, (2007) in their study ‘The role of Site Features, User Attributes,
and Information Verification Behaviours on the Perceived Credibility of Web-Based
Information’ published in New Media & Society found that message credibility varied across
Internet site genres. Specifically, the message on any news organization site was rated
significantly more credible than messages on all other genres of sites. This study focuses on
message credibility as the primary dependent variable; specifically users’ perceived
credibility of health information is attributed to different online sources.
 We know more about which communication strategies improve overall population
health than we do about which strategies reduce health disparities. Indeed, the goals of
increasing overall population health and reducing health disparities sometimes conflict; that
is, improvements in one subgroup's health may improve the general population's overall
health while simultaneously increasing health disparities among the population's subgroups
(Keppel, Bilheimer, and Gurley 2007; Kindig 2007).

Public health research emphasizes individual behaviours and medical care, rather than
SDH, as the primary determinants of health. Indeed, in the past few decades, the fields of
medicine, public health, and health communication have done more research on the
effectiveness of behaviour change and health care interventions than on SDH (Lantz,
Lichtenstein, and Pollak 2007).

New ways of inspiring and exploiting knowledge sharing are forcing organizations to
expand their knowledge sharing technologies and practices (Mentzas et al, 2007).

Mayer Brezis (2008) has explained in his study that mass media misrepresent the
emerging health hazards through comparison of common threats to public health. Since
premature mortality in industrialized societies is most often due to well-known risks such as
smoking and physical inactivity, their under-representation on public agenda may cause sub
optimal prioritization of public health resources.

In a study conducted by Bennett and Glasgow (2009), they examined the issues of
how citizens seek to consume medical information and how the World Wide Web transforms
the relationship between the public and medical professionals.

Lane et.al (2009), in research article ‘Persuasive Strategies for Media-Based Health
Campaign’ presented at the annual meeting of the International Communication Association,
reveal that limited quality of primary research and limited information on key aspects of mass
media effects. This study is supporting the view that these channels of communication may
have an important role in influencing the use of health care intervention. Those engaged in
the promotion of research information in clinical practice should consider mass media as one
of the tools which may encourage the use of effective services.

Six characteristics have been identified that provide value to social media (Postman,
2009):

1. Authenticity: possibility to let the real voices of real people come through.
 2. Transparency: ability for shareholders to see the financial performance; through
blogs, communities and others information can also be made visible to the public.
3. Immediacy: ability of companies, members of the public to communicate, and to
engage in online conversations.
4. Participation: possibility for anyone to participate in corporate conversation, on
the company’s blog, independent forums, personal blogs, etc. online.
5. Connectedness: ability to connect and share in thousands of places.
6. Accountability: ability to detect users (leave a trail of IP addresses and other
clues).
Social media has a variety of broad definitions, such as "collaborative online
applications and technologies which enable and encourage participation, conversation,
openness, creation and socialization amongst a community of users” (Bowley, 2009:15),
web-based tools and practices enabling participation and collaboration based on individuals’
activities (Storey et al, 2010).

Annie Y.S. Lau (2011) has discussed the unintended consequences of clinical
information technologies (IT) on patient safety, yet there has been little discussion about the
safety concerns in the area of consumer health IT. It presents a range of safety concerns for
consumers in social media, with a case study on YouTube conducted a scan of abstracts on
‘quality criteria’ related to YouTube. Five areas regarding the safety of YouTube for
consumers were identified: (a) harmful health material targeted at consumers (such as
inappropriate marketing of tobacco or direct-to-consumer drug advertising); (b) public
display of unhealthy behaviour (such as people displaying self-injury behaviours or hurting
others); (c) tainted public health messages (i.e. the rise of negative voices against public
health messages (d) psychological impact from accessing inappropriate, offensive or biased
social media content; and (e) using social media to distort policy and research funding
agendas. The potential harm associated with the use of unsafe social media content on the
Internet is a major concern. More empirical and theoretical studies are needed to examine
how social media influences consumer health decisions, behaviours and outcomes, and devise
ways to deter the dissemination of harmful influences in social media.

Diane Levin Zamiri (2011) analysed that increasing media use among adolescents and
its significant influence on health behaviour warrants in-depth understanding of their
response to media content. This study developed the concept and tested a model of Media
Health Literacy (MHL), examined its association with personal/socio-demographic
determinants and reported sources of health information, while analysing its role in
promoting empowerment and health behaviour (cigarette/water-pipe smoking,
nutritional/dieting habits, physical/sedentary activity, safety/injury behaviours and sexual
behaviour). The school-based study included a representative sample of 1316 Israeli
adolescents, grades 7, 9 and 11, using qualitative and quantitative instruments to develop the
new measure The 44 findings suggest that as a determinant of adolescent health behaviour,
MHL identifies groups at risk and may provide a basis for health promotion among youth.

Facebook has become firmly established across socio-geographic groups that

facilitates anonymity and personal connection is a private choice that have made Facebook
well suited and popular tool for health promotion (Korda & Itani, 2011).

K.Radha (2011) has explained good health for all in the 21st century as targeted by
WHO health is a vital indicator of human development. In present days, diseases create
challenges to human society. Health awareness promotes the people to prevent them from life
threatening diseases. In urban areas people are highly aware about challenged diseases, but in
rural areas lack of medical facilities and unawareness may be considered as the main causes
of diseases. Hence, the media is one of the communicator to all the rural people through
various ways of health awareness. If health awareness is increased, then definitely they can
work more effectively and may contribute in rural development. So, the media is very
important to educate the rural people about health awareness for our bright future It
highlights the impact of mass media on health awareness among the rural mass. This study
cover the rural people in omalur Taluk.

Melanie J. Rock (2011) Literature has discussed that media advocacy is a well-
established strategy for transmitting health messages to the public. This discusses a media
advocacy intervention that raised issues about how the public interprets messages about the
negative effects of poverty on population health. In conjunction with the publication of a
manuscript illustrating how income-related food insecurity leads to disparities related to the
consumption of a popular food product across Canada. All the media coverage conveyed our
intended message that food insecurity is a serious population health problem, confirming that
message framing, personal narratives and visual imagery are important in persuading media
outlets to carry stories about poverty as a determinant of population health. Among
politicians and members of the public through on-line discussions, the coverage provoked on-
message as well as off-message reactions. Population health researchers and health promotion
practitioners should anticipate mixed reactions to media advocacy interventions, particularly
in light of new Internet technologies. Opposition to media stories regarding the socio-
economic determinants of population health can provide new insights into how we might
overcome challenges in translating evidence into preventive interventions.

Social media can be used effectively for engaging the public and communicating key
public health messages. According to a survey conducted on 4033 clinicians by QuantiaMD
and the Care Continuum Alliance in September 2011, nearly 90% of physicians reported
using at least one social media site personally. One such example is Dr Majd Isreb, MD,
FACP, FASN; a doctor specializing in Nephrology, Hypertension, Dialysis and Renal
Transplant, who setup a professional Facebook page
(https://www.facebook.com/pages/Majd-Isreb-MD-FACP-FASN/328625408598). Dr Isreb
posts daily to this page the latest scientific facts, encourages physical fitness, activity and
spreads public health messages to patients and community members. Recent examples of his
postings include messages such as: ‘Please try to avoid drinking sport drinks (like Gatorade,
etc.) for hydration, unless you are participating in a marathon, iron man or you are a
professional athlete. They have lots of sugar and will lead to obesity for the ‘sedentary’
person!’, and ‘If you are cooking, garlic salt has less sodium than regular salt’.

Vuori (2011) characterises social media by considering the extent to which they
support communication, collaboration, connecting, completing and combining (5C).

The use of social media platforms in disease surveillance was reviewed by Ellis et al
(2012). Their literature review revealed the effectiveness of social media platforms in speed,
accuracy, and cost performance; therefore, they recommended the use of social media
programs to support existing disease surveillance systems.

Ronald E Rice (2012) found that health communication campaigns are purposive
attempts to raise awareness, improve knowledge about, or influence behaviour related to,
health issues in large audiences within a specified time period using an organized set of
communication activities and featuring an array of mediated messages in multiple channels
generally to produce non-commercial benefits to individuals and society. Health interventions
are typically more narrowly focused on specific programs or tools designed to achieve more
individual-level goals, typically without mass media support, though some campaigns are
referred to as interventions. Campaigns use a wide variety of media technologies (TV, mobile
phone, computer, video game console, radio, etc.), media formats (soap operas, text
messages, games, social games, virtual worlds, web sites), and environments (home, school,
work, play, waiting rooms) to encourage people to improve their health behaviour.

Facebook make it easier for people with rare disorders to find each other and share
that expertise, that’s helping patients and medical research. Most of the American doctors get
information about a therapy or condition online and use SNS for professional purposes, like
contacting expert doctors for patient case discussions, sharing expertise to other doctors
within various Facebook groups that have been used in different specialities. Recognizing
that such Social Networking Sites forums provide opportunities for increased communication
with patients, a number of healthcare providers have established a SNS presence (Shute,
2012).

Facebook appears to be more effective in terms of time and cost of health

communication itself. Facebook is useful in maintaining and promoting a healthy lifestyle.
The content of the information posted motivates and remind the patients to give emphasis on
a particular health behaviour. The post of patients will inform as to what sort of information
the patient usually asks and if there is any positive change in the health outcomes. For health
enthusiasts, Facebook can be an effective reference for obtaining tips and information to keep
their health in order (Woolley & Peterson, 2012).

SNS can increase the timely dissemination and potential impact of health and safety
information, facilitate patient networks for information sharing to more diverse users
globally. It can personalize and reinforce health messages that can be more easily customized
to users which can provide direct feedback loop with patients and doctors. SNS facilitates
interactive communication and empower patients to make safer and healthier decisions (Fox,
2011; Gupta, Tyagi, & Sharma, 2013).

Moorhead et al (2013) reviewed studies that were conducted to investigate the uses,
advantages, and limitations of social media platforms in realizing fruitful communication
between health professionals, patients, and the general public. Although the advantages of
using social media platforms in health communication were identified in some relevant
studies, we noticed a lack of studies that discussed the assessment of the effectiveness of
social media platforms in shaping and modifying health communication practices in the short
and long terms.

Jalonen, (2014) described the scope of social media into the following:
1. Communication: social media provides new tools to share, store and publish contents,
discuss and express opinions and influence:

2. Blogs (e.g. Blogger) and microblogs (e.g. Twitter),

3. Video sharing (e.g. YouTube),

4. Presentation sharing (e.g. SlideShare),

5. Instant messaging service (e.g. Skype).

6. Collaboration: social media enables collective content creation and edition without location
and time constraints:

7. Wikis (e.g. Wikipedia)

8. Groupware/shared workspaces (e.g. GoogleDocs).

9. Connecting: social media offers new ways of networking with other people, socialising
oneself into the community:

10. Social networking services (e.g. Facebook, LinkedIn).

11. Completing: social media tools are used to complete content by describing, adding or
filtering information, tagging contents, and showing a connection between contents:

12. Visual bookmarking tool (e.g. Pinterest),

13. News aggregator (e.g. Digg).

14. Combining: social media tools are developed for mixing and matching contents.
Combination of pre-existing web services that allow a certain user within a platform to use
another application, in a specific window, without the need to get out of the initial website
(Bonson and Flores, 2011).

15. Mash-ups (e.g. Google Maps).

Dumbrell and Steele (2014) presented an informal knowledge management

framework based on the system capabilities present in social media technologies as well as
the requirements of older adult users. The system capabilities distinctive to social media
technologies are: public peer-to-peer sharing, content evaluation amongst peers, and the
“push” nature of these systems.
 Behringer and Sassenberg (2015) studied the relation between importance of
knowledge exchange, deficits in knowledge exchange, perceived usefulness of social media
for knowledge exchange, as well as social media experience on the one hand and the
intention to use knowledge exchange technology on the other hand. The results showed that
the interplay between the importance and deficits concerning knowledge exchange, perceived
usefulness of social media for knowledge exchange, and experience in social media use
jointly affected the intention to apply social media for knowledge exchange after their
implementation.

An investigation carried out by Collinson et al (2015) that indicated the importance

of controlling the spread of influenza and reducing the infection effects on a population to
public health. Social media campaigns related to epidemics or pandemics can be beneficial in
conveying information to the general public, thereby inducing positive attitudes and
behaviours that may slow the spread of the disease, such as hand washing and social
distancing.

The effectiveness of interventions made by social media networking sites in

modifying the health behaviours of individuals was the subject of an investigation conducted
by Laranjo et al (2015), who uncovered a positive impact of those interventions on the health
behaviours of individuals, but with a remarkable level of heterogeneity.

A model was suggested by Misra et al (2015) to explore the impact of awareness

realized by social media campaigns on infectious disease prevalence, considering that the
campaigns launched on social media platforms represent a variable whose growth depends on
the number of individuals infected. The proposed model is based on the assumption that
social media health campaigns lead to behavioural changes among individuals, causing them
to isolate themselves and protect themselves from infection. The findings of the study by
Misra et al, referred to above, reveal a decrease in the number of infected people with the
increasing spread of social media health campaigns.

Another study (Sigalaa and Chalkiti, 2015) investigates the relation between social
media use and employee creativity by adopting a knowledge management approach in order
to consider the influence of social networks and interactions on individuals’ creativity. Their
findings highlight the need to shift focus from identifying and managing creative individuals
(micro level) and/or organisational contexts (macro level) to creating and managing creative
social networks (meso level). The use of social media for externalising, disseminating and
discussing information with others within various social networks as well as for combining
and generating shared (new) knowledge can further trigger, enrich and expand the
employees’ individual cognitive abilities and provide them with stimuli for generating and
(co)- creating more and newer ideas/knowledge.

Huebsch et al (2016) suggested that social media platforms allow health practitioners
to establish a direct relationship with their clients and that health promotion planners must put
forward their creative best to integrate social media platforms within their strategies to make
full use of the potential of these platforms when marketing their products and services.

Sharma et al (2017) found that most of the information posted on Facebook about the
Zika virus was inaccurate and irrelevant. The influence of social media communication on
shaping the behaviours’ of the general public was the concern of a study about the Zika
viruses. It was found that users’ trust in both media and authorities represents an important
factor in the relationship under study. Most citizens lack accurate and relevant knowledge
about the spread of infectious diseases over time and across space. Therefore, social media
platforms can be used to establish a database of disease occurrences in terms of time and
space. As useful surveillance tools, information on social media platforms was found to
outperform official information about the outbreak and spread of infectious diseases,
particularly in timeliness.

The Information Technology (Guidelines for Intermediaries and Digital Media Ethics
Code) Rules of 2021 (hereinafter referred to as 'the Rules') has been enacted by the Central
Government under the powers conferred to it by Sections 69 A(2), 79(2)(c) and 87 of the
Information Technology Act, with thorough coordination with the Ministry of Electronics
and Information Technology and the Ministry of Information and Broadcasting. The
formulation of these Rules is in response to the growing criticism against the government,
while it recognizes the right to criticize and disagree as an essential element of democracy. It
aims to provide a robust complaint mechanism for social media and OTT platform users to
address their grievances, a mechanism earlier inexistent.

It emphasizes on the need of social media intermediaries and online content providers,
whether for entertainment or informative purposes, to strictly comply with the Constitution
and domestic laws of India. It extends its approach to instil a sense of accountability against
misuse and abuse by social media users and is the first of its kind to bring social media use
under the regulatory framework of the Information Technology Act.
 These rules have been in light of the recent run-down on the OTT platforms by the
government, which have been actively, rather vehemently, lobbying for stronger and more
stringent regulations in place. However, contrary to such a view, as per the PIB, the Rules
have been formulated keeping in mind the importance of free speech and journalistic and
creative freedoms. Regardless of the political connotations, the enactment of these Rules puts
India at par with international regimes on digital media regulation, providing a more
comprehensive and holistic protection to its users.
 Chapter III

Research Methodology

This chapter gives an outline of the research methodology used to conduct the study.
The methodologies will include areas such as Statement of the Problem, Significance of
Study, Objectives, Definitions, Pilot Study, Research Design, Universe/Population, Unit of
the study, Sample Size, Inclusion and Exclusion Criteria, Sampling Design, Tool of Data
collection, Data Analysis and Interpretation and Chapterization.

Statement of the Problem

The spread of pandemics like COVID-19 is unprecedented in almost every aspect for
the public sector, including communications. Public information professionals are being
asked to provide regular updates in uncertain times to an anxious public by using social
media. This study explores the effective use of social media in public health education by the
government of Kerala. Since Kerala had made a great use of social media in spreading public
health education due to its high literacy rate and well infrastructure development.

Significance of Study

Advancement of the social media has become a basic avenue for accessing health
information, and for the provision of interventions to imbibe healthy behaviours. In the
present scenario, many governmental and non-governmental organizations use social media
as a platform for the information sharing, especially in the field of health education. This
study signifies the effective use of social media in health education. The rationale for
conducting the study in Kerala is that Kerala is a state having high literacy rate. Hence social
media can be effectively used as a medium for creating health education in the public.

With many on people on edge and glued to their screens, the wrong message could
exacerbate things. The public is looking to government not just for direction, but also to set
the tone in how to cope. It’s especially important for the public sector to get the message out
in a clear, calm, professional manner. Even though public is highly concerned about their
health but they are not having enough patience to check the complete information regarding
the health awareness in the social media. So the scope of this study is to investigate the key
factors that lead to effective usage of social media as a mean to receive, read and apply health
awareness messages.

Objectives

General objective

 To assess the effective use of social media in public health education by the government
of Kerala.
Specific objectives

 To understand the socio-demographic profile of the respondents

 To study the role of social media in dissemination of public health awareness.
 To identify the challenges faced by the officers while sharing health awareness
messages in the social media.
 To identify the effective form of message in the social media for sharing the health
awareness messages.
Definitions

Conceptual definitions

Wojtczak (2002) defines Effectiveness as a measure of the extent to which a specific

intervention, procedure, regimen, or service, when deployed in the field in routine
circumstances, does what it is intended to do for a specified population

According to Maya E. Dollarhide, ‘Social media is computer-based technology that

facilitates the sharing of ideas, thoughts, and information through the building of virtual
networks and communities. By design, social media is internet-based and gives users quick
electronic communication of content. Content includes personal information, documents,
videos, and photos. Users engage with social media via computer, tablet or smartphone via
web-based software or web application, often utilizing it for messaging’.

World Health Organization’s (1986) health promotion glossary defines that Public
health is the science and art of promoting health among common public. It aims at the
prevention of disease, and prolonging the life of people. This prevention of disease and
prolongment of life is done through the well-coordinated and organized efforts of different
segments of society.
 WHO (1986) health promotion glossary explains Health education as the
combinations of learning experiences which are designed to help individuals and
communities have improve control over their health. This improvement in control is done by
increasing their knowledge about the surrounding or influencing their attitudes towards
health.

Operational definitions

Effectiveness as a measure of the extent to which District Education and Media

officers use the social media to promote public health awareness.

Social media is defined in the study as social networking sites which focusses more
on the Facebook.

Public health refers to the science and art of promoting health among common public
which aims in the prevention of disease and ensure the wellbeing of public.

Health education means providing information, & instructing people about health to
attain & maintain better health through Facebook by the government of Kerala.

Pilot Study

The researcher contacted Mr. Santhosh P A, District Education and Media Officer of
Palakkad District Medical Office (DMO) and enquired about the feasibility of study.

Research Design

Exploratory research design is used in the study.

Universe/Population

Total officers who are involved in the sharing of health education through social
media in Kerala (70)

Unit of the study

District Education and Media Officer of DMO in Kerala

Sample Size

14 District Education and Media Officers of DMO in Kerala

Inclusion and Exclusion Criteria

Since the study focuses on the development of effective message framework to

propagate health awareness through social media. The researcher includes only the Public
Information Officers of DMOs in Kerala who are directly involved in this process. And the
researcher excludes all the other officers of DMOs in Kerala.

Sampling Design

Purposive sampling is used as the sampling design in the study. Because the
researcher select the sample item based on the judgment of direct involvement of the officers
in the sharing of health awareness messages.

Tool of Data collection

Tool of data collection is semi-structured interview.

Data Analysis and Interpretation

Thematic analysis is used by the researcher for the analysis and interpretations of the
data.

Chapterization

Chapter I: Introduction

Chapter II: Review of Literature

Chapter III: Research Methodology

Chapter IV: Data Analysis and Interpretation

Chapter V: Findings, Suggestions and Conclusion

Bibliography
Limitations

 Main limitation of this study is that it doesn’t take into account about the behavioral
change of the public after getting the awareness about various health messages that
are received through the social media.
 Another limitation of this study is that it doesn’t include every forms of social media
separately, as every media has specific traits in influencing the people.
 Another limitation of this study is that it doesn’t include the spreading health
education by other governmental and non-governmental agencies.
Ethical Considerations

 The researcher will gain consent from the respondent prior to the study and all
communication relating to the study will be carried out with honesty and
transparency.
 The researcher will ensure adequate confidentiality and protection of the privacy of
the participants.
 Chapter IV

Analysis and Interpretation

The researcher used thematic analysis for analyzing the data that had been collected
through semi-structured interview. At first the familiarization of the data that had been
collected through semi-structured interview was made by repeated and careful reading. Then
several codes were assigned by the researcher to the data for describing the contents. Then
the themes were built by the researcher based on the similarities and differences in the code
assigned. The themes were defined and renamed after reviewing it. The analysis report was
made by the researcher and it is given below:

Effective use of social media in public health education

Code Category Theme

Age

Influence of Personal
Gender Personal
factors Factors
Education

Type of residence
 Awareness about the causes
and mode of spread of the
diseases.

Awareness about its

treatment and prevention.
Social media Purpose of social media
Awareness about the health
policies and schemes.

Analyzes fake news and

anti-propaganda and bring it
to the notice of the public.

Cost-effective

Accurate and precised

information

Saves time
Social media Benefits of
social media
Reach to a large set of
people

Can use innovative and

creative ideas to catch the
attention of public
Health education

Health promotion

Online consultation
Social media Scope of social
Health marketing
media
Health assessment

Advocacy

Resource mobilization

Friends

Actionable insights Facebook Features of Facebook

Boosting

Special training

Infrastructure facilities

Adequate financial assistance

from the
Challenges faced by the
Man Power Challenges officers in their work

Work pressure

Meaning fullness of work

Active monitoring of harmful
contents and fake news

Verification of the users Digital media Influence of rules and

ethics code rules, regulations
2021

Identification of first
originator of the information

Type of messages

Creativity of the message

Content of the message

Customization of message Message Effective message framework

Length of message

Mode of sharing

Frequency of sharing

Figure – 1 – Thematic analysis table

 WHO describes personal factors as internal factors, which ‘may include gender, age,
coping styles, social back-ground, education, profession, past and current experience, overall
behaviour pattern, character and other factors that influence how disability is experienced by
the individual’ (WHO, 2001, p. 11). This study defines personal factors as the particular
background of the respondent’s life and living, including features of the respondent that are
not part of a health condition or health states, and which can impact functioning positively or
negatively. These factors vary from person to person that results in a different set of
perceptions, attitudes and behaviour towards certain services.

Age division taken in the study by focussing on the adulthood. 14% District
Education and Media Officer belong to the age category of 36-45 years old. And 86% District
Education and Media Officer belong to the age category of 46-55 years old. Even though
Facebook is the most used social media platform, regardless of age. Youth are more equipped
with updated technical knowledge and skills to use the social media compared to the old
generations. However District Education and Media Officers self–learns to use the social
media at their level best.

29% of the respondent samples are female and remaining 71% are male. Even though
all gender has equal value in their working status. It is considered that men are more creative
than women. However irrespective of the gender, all the District Education and Media
Officers perform their role in an efficient manner.

Educational qualification is an important factor for the effective working in any field.
57% District Education and Media Officers pursued post-graduation degree and remaining
43% are having degree as their educational qualification. They took post-graduation degree
or degree in the subjects like sociology, social work etc. This helped them to deeply
understand the dynamics in the society.

Type of residence based on rural, semi-urban and urban is another personal factor
taken for the study. 57% District Education and Media Officer lives in rural area. 29% and
14% District Education and Media Officer lives in semi-urban and urban area respectively.
Generally it is said that urbanization act as a catalyst in the development of technology and
social media. However type of residence does not influence in the effective use of social
media. Since the district medical office (working place of District Education and Media
Officers) is located in the urban area. So that sufficient network speed compared to that of
semi-urban and rural area is obtained. Hence they are able to render their activities
effectively.

All the District Education and Media Officers unanimously said that the major
purpose of social media in public health education is awareness generation. Awareness about
the causes, mode of spread of the diseases, its treatment and prevention and various health
policies and schemes are shared through the social media. Another important purpose of
social media in public health education is the analysis of fake news and anti-propaganda.
There is a media surveillance group under the state government of Kerala where every
District Education and Media Officers need to report the fake news that had been propagated
through any media including the social media.

As the social media has remarkable benefits. It is effectively used in the public health
education. All the District Education and Media Officers had mentioned that now social
media is widely used compared to that of traditional media. Because it is cost-effective,
shares accurate and precised information, saves time, reach to a large set of people and also
can use innovative and creative ideas to catch the attention of public. All the District
Education and Media Officers agreed to the fact that the usage of social media is environment
friendly. Because it leads to zero paper waste and prevents deforestation, no expenditure of
fuel due to lack of travelling and thereby reduces atmospheric pollution.

Scope of social media in the health sector is widening in Kerala. It is mainly due to
the good infrastructure facilities and high literacy rate in Kerala. Various scope of social
media in the health sector are health education, health promotion, online consultation, health
marketing, health assessment, advocacy and resource mobilization.

Respondents in Facebook
60
Percentage (%)

50
40
30
20
10
0
Acceptance of friends Acceptance of friends Official page
request with criteria request without criteria

Figure - 2
 Seven district medical office (50%) are not preferring any criteria for the acceptance
of friends’ request in their Facebook account. But five district medical office (36%) are
preferring any criteria for the acceptance of friends’ request in their Facebook account like
priority towards health workers, officials, known persons and natives. The remaining two
districts (14%) are having official Facebook page which helps the officers to review about
how many people viewed, shared, liked the messages and are following the page. This feature
of the Facebook is called ‘actionable insights’ which cannot be applicable to normal
Facebook profile account. No district is using the technique like boosting to promote the
page.

Special Training for the usage of social media to

the officers

Received training Not received training

Figure - 3

Several challenges are faced by the officers while using social media in public health
education. 36% District Education and Media Officers revealed that they did not received
any special training for the usage of social media. But the remaining 64% said that they had
received special training for the usage of social media. However it was not effective. They
faced many difficulties due to the lack of sufficient training. Lack of updated technical
knowledge affect the officers to perform better and it also consumes a lot of time to do their
work in social media.

Availability of infrastructure facilities in DMO of

Kerala for the use of social media

Adequate Inadequate Moderate

 Figure - 4

14% District Education and Media Officers revealed that they are not availing enough
infrastructure facilities for carrying out their work in social media. 36% of them stated that
they are availing moderate infrastructure facilities and the remaining 50% said that they are
availing enough infrastructure facilities for carrying out their work in social media. Some
District Education and Media Officers pointed out that they are receiving poor network
connection in the office. Absence of power generator interrupts their work when power
supply fails. They feel burden when the replacement of equipment is required. Because
replacement of equipment is not done immediately and takes a lot of time even after the
repeated requests for the replacement.

14% District Education and Media Officers mentioned that they get adequate
financial assistance from the government for carrying out their work in social media. 36% of
them stated that they are availing moderate financial assistance from the government and the
remaining 50% said that they are not getting get adequate financial assistance from the
government for carrying out their work in social media.

57% District Education and Media Officers mentioned that another challenge is due to
the lack of adequate man power resources and emergence of additional work that had
entrusted upon them. They also revealed that they cannot evaluate the behavioral change in
the public and hence meaningfulness of work is yet another challenge faced by them.
However 36% of them are very satisfied in their work by sharing relevant health awareness
messages in the social media. And remaining 64% are moderately satisfied as they face some
work pressure.

93% District Education and Media Officers mentioned that they hires professional
experts to assist their work due to the lack of adequate man power resources. And remaining
7% are not hiring professional experts to assist their work due to the inadequate financial
assistance from the government. They depends on the information that had circulated in the
state government official health pages and from other districts.

All the District Education and Media Officers had mentioned that the professional
experts that they hires are available and do their work within the time. And no officers faced
any difficulties from the vetting authority. They also faced no issues like authenticity, copy
right issues and timely relevance of the information due to the limited knowledge about the
sources of sharing information. They only posts and shares the information from authentic
and official sources.

57% District Education and Media Officers revealed that the Information and
technology (guidelines for intermediaries and digital media ethics code rules, 2021)
influenced their work. But remaining 43% said that it does not influence their work. However
the new rule highlights on the matters such as active monitoring of harmful contents and fake
news, verification of the users and identification of first originator of the information which
has strong influence in their work. Some of them are not well aware about the new rules and
regulations.

Effective message framework ensure spreading health awareness messages effectively

in fast and wider scale through social media. An effective message framework includes
different elements about the messages such as its type, creativity, content, customization,
length etc. Another factor that influence effective message framework is the frequency and
mode of sharing the messages.

Most shared form of message in social media

100
No. of disrticts (%)

80
60
40
20
0
Images Videos Memes
Type of message

Figure - 5

79% of district medical office share health awareness messages mostly in the form of
images in the social media. Posters are the commonly used form of images. Trolls, memes,
cartoons etc. are also used to create health awareness in social media. Readers move beyond
words and sentences to discourse and be equipped with knowledge of certain textual Posters
are an efficient tool to influence the public opinion because they can reach wide and specific
audiences (children, women), and they are accessible to people who are otherwise isolated by
illiteracy or poverty. According to this, posters can have a direct effect on the public attitude
and behaviour.
 14% of district medical office share health awareness messages mostly in the form of
videos in the social media. Short videos of about 30 seconds to 1 minute are commonly
shared. Video has become so prominent among the rising generation. Because it’s become
clear just by looking at elementary video content. Body language and verbal tone play a huge
role in conveying a message. Viewers are able to determine exactly what the speaker is trying
to get across by observing body language, verbal tone and other visual cues.

Video includes a call-to-action, just like most blog posts and podcasts, the results are
more satisfactory. Several districts use celebrities to act in the video so that it health
awareness messages reach into the public easily.

And 7% of district medical office share health awareness messages mostly in the form
of memes in the social media. Memes are a free form of entertainment, always an option even
when you don’t have the time for more time consuming hobbies. Better yet, making them is
simple enough that they penetrate into a wide variety of niche circles, being such perfect
‘bites’ of culture and humour that they mix together to create a viral piece of content.

By socialistic perspective memes seems to be a unique and effective tool in order to

create Social awareness. Social, political, cultural, economic is what the spares infested by
the memes itself. It brings social consciousness concern health, education and other
dimension of the society. Especially memes deliberates on currently ongoing situation. For
instance, memes creates massive awareness in regards to Covid-19 virus which is confined as
pandemic.

All the District Education and Media Officers ensure the creativity and clarity in the
content of the messages that are shared. So that public gets interested to read and understand
the health awareness messages. All the District Education and Media Officers remarked that
when health threats are urgent, the best methods to engage priority audiences quickly are
frequent sharing of the messages, using creative and interesting form of messages and using
all forms of social media.
 Usage of social media by DMO in Kerala
15
No. of districts

10

0
Facebook WhatsApp YouTube Instagram Twitter
Types of social media

Figure - 6

WhatsApp is used in all the districts to share health awareness messages. There are
several groups in the WhatsApp at various hierarchical level to reach all the individuals in the
community. YouTube is another social media which is used by five districts (36%) in Kerala
to share the health awareness messages. Instagram and Twitter are another social media
which is used by two districts (14%) in Kerala to share the health awareness messages.

All the District Education and Media Officers had mentioned that the messages can be
delivered so that the public have enough time to understand and act on the messages by
sharing precised information and avoiding lengthy messages. However they often share
lengthy messages when it is a government circular, order or instructions. But its condensed
form is also shared in the social media at the same time. Because public is impatient to read
and grasp the lengthy messages.

All the District Education and Media Officers had stated that the health awareness
messages are customised based on local time, location, health situations, age, vulnerable
groups and culture. They take special care in not disrespecting or humiliating any community
while sharing customised health awareness messages based on the culture.
 Frequency of sharing the message in social media
60
No. of disrticts (%)

50
40
30
20
10
0
Daily Alternative Weekly Alternative Depends on the
days weeks context

Figure – 7

Frequency of sharing the message greatly influence the public to catch their attention
in the health concerns. Frequent sharing of messages aids to recollect the matter in
individuals and it will also help to keep in touch with the content. However only seven
districts in Kerala (50%) daily share the health awareness messages in the social media
whereas three districts (22%) share the health awareness messages weekly. Health awareness
messages are shared in the social media only in alternative weeks by two districts (14%). The
remaining two districts (14%) share the health awareness messages in the social media
depending upon the context and need.

Chapter V

Findings, Suggestions and Conclusion

Findings

 86% District Education and Media Officer belong to the age category of 46-55 years
old.
 The basic level of educational qualification for the post of District Education and
Media Officer is degree. However 57% District Education and Media Officers
pursued post-graduation degree.
 The major purpose of social media in public health education is awareness generation.
 Another important purpose of social media in public health education is the analysis
of fake news and anti-propaganda.
 Now social media is widely used compared to that of traditional media.
 Scope of social media in the health sector is widening in Kerala.
 Only two districts are using official Facebook page to share health awareness
messages and other districts are using common Facebook account profile for the same
purpose.
 Special training for the usage of social media was given to all the District Education
and Media Officers in 2015. However it was not effective.
 Majority of officers (50%) said that they are availing enough infrastructure facilities
for carrying out their work in social media.
 Majority of officers (50%) said that they are not getting get adequate financial
assistance from the government for carrying out their work in social media.
 57% District Education and Media Officers mentioned the lack of adequate man
power resources and emergence of additional work that had entrusted upon them.
 93% District Education and Media Officers mentioned that they hires professional
experts to assist their work
 Majority of officers (64%) are moderately satisfied in their work by sharing relevant
health awareness messages in the social media.
 The Information and technology (guidelines for intermediaries and digital media
ethics code rules, 2021) has strong influence in their work. Some of them are not well
aware about the new rules and regulations.
 79% of district medical office share health awareness messages mostly in the form of
images in the social media.
 14% of district medical office share health awareness messages mostly in the form of
videos in the social media.
 7% of district medical office share health awareness messages mostly in the form of
memes in the social media.
 Other forms of messages like text, cartoons, animations etc. are also used to share
health awareness messages in the social media.
 The other forms of social media used for the purpose of public health education are
WhatsApp, YouTube, Instagram and Twitter.
 WhatsApp is the widely used social media similar to that of Facebook.
 Length of the messages influence the public to understand the messages. Short
messages are more shared.
  All the District Education and Media Officers had stated that the health awareness
messages are customised based on local time, location, health situations, age,
vulnerable groups and culture.
 Frequency of sharing the message greatly influence the public to catch their attention
in the health concerns. However only seven districts in Kerala (50%) daily share the
health awareness messages in the social media.

Suggestions

 The use of social media should be promoted in the field of health education, health
promotion, online consultation, health marketing, health assessment, advocacy and
resource mobilization.
 Facebook official pages need to be created by the DMO so that the restrictions to
accept the friends’ request may not arise.
 The technique like boosting to promote the page is better to use in order to catch the
public attention.
 Adequate financial assistance and availability of infrastructure facilities must be
provided by the government according to the need.
 Special training for the usage of social media must be given to all the District
Education and Media Officers for making them updated with the latest technical
knowledge and features of social media. So that unnecessary dependence on the
externals can be avoided and cost to get the external assistance can be avoided. Thus
money can be saved.
  Professional experts like graphic designers, animators, editors etc. need to be
appointed in the working team of media wing under the district medical office.
 Awareness classes on the new rules, regulations and policies in the social media and
health sector must be provided to officers in the district medical office.
 Health awareness messages have to be frequently shared in the social media, if
possible daily.
 Social media can be used for providing a space to discuss medical conditions outside
of the healthcare providers’ office. Patients and their families can use social media
technologies to share their experiences and their findings and educate others with
similar conditions. They repackage the information they find for others, creating
forums for knowledge discovery and discussion.
 Specific targeted group need to be created in the social media. So that the
customization of health awareness messages can be made more effectively by sharing
it in the specific targeted group.

Conclusion

It is the study on the effective use of social media in public health education by the
government of Kerala. Almost all the district medical office in Kerala is effectively using
social media to promote public health education. Short, authentic, precised, creative health
awareness messages are shared in the social media. Along with that, the fake news are also
picked up and bring to the notice of public. Hence the authentic social media accounts of the
government helps the public to follow the real news and also helps them to identify the fake
news.

Social media presents a powerful tool for reaching, engaging, and connecting
individuals for public health and health promotion. Social network platforms have a large
reach at relatively low cost, representing a distinct advantage over face-to-face approaches.
Social media has been utilized among health professionals for continuing education and
dissemination of clinical practice changes. Social media (i.e., Web 2.0 technologies) can
increase the depth of engagement and connection with extensive reach to underserved,
diverse populations and with evidence-based content.

If the separate groups for specifically targeted category of pubic is created in the
social media. Then customized health awareness can be easily shared without any bias or
discontents. Behavioural changes of such individuals can be also assessed through such
groups by maintaining a rapport relationship.
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 Appendix

Questionnaire

Socio-demographic profile

1. Age

o 25-35

o 36-45

o 46-55

2. Gender

o Female

o Male

o Others

3. Educational qualification

o Degree

o Post-Graduation

o Others

4. Type of residence

o Rural

o Semi-Urban

o Urban

Role of social media

5. What are the purposes of social media in generating public health education?

o Awareness about the causes and mode of spread of the diseases.

o Awareness about its treatment and prevention.

 o Awareness about the health policies and schemes.

o Analyzes fake news and anti-propaganda and bring it to the notice of the
public.

o Others

6. Why social media is widely used compared to that of traditional media?

o Cost-effective

o Accurate and precised information

o Saves time

o Reach to a large set of people

o Can use innovative and creative ideas to catch the attention of public.

o Others

7. Is there any criteria for accepting the friend requests in the Facebook page?

o Yes

o N0

8. If yes, can you mention those criteria?

o Health workers

o ASHA workers

o Political representatives

o Other people representatives

o Others

9. Do you use the technique like boosting to promote the page?

o Yes

o No
 10. Do you think that usage of social media is environment friendly?

o Yes

o No

11. If yes, why did you think that usage of social media is environment friendly?

o Zero paper waste and prevents deforestation.

o No expenditure of fuel due to lack of travelling.

o Reduces atmospheric pollution.

o Others

12. If no, why did you think that usage of social media is not environment friendly?

o E-wastes

o Lead to soil pollution

o Others

13. What is the scope of social media in the health sector?

o Health education

o Health promotion

o Online consultation

o Health marketing

o Health assessment

o Advocacy

o Resource mobilization

Challenges faced by the officers

14. Have you received any special training for the usage of social media?

o Yes
 o No

15. If not, do you feel any difficulties due to the lack of training?

o Lack of technical knowledge

o Unable to perform the work quickly and effectively
o Others
16. What are the infrastructure facilities that you are availing for your work?

o Computer

o Internet

o Supportive working environment

o Power supply

17. Do you get adequate financial assistance from the government?

o Yes

o No

18. Do you hires professional experts to assist your work?

o Yes

o No

19. If so, are they available and do their work within the time?

o Yes

o No

20. Have you faced any difficulties from the vetting authority?

o Yes

o No

21. Do you face any issues due to the limited knowledge about the sources of
information?
o Yes
 o No

22. What are the issues faced due to the limited knowledge about the sources of
information?

o Authenticity

o Copy right issues

o Timely relevance of the information

o Others

23. How well are you satisfied with your work?

o Very satisfied

o Moderately satisfied

o Neither satisfied nor dissatisfied

o Dissatisfied

o Very dissatisfied

24. What is the reason behind your satisfaction level?

o Work pressure

o Health issues

o Meaningfulness of work

o Others
25. Does the Information and technology (guidelines for intermediaries and digital media
ethics code rules, 2021) influenced your work?

o Yes

o No
 26. How did the Information and technology (guidelines for intermediaries and digital
media ethics code rules, 2021) influenced your work?

o Active monitoring of harmful contents and fake news

o Verification of the users

o Identification of first originator of the information

Effective form of message

27. Which type of messages are mostly shared?

o Images

o Text

o Videos

o Memes

o Cartoons

o Animations

o Website/blog post

o Podcasts

28. How often do you able to share the messages?

o Daily

o Alternative days

o Weekly

o Alternative weeks

o Monthly

o Others

29. When health threats are urgent, what are the best methods to engage priority
audiences quickly?
 o Frequent share of the messages

o Using creative and interesting form of messages

o Usage of all forms of social media

o Others

30. How can messages be delivered so that the public have enough time to understand and
act on the messages?

o Sharing precised information

o Avoiding lengthy messages

31. On what basis, do you customize health awareness messages?

o Local time

o Location

o Health situations

o Age

o Vulnerable groups

o Culture

32. Does the length of the messages influence the public to understand the messages?

o Yes

o No