Enhancing Healthcare Services and Brand Engagement Through Social Media Marketing Integration of Kotler's 5A Framework With IDEA Process

Information Processing and Management 60 (2023) 103379
Contents lists available at ScienceDirect
Information Processing and Management

journal homepage: www.elsevier.com/locate/infoproman
Enhancing healthcare services and brand engagement through

social media marketing: Integration of Kotler’s 5A framework with
IDEA process
Chih-Lung Hung a, b, Jen-Her Wu c, Pei-Yu Chen d, Xiaoyu Xu e, Wan-Ling Hsu f,
Li-Min Lin g, Ming-Che Hsieh h, *
a
CAO, Administrative Center, E-DA Hospital, No.1, Yida Rd., Yanchao District, Kaohsiung 82445, Taiwan (R.O.C.)
b
Instructor, Department of Healthcare Administration, I-Shou University, No.8, Yida Rd., Yanchao District, Kaohsiung 82445, Taiwan (R.O.C.)
c
Department of Information Management, Southern Taiwan Interdisciplinary Center for Innovative Technologies, Advisory Board Member, E-DA
Healthcare Group, National Sun Yat-Sen University, No. 70, Lien-Hai Rd., Kaohsiung 804, Taiwan (R.O.C.)
d
Department of Information Management, National Sun Yat-Sen University, No. 70, Lien-Hai Rd., Kaohsiung 804, Taiwan (R.O.C.)
e
School of School of Economics and Finance, Xi’an Jiaotong University, No. 74, Yantaxi Rd., Xi’an, Shaanxi 710061, China
f
Deputy CAO of Nursing, Administrative Center, E-DA Hospital, No.1, Yida Rd., Yanchao District, Kaohsiung 82445, Taiwan (R.O.C.)
g
Department of Nursing, Meiho University, No. 23, Ping Kuang Rd., Pingtung 91202, Taiwan (R.O.C.)
h
Department of Information Science and Management Systems, National Taitung University, No. 369, Sec. 2, University Rd., Taitung 950309,
Taiwan (R.O.C.)
A R T I C L E I N F O A B S T R A C T
Keywords: Social media marketing can be an effective solution for healthcare organizations to build long-
Cyberpsychology term relationships with patients. However, previous studies mainly focused on isolated aspects
5A framework of social media marketing. This lack of integration has limited the development and adoption of
IDEA
social media marketing. This study proposes a social media marketing methodology (SMMM) that
Content design
Social media marketing
incorporates Kotler’s 5A consumer experience path with the IDEA (identify, develop, engage, and
Healthcare marketing assess) content marketing process and well-known social media design principles in providing
marketing roadmap and content design guidance for implementing social media marketing. Two
cases (one for a medical center with 56 posts reaching 101,342 potential clients and another for a
postpartum nursing home with 52 posts reaching 61,245 potential clients) are used to examine
and evaluate the usability of the methodology. The results show that the engagement rate in both
cases is well above the average level in Taiwan, and all users have a positive response to the use of
the methodology. These findings support that the methodology provides a nominal process model
for implementing social media marketing, facilitates the design of post content, and enhances
patient engagement with healthcare brands and services.
1. Introduction
The rapid growth of the Internet and social media has strongly influenced the behaviors of people, especially how they disseminate,
share, and acquire information pertaining to diseases and health education. For instance, the number of pretreatment health-related
* Corresponding author.
E-mail address: hmz@nttu.edu.tw (M.-C. Hsieh).
https://doi.org/10.1016/j.ipm.2023.103379
Received 2 October 2022; Received in revised form 18 March 2023; Accepted 3 April 2023
Available online 21 April 2023
0306-4573/© 2023 Elsevier Ltd. All rights reserved.
C.-L. Hung et al. Information Processing and Management 60 (2023) 103379
internet searches increased by 20% within a 5-year (2015–2019) period (Day et al., 2019). Technological advancements and market
competition have created major challenges for healthcare providers with respect to the differentiation and promotion of their services
(Khan & Kulshreshtha, 2020). In addition, healthcare services are increasingly focused on patient-centeredness, especially after the
outbreak of COVID-19 (Latimer et al., 2017; Jabarulla & Lee, 2021; Wickremsinhe et al., 2022). Therefore, the implementation of a
robust marketing strategy is necessary for healthcare organizations (e.g., hospitals, healthcare centers, postpartum care centers, and
nursing homes) to engage patients and consumers and build long-term relationships with them.
As the world is becoming more digitally oriented, the health care industry is increasingly visualizing health care marketing, with
social media as an important tool and channel for brand building, health promotion, research and education, marketing and branding
for individuals and practices, and recruitment (Farsi, 2021; Neal & Lyons, 2021). Social media (e.g., Facebook, YouTube, and
microblogs) provides a new channel through which healthcare organizations can develop sustainable, ubiquitous, and in-depth re
lationships with the public and specific communities and types of patients (Wong et al., 2016; Chen et al., 2020). The incorporation of
social media is particularly appropriate for healthcare organizations that require effective measures for promoting new ventures but
lack the financial resources and technical capability to implement conventional and professional advertising campaigns and marketing
programs (Jalal et al., 2021).
The marketing of healthcare services (e.g., the promotion of treatment directed to the cure of the disease or injury) is different from
other marketing contexts because health care involves health-related concerns and is of vital importance when compared to other
commercial goods (Li et al., 2018). The context of health care differs significantly from more general business contexts, as health care
consumers are more sensitive to potential risks associated with health-related decisions (Bansal et al., 2010). Before seeking or sharing
health information on social media, health care consumers have to ensure that the benefits of the behavior outweigh the risks (Bansal
et al., 2010). Thus, compared to services (e.g., the promotion of feature and goodness directed to products/services) in a commercial
goods context, the promotion of healthcare services should highly rely not only on brand and trust building, but also on professional
expertise, and authority related to health care.
Prior research indicated that health care professional-patient online interactions via social media has a positive effect on patient
satisfaction, brand relationship quality (Richter & Kazley, 2020), patient empowerment, or social and economic returns, reputation
and popularity for health care professionals (Shang et al., 2019). With the emergence of online channels, the paradigm of interaction
between health care professionals and patients has changed, and the guidelines for interaction should also change. Shang et al. (2019)
conducted a comprehensive assessment of the antecedents and consequences of health care professional-patient online interactions
through a meta-analysis. They point out that the specifications and principles of design (e.g., concerning privacy) as one of the po
tential research topics in health care marketing deserving further exploration in the context of online health care settings.
However, the literature on social media marketing in the context of healthcare organizations is fragmented and focused on isolated
topics (Felix et al., 2017). For instance, Kolter et al. (2016) have proposed a new paradigm of “Marketing 4.0′′ that considers the
decision journeys of consumers on the basis of the five-A consumer experience pathway (i.e., aware, appeal, ask, act, and advocate),
previous studies on healthcare have mainly investigated consumer behaviors in a single stage. The IDEA method is widely used by the
marketing community to manage and assess their activities pertaining to thought leadership content publishing, but practitioners and
researchers have highlighted the difficulties of their practical application. In addition, prior studies have proposed various guidelines
for post element design alone. Specifically, research on developing a pragmatic roadmap for healthcare organizations to implement
effective social media marketing and establishing a systematic framework for post content design in the context of social media
marketing is lacking. These research gaps limit the application of social media marketing and promotion of patient engagement in
healthcare services.
Therefore, the purpose of this study is to develop a social media marketing methodology (SMMM) that integrates Kotler’s 5A
framework (Kolter et al., 2016) with the IDEA content marketing process (Think Marketing, 2013) and well-known social media design
principles in providing a nominal process model for implementing social media marketing to address the aforementioned research
gaps. The present study employed the design science research methodology (DSRM; Peffers et al., 2007) to develop the SMMM and
demonstrate its usability with the application of real-world scenarios. The present study contributes to the social media marketing
literature by providing a comprehensive and pragmatic methodology to the implementation of social media marketing. It can also
facilitate post content design and enhance patient engagement with healthcare brands and services.
2. Related works
The emergence of social networking sites has provided a new medium for brand communications (Kang et al., 2014). Social media
marketing is defined as the creation of specific messages or content on social networking services (e.g., blogs, YouTube, Facebook) to
attract the attention of consumers and achieve marketing goals (Chawla & Chodak, 2021). Kim and Kim (2019) found that content
marketing with Facebook facilitates user interactions and maintain their social relationships. By publishing and disseminating relevant
and valuable posts on social networks, organizations can attract, acquire, and engage with a clearly defined and understood target
audience to drive revenue-producing customer activity (Felix et al., 2017). Social media marketing can elicit discussions among
Internet users and encourage consumers to disseminate promotional information through their own personal social networks, sub
sequently enhancing consumer relationships and satisfaction.
Studies have explored the use of social media in the healthcare field and verified its effects on patient behaviors and business
benefits. With respect to the behaviors of social media users (patients), Lin and Kishore (2021) argued that social media (e.g., asocial
media affordance and online social support) can help patients to improve their self-management of chronic diseases. Lin and Lu (2011)
discovered that ties related to social interaction (structural dimension), shared values (cognitive dimension), and trust (relational
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dimension) play key roles in the continued intention of social media users to use Facebook fan pages. For business benefits, several
studies have explored the effects of using social media as a marketing tool on healthcare business outcomes, for example, the intention
of patients to purchase healthcare services and improvements in consumer relationships. Similarly, Wong et al. (2016) suggested that
social media provides new channels for hospitals to engage with communities; for example, numerous children’s hospitals in the
United States have established social media fan pages. In fact, numerous researchers have recommended the use of strategic social
media marketing as a business improvement tool in various fields. Kang et al. (2014) suggested that active fan participation can in
crease the brand trust and commitment of the followers of a brand. Yang and Che (2020) verified the marketing effects of online social
ties on purchase frequency. Wang et al. (2020) found that social interaction has a positive effect on consumer engagement in a social
community, and in turn facilitating consumer engagement in social commerce. Similarly, Dolega et al. (2021) provided empirical
evidence of the effectiveness of social media as a marketing tool for enhancing business outcomes, including website traffic, product
orders, and sales income. However, the research on how to implement effective social media marketing in the healthcare field is
limited, such as in developing a pragmatic roadmap for healthcare institutions to implement effective social media marketing and
providing a systematic framework for post content design in the healthcare services.
2.1. The 5A framework in the marketing 4.0 era
Kotler et al. (2016) indicated that in the era of Marketing 4.0, the initial brand requirements of consumers are influenced by their
surrounding community, which may ultimately determine their attitudes toward the brand. To understand a brand, consumers develop
connections with other consumers by asking questions and becoming brand advocates. In addition, Internet users actively interact with
people in the online community; consumers who require information also conduct Internet searches and communicate with other
consumers to obtain information. Kotler et al. (2016) suggested that the 5A pathway starts with the aware stage, during which
consumers passively observe the numerous brands that they are already aware of. Consumers may remember their previous in
teractions with various brands and focus again on these brands, if necessary. They then proceed to the appeal stage, during which they
will reinforce an existing memory or form a new one and eventually focus only on a small number of brands. In the third stage (i.e., ask
stage), consumers satisfy their curiosity by actively consulting their friends, family members, or even the brand owner about the
products of a brand. Additionally, they can also search and ask for additional information online. Consequently, companies must
establish a presence on the most popular social media channels to stimulate the interest of buyers. If the brand information obtained
during the ask stage is positive, consumers then proceed to the act stage (i.e., purchase of a product). After consumers have made their
purchases, brands must ensure that their consumers are satisfied and engage with them to establish a brand relationship. Over time,
loyal consumers who are satisfied with the product or service of a brand will recommend the brand to others without prompting and
become brand advocates. Consumers who undertake the risk of recommending a brand are its major consumers (Kotler et al., 2016).
In accordance with the 5A framework of Marketing 4.0, marketers should guide consumers on their journey from becoming aware
of a product or service (aware stage) to the final stage. However, studies on e-health have mainly investigated 5A model–related
consumer behaviors in a single stage, such as the investigation of the determinants of “purchase intention” during the act stage (e.g.,
Jang et al., 2018; Shulman & Geng, 2019; Wang et al., 2021), the factors influencing “social sharing” or “recommendation” during the
advocate stage (e.g., Yang & Gao, 2021; Oeldorf-Hirsch et al., 2019), and the antecedents of “information seeking” during the ask stage
(e.g., Zhao & Zhang, 2017; Zimmerman & Shaw, 2020). The aforementioned studies have thus mainly focused on the antecedents or
consequences of a single stage instead of decision-making as a process (Kim & Hawkins, 2020). By contrast, few researchers have
conducted holistic and 5A-oriented studies investigating the complete consumer journey. For instance, the 5A framework does not
clarify how 5A strategies should be executed (e.g., how to identify specific consumer segments at various stages of the 5A framework).
Furthermore, the development of ideas and content that express a company’s core values at each stage is a topic that warrants further
clarification. Topics related to how businesses can engage with specific consumers and assess the outcome of stage-specific strategies
have also not been extensively explored.
2.2. IDEA
Content marketing is a management process in which a firm identifies, analyzes, and satisfies consumer demand by distributing
digital content through electronic channels (Holliman & Rowley, 2014). The content created through content marketing includes the
static content found on web pages and various forms of dynamic media content (e.g., videos, podcasts, user-generated content, and
interactive product selectors; Smith & Chaffey, 2013). IDEA is an established method that managers apply to manage and assess their
activities pertaining to thought leadership content publishing (Think Marketing, 2013). Under the IDEA concept, “I” stands for
“identify,” meaning that managers should identify their target audience and identify the informational needs of their target consumers
(Järvinen & Taiminen, 2016); “D” stands for “develop,” meaning that managers should develop marketing content that is adapted to
their target audience and distributed through the appropriate social networks (Morgan et al., 2019; Ho et al., 2020); “E” stands for
“engage,” meaning that managers should encourage their audience/consumers to contribute ideas to their brands on social media
platforms (Kee & Yazdanifard, 2015); and “A” stands for “assess,” meaning that managers should assess the effects of their measures on
their businesses and make appropriate revisions or reinvestments.
IDEA and IDEA-derived recommendations are widely recognized by the marketing community, but practitioners and researchers
have highlighted the difficulties of their practical application. IDEA does not provide a process point of view for designing strategies for
the different stages of social media marketing. The four aspects of IDEA should thus be carefully designed to incorporate particular
features for different stages of marketing (Wu, 2022). Wu (2022) proposed an initial integration of Kotler’s 5A framework with IDEA.
3
For example, during the “identify” stage, the targeted audiences may differ considerably in terms of their knowledge of a specific
brand. Therefore, the subsequent “D,” “E,” and “A” stages should differ with respect to how consumers are targeted at each stage of the
consumer journey. Thus, a successful application of IDEA requires an integrated framework that clearly identifies the stages of a
consumer’s journey and provides a process point of view for designing effective marketing strategies for different consumers. However,
the research on this topic is limited, and a solution framework for e-health social media marketing has yet to be developed.
2.3. Design of post elements in social media marketing
Social media marketing is implemented by publishing posts on a fan page. Post content should be well-designed to achieve the
marketing goals for each stage. Studies have proposed various guidelines for post element design. Facebook applies the “442 principle”
(Shi, 2015) to the proportion of content: a post should contain 40% informational content (i.e., nonsales content that provides
knowledge to consumers), 40% indirect commercial information (e.g., brand events or news), and 20% direct sales information (e.g.,
discounts or links to official shopping websites).
Stelzner (2011) highlighted that building a professional image and expanding one’s influence in online communities requires the
regular publication of high-quality post content; they also indicated that high-quality content should be highly relevant, educational,
readable, visually appealing, dialogic, and not sales-oriented. Several elements of the aforementioned principles have been verified by
researchers. De Vries et al. (2012) and Zhang, Wei, Fukuda, Zhang, & Ji, 2021 indicated that the number of comments and likes
received for a post are affected by several factors, which include vividness (features of the post), interactivity, the location of the post,
and the proportion of positive comments. Goh et al. (2013) suggested that the comments of actual consumers in response to a brand
post significantly affect the decisions of other consumers; they also indicated that these effects are greater than those of other in
formation distributed through other channels. Similarly, Antoniadis et al. (2019) highlighted that the inclusion of images, videos, and
links in a post can positively affect the number of likes and comments received for that post. Moreover, the publication time of a post (e.
g., on the weekends or during working hours) also affects the feedback received from followers.
Coelho et al. (2016) argued that the content posted in a social community should be tailored to generate a high number of
comments, likes, and forwards; such content includes comparative content highlighting various differences, topics pertaining to
current events, incentives for specific consumers with unique gift-like feedback, and incentives for expanding a consumer base. In
addition, Stelzner (2011) proposed the concept of “effective content articles” that include practical how-to-do strategies, expert in
terviews, industry overviews, case studies, news reports, and stories with unconventional comments.
According to a BuzzSumo analysis of more than 800 million Facebook posts in 2016, posts with less than 50 characters are more
engaging than long posts (Moeller, 2017). Buddy Media’s research on Twitter best practices regarding tweet length reported similar
results; that is, Tweets with less than 100 characters received 17% more engagement (McLachlan, 2022). With the help of its data
partner BuzzSumo, Dean (2019) analyzed 912 million blog posts on social media networks and discovered that posts with 1000–2000
words received an average of 56.1% more shares than did posts with less than 1000 words. Additionally, it reported diminishing
returns for articles with more than 2000 words. Phillip (2016) revealed that among the top 500 leading brands on Facebook, 28% used
Fig. 1. Proposed process model for implementing social media marketing methodology.
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emojis in their posts in the fourth quarter of 2014, and by the fourth quarter of 2015, this percentage had increased to 40%. Enterprises
can use emojis in their posts to not only attract consumers but also to encourage consumers to participate in their posts.
Although studies have highlighted the elements of post features that influence the success of social media marketing (e.g., number
of likes, comments, and shares), the literature has only explored this topic from specific perspectives instead of comprehensively
identifying the design principles for each element of a post and the post content elements that are relevant for each social media
marketing stage. Because posts are a tool for promoting a brand in social networks, the aforementioned topics are essential for
determining the success and applicability of the social media marketing implemented by marketing practitioners in the healthcare
sector.
3. Development of methodology
In accordance with the DSRM (Peffers et al., 2007), a social media marketing methodology (SMMM) extended from Wu (2022) was
developed in the present study by integrating Kotler’s 5A framework with the IDEA content marketing process and well-known social
media design principles to address the aforementioned research gaps. Because the SMMM is primarily used by healthcare organizations
to enhance engagement and build long-term relationships with patients and consumers, we refer to patients and consumers collectively
as clients below. The development process is described in the subsequent subsections.
3.1. Integrating Kotler’s 5A framework with IDEA
As shown in Fig. 1, Kotler’s 5A framework for describing a client’s journey is integrated with IDEA to establish a comprehensive and
accurate framework, called SMMM, for designing an integrated social media marketing strategy.
The SMMM process is constructed as a nominally cyclical structure. Typically, the SMMM process begins with the “aware” stage;
however, marketers are not required to progress sequentially from the “aware” stage to the “advocate” stage. In practice, they may start
at any stage. During the “aware” stage, the objective is to create brand awareness among potential clients through the IDEA process and
social media design. Therefore, at this stage, key performance indicators (KPIs) related to brand awareness (e.g., reach, impressions,
clicks, and CRR (Click Rate by Reach)) can be used to assess operational effectiveness (Colicev et al., 2019). When the KPI targets for
the “aware” stage are achieved, potential clients become followers and the SMMM process enters the “appeal” stage. During the
“appeal” stage, the objective is to attract the attention of followers and keep them engaged and interested in the long-term. KPIs related
to brand attractiveness (e.g., likes, saves, followers, ERR (Engagement Reach Rate), and CVR (Conversion Rate)) are often used to
assess operational effectiveness (Marzouk, Salminen, Zhang, & Jansen, 2022). When the KPI targets for the “appeal” stage are ach
ieved, the “ask” stage should be implemented to encourage comments and questions (e.g., search question) from followers. To assess
the operational effectiveness of the “ask” stage, KPIs related to client curiosity (comments, engagements, ERR, and ER (Engagement
Rate)) should be used (Li et al., 2022). In practice, the IDEA process for the “appeal” stage is usually repeated during the “ask” stage.
Fig. 2. Social media design principles.
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When a close relationship with followers is established by responding to their comments and questions, the “act” stage must be
initiated to create fan intention to make a purchase commitment. In accordance with the IDEA process and social media design
principles that are relevant to the “act” stage, paid media can be used to promote fan participation (in activities) and engagement. The
KPIs are related to client commitment include shares, friend tagging, and number of participants (Sweeney et al., 2014). Finally, to
further increase the emotional resonance of existing clients and expand their influence, the “advocate” stage should be initiated. At this
stage, posts that are likely to emotionally resonate with existing clients are published and pinned to the top of a fan page to generate
more page views. The KPIs related to brand affinity (e.g., total followers, positive comments, spontaneous tweets, backlinks, links to
website, and earned media positive reviews) can be used to assess operational effectiveness (Wirtz et al., 2013).
3.2. Social media design principles
To enhance healthcare service interactions through social media marketing, social media posts must be designed to be friendly,
helpful, and effective (Stelzner, 2011; De Vries et al., 2012). Through a literature review, a comprehensive summary of social media
design principles was created and is represented as a branching mind map with three hierarchical levels (Fig. 2).
(1) Effective content types
The content types can be comparative content that highlight differences, topics with current events, incentives for specific clients
that are provided as gift-like feedback, or incentives for expanding potential clients and receiving more comments, likes, and forwards
(Coelho et al., 2016). Content can also include practical strategies, such as how-to guides, expert interviews, industry overviews, case
studies, news reports, and stories with unconventional comments that enhance user knowledge (Stelzner, 2011). In addition, the use of
lists containing frequently asked questions (FAQs) can help social media personnel to address easy-to-access-and-answer topics and
provide services for answering such questions (CopyPress, 2021).
(2) Good content attributes
The high-quality content attributes proposed by Stelzner (2011) and De Vries et al. (2012) are summarized in the present study as
friendliness and helpfulness attributes. To achieve a favorable user experience, user-friendly posts should be highly readable, inter
active, visually appealing, vivid, dialogic, not sales oriented, and appropriately long. To establish advantages and provide services, a
helpful post should be highly relevant, educational, informative, and entertaining.
To increase interactions, Heston (2022) argued that brands must post frequently and engage clients in two-way dialog through
posts that ask questions. To avoid a sales perspective, Facebook proposed the 442 principle (Shi, 2015). With respect to the ideal post
length, Carter (2022) recommended that short posts should be written to maximize the likelihood of answering search intent quickly
and long posts should be written to increase the likelihood of mass sharing.
(3) Proper use of social media functions
The visual characteristics of and information transfers conducted on a fan page are indispensable components of a social com
munity marketing strategy. Through subtle changes to content layout and image presentation, a brand can impress its audience. Five
social media functions can be used, namely the hashtag, emoji, tag, pin to top, and paid media functions. The hashtag function (#) can
be used to write short posts. A hashtag comprises a pound sign and a word or string of words up to a sentence. It is often used for posts
published on social websites or blogs to connect individual posts together. Thereby, users can connect to posts with the same hashtag
on a platform by clicking the hashtag.
The emoji function is an emoticon function that is commonly used by smartphone users to express emotions. People often use them
in a sentence or story (Phillip, 2016). Emojis can be used to increase the willingness of clients to comment, thereby increasing cli
ent–brand interactions.
A tag follows the “space@name/user name” format, and it can be used to increase the touch rate of followers by attracting followers
of other pages to read posts, which expands the readership of a fan page. In addition, a tag can trigger the display of fan page/personal
account information when a potential client hovers the mouse pointer over it (Muntinga et al., 2011). A potential client who clicks a tag
is brought to a fan page, which effectively increases the number of likes received by the fan page.
To ensure that a post is seen, brands can use the pin-to-top function to push a post to the top of their clients’ timeline feeds
(Yellowdig, 2022). The pinned post then appears at the top of the timeline feeds of the members of a given community, making it a
straightforward process for clients to find and view highly relevant posts. Porterfield (2012) demonstrated how a pinned post can be
used to build a fan base and email list by offering something of value in exchange for likes or the names and emails of fans. A pinned
post can also be used to pin information that first-time visitors should see first when they visit a page.
Paid media include social media ads, paid search ads, pop-up ads, banner ads, interstitial ads, and video ads. To reach target
audiences who are actively looking for similar services, the use of paid media through the purchase of ad inventory on a media channel
or publisher site can be useful (Pereira, 2021). This strategy is especially useful for content that requires organic engagement and
impression boosting (Kendall, 2021).
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Table 1
Solutions based on social media marketing methodology.
Stage Identify Develop Engage Assess
Aware • Objective: Build • Develop posts that are • Introduce equipment and • Assess effectiveness of
awareness of likely to attract potential services that are highly approach by evaluating brand
advantages of a brand clients. relevant to client. awareness.
among target clients. • Develop content or topics • Demonstrate comparative • Use related metrics (e.g.,
• Identify potential clients based on a value advantages. reach, impressions, clicks, and
and their concerns. proposition. CRR).
Focus on social media design principles
• Effective content types: comparative content, news reports, and current events.
• Positive content attributes: high relevance, high readability, avoidance of sales perspective, and use of short posts.
• Appropriate use of social media functions: emoji, hashtag, pin to top, and paid media.
Appeal • Objective: Maintain • Develop posts that are • Use interesting content and • Assess effectiveness of
attractiveness of brand likely to attract followers. topics to retain attention of approach by evaluating brand
fan pages to target followers and encourage them attractiveness.
clients. to continue following fan • Use related metrics (e.g., likes,
• Identify topics and pages. saves, followers, ERR, and CVR
content that are likely to • Attract more followers by reach to followers).
attract followers. sharing practical knowledge
or news and current affairs.
• Effective content types: current events, expert interviews, and case studies.
• Positive content attributes: visual appeal, vividness, avoidance of sales perspective, and educational value.
• Appropriate use of social media functions: emoji, hashtag, pin to top, and earned media.
Ask • Objective: Encourage • Develop posts that are • Engage followers in two-way • Assess effectiveness of
followers to leave likely to attract the dialogues. approach by evaluating client
comments and ask comments and questions • Build closer relationships with curiosity.
questions. of followers. followers by responding to • Use related metrics (e.g.,
• Identify the concerns their comments and comments, engagements, ERR,
and issues of followers. questions. and ER).
• Motivate followers to react or
ask further questions about a
brand.
• Effective content types: FAQs and how-to guides.

• Positive content attributes: dialogic text, interactivity, educational value, and use of short posts.
• Appropriate use of social media functions: emoji, hashtag, chatbot, and paid media.
Act • Objective: Engage • Develop posts and • Use paid media to promote • Assess effectiveness of
followers to encourage organize activities that are participation of followers in approach by evaluating client
purchases and activity likely to evoke the activities and to engage commitment.
participation. intention of followers to deeply with followers. • Use related metrics (e.g.,
• Identify motivations make commitments. • Introduce offline activities shares, friend tagging, activity
that are likely to evoke and online fan page activities participants, ER, and CVR total
the intention of with incentives to attract followers to activity participants).
followers to make followers to participate,
commitments. thereby building brand trust
and brand preference.
• Effective content types: incentives.

• Positive content attributes: interactivity, entertainment, and informativeness.
• Appropriate use of social media functions: emoji, hashtag, @tag, pin to top, and paid media.
Advocate • Objective: Transform • Create posts that are likely • Pin posts to the top of fan • Assess effectiveness of
followers into brand to resonate with clients. pages to increase page views. approach by evaluating brand
advocates. • Attract followers to stay on affinity.
• Identify topics that are fan pages, read comments, • Use related metrics (e.g., total
likely to resonate and eventually make purchase followers, positive comments,
emotionally with past decisions. spontaneous tweets, backlinks,
customers. links to website, and earned
media positive reviews).
(continued on next page)
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Table 1 (continued )
Focus on social media design principles:
• Effective content types: industry overviews, expert interviews, and case studies.
• Positive content attributes: high relevance, visual appeal, and use of long posts.
• Appropriate use of social media functions: @tag, pin to top, and earned media.
3.3. SMMM solution
Table 1 lists the 5A stages, 5A stage objectives, social media marketing solutions, focused social media design principles, and
related KPIs. This solution framework provides a clear roadmap for each stage with respect to the development of ideas and content
that express a company’s core value (under design guidance) to achieve marketing goals, and it can be applied directly by marketing
practitioners to guide marketing activities.
Therefore, managers should identify (i.e., “I” of IDEA) potential clients who are unaware of the brand (target audience) and their
concerns at the “aware” stage. Next, on the basis of a value proposition, these managers should develop (i.e., “D” of IDEA) content or
topics that may appeal to their target audience and use paid media to engage (i.e., “E” of IDEA) with their target audience and create
brand awareness among them. Based on the design principles of comparative content, avoiding a sales perspective, and high relevance,
posts can introduce equipment and services that are highly relevant to clients and exhibit comparative advantages. At this stage, the
hashtag and pin-to-top functions and paid media are highly suitable options for increasing the page views by potential clients. Finally,
managers should assess (i.e., “A” of IDEA) the effectiveness of their strategy in terms of whether (and how) the attractiveness of their
brand can be improved. The use of KPIs related to brand awareness (e.g., reach, impressions, clicks, and click rate by reach [CRR]) is
recommended.
The implementation of IDEA during the “appeal” stage should, however, be different from that during the other stages; this is
because the objective of the “appeal” stage is to increase brand attractiveness among followers. Thus, managers should identify topics
and content that are likely to attract followers and incorporate these topics and content into published posts; through this strategy, they
can consistently retain the attention of followers and encourage them to continue following their fan pages. In accordance with the
design principle for how-to guides, posts can attract more followers by sharing practical knowledge or news and current affairs. Finally,
managers should assess the effectiveness of their strategies by assessing the attractiveness of their brands. The use of KPIs related to
brand attractiveness (e.g., likes, saves, followers, engagement rate by reach [ERR], and conversion rate by reach to followers [CVR reach
to followers]) is recommended.
In the “ask” stage, the objective is to encourage followers to leave comments and ask questions. At this stage, managers should
identify fan concerns and issues and create posts that are likely to attract comments and questions from followers. Based on the design
principles for effective content (e.g., FAQs and how-to guides) and positive content attributes (e.g., dialogic text and interactivity), a
post can employ guided conversations to motivate followers to react or ask questions about a brand. To maximize the likelihood of
answering a search query quickly and to engage followers in a two-way dialog that allows for a stronger relationship with followers to
be formed (through responses to comments and questions), the use of short posts and the emoji, @tag, and chatbot functions is
recommended. Finally, managers should assess the effectiveness of their strategies by assessing the curiosity of clients about their
brand. To this end, KPIs such as comments, engagements, ERR, and engagement rate (ER) should be used.
In the “act” stage, the objective is to engage followers and encourage them to make purchases and participate in activities.
Managers should identify motivations, create posts, and organize activities that are likely to evoke the intention of followers to make
commitments. Based on the design principles for effective content types (e.g., incentive and industry overview) and positive content
attributes (e.g., entertainment and informativeness), posts should introduce offline activities and online fan page activities with in
centives to attract followers to participate; this strategy enables a business to build brand trust and brand preference. To encourage
followers to participate in activities and to attract more potential clients, the use of social media functions (e.g., the hashtag and pin-to-
top functions) and paid media is recommended. Finally, managers should assess the effectiveness of their strategies by assessing client
commitment. To this end, KPIs such as shares, friend tagging, activity participants, ER, and conversion rate by total followers to
activity participants (CVR total followers to activity participants) should be used.
In the “advocate” stage, the objective is to transform followers into brand advocates. Managers should identify topics and develop
posts that are likely to resonate emotionally with past customers. Based on the design principles for effective content (e.g., expert
interviews and case studies) and positive content attributes (e.g., high relevance and visual appeal), posts should focus on sharing
actual experiences and TV interviews that are highly relevant and visually appealing. In addition, the pin-to-top function can be used to
increase page views, long posts can be used to increase the likelihood of mass sharing, and paid media can be used to attract more
potential clients.
3.4. Data collection and analysis
3.4.1. Data collection

Finally, managers should assess the effectiveness of their strategies by assessing brand affinity. To this end, KPIs such as total
followers, positive comments, spontaneous tweets, backlinks, links to website, and earned media positive reviews through experiments
8
should be used (see Table 1). In addition, other types of data also need to be collected and used to validate results and findings. This
may include collecting multiple types of data through semi-structured interviews, media coverage, notes taken at regular meetings,
and archival documents across the cases studies (see Table 2). The interview data were our major data set. Other types of data, e.g.,
notes taken at the regular meeting and media coverage were used to further validate findings. For instance, individual interviews were
conducted and media coverage collected after the marketing events. To provide evidence directly from the data, we present quotes
taken from meetings that support the findings (Pratt, 2008). Media coverage data identified relevant information and was used to
supplement the critical incidents obtained from the interview data to form a more complete understanding of the incidents. These
qualitative or media coverage data can be used to evaluate and support the usability or usefulness.
3.4.2. Data analysis

The KPIs such as total followers, positive comments, spontaneous tweets, backlinks, links to website, earned media positive re
views, ER, and so forth are calculated based on the data captured from Facebook backend. In addition, we analyzed our interview data
using the content analysis approach (Neuendorf, 2017). Focusing on our primary interview data, we used open coding to capture
informants’ perceptions and interpretations regarding their personal background, engagement in health content marketing, and in
teractions with other healthcare actors (Strauss & Corbin, 1998). Other types of data such as notes taken at regular meetings and from
media coverage were used to further validate findings and supplement macro-level background information.
4. Case demonstration and evaluation
Two institutions were studied to examine and evaluate the usability of the methodology, namely, (1) E-D Hospital and (2) Bassinet
Postpartum Nursing Home (both names are pseudonyms). E-D is a medical center and Bassinet is a large size postpartum nursing home.
These two represent a diversity of healthcare organizations. In accordance with the SMMM solution, we designed posts for each of the
five stages and posted them on the two institutions’ Facebook pages. The posts published at each stage were designed to achieve the
stage-specific objectives outlined in the solution approach. The participants were regular Facebook users who visited Bassinet’s
Facebook fan page. The Facebook system automatically recorded visitor data (e.g., number of likes, comments, and questions
contributed by visitors). These data were used in the performance evaluation process to assess whether the objectives for each stage
were achieved. Finally, we evaluated the SMMM in terms of its objectives.
4.1. E-D hospital
E-D Hospital (hereinafter referred to as E-D) began operations in April 2004 with an emphasis on emergency medicine and critical
care. E-D is a medical center in Kaohsiung City with 1,249 beds and 271 physicians. It provides comprehensive primary care services
and facilities (e.g., edge radiosurgery system, positron emission tomography–computed tomography, I-CON gamma knife, 64-slice
computed tomography, and magnetic resonance imaging) and other services (e.g., total joint replacement, brachial plexus injury
treatment, laparoscopic bariatric surgery, hyperhidrosis treatment, gamma knife radiosurgery, prostate laser surgery, and poly
somnography and cardiac catheterization examination with intervention) to meet the short-term medical needs and long-term nursing
service needs of the public. Because E-D had not yet established a systematic social media marketing strategy and operation model, it
aimed to understand its audience profile, attract potential clients, and enhance interactions involving E-D healthcare services through
community analyses of Facebook fan pages. Table 3 describes the implementation of the SMMM solution for E-D. The five stages
pertaining to the applied strategies, post design principles, and operation methods were customized to identify E-D’s target clients and
their informational needs, improve E-D’s Facebook page engagement, and improve E-D’s healthcare services.
In the early stage when the Facebook community of E-D was just established, the objective was to attract offline clients to use E-D’s
online platforms and build awareness of the E-D brand among E-D’s target clients. We identified offline contact points, which included
people who learned about E-D from other channels, people who attended E-D events, and people who sought medical care at E-D. Nine
posts were designed to introduce equipment and services that are highly relevant to medical care; these posts allowed potential clients
to become aware of E-D’s advantages (e.g., New Year’s greetings from the hospital president, the launch of the hospital’s fourth-
generation Da Vinci robotic arm surgical system, the successful completion of a single-port laparoscopic hysteromyomectomy, and
the hospital’s International Women’s Day 2018 celebrations). In this context, effective content types included comparative content,
current events, expert interviews, and case studies. Because the implementation of the SMMM solution started during the Chinese New
Table 2
Data collection and analysis.
Type of data Use in analysis
Individual interviews with various targets (e.g., CAO, leader, post Transcribed interviews were coded to support the marketing results and findings.
designers) after the main research theme was identified
Media coverage Identified relevant information (e.g., public service events, innovative services) was used to
supplement the critical incidents obtained from the interview data and form a more
complete understanding of the incidents.
Notes taken at the Regular Meeting Notes on presentations were used to better understand the most up-to-date progress of the
marketing. Follow-up interviews were conducted with the interviewees who also attended
the meeting when necessary.
9
Table 3
Implementation of social media marketing methodology solution for E-D hospital.
Aware • Objective: Attract offline • Introduce equipment and • Build visibility of brand • Use reach and CRR as
clients to use online services that are highly relevant among nonfollowers metrics for assessing
platforms and build to client needs. through paid media. brand awareness.
awareness of E-D brand • Build awareness of E-D’s
among target clients. advantages among potential
• Identify offline contact clients by using comparative or
points and potential clients informative content.
as patients and their
families who require
primary care services.
Appeal • Objective: Attract attention • Attract attention of more • Encourage followers to • Use ERR and CVR reach to
of more followers. followers by posting and sharing continue following fan followers as metrics for
• Identify topics and content knowledge and news that are groups through topics assessing brand
that are likely to attract relevant to patients. that interest them. attractiveness.
followers.
Ask • Objective: Encourage E-D • Motivate followers to react or ask • Build cordial • Use ERR and ER as
followers to leave questions about E-D by using relationships with metrics for assessing
comments and ask posts to guide conversations. followers by responding client curiosity.
questions. to questions and
• Identify concerns and messages.
issues of E-D followers.
Act • Objective: Engage • Develop offline or online • Encourage followers to • Use ER and CVR total
followers through activities activities with fan-specific in engage further with the followers to activity participants
hosted by E-D. centives to attract followers to brand by participating in as metrics for assessing
• Identify motivations that participate in activities; the ob activities. client commitment.
are likely to evoke jectives are to build brand trust
intention of E-D followers and encourage followers to select
to participate in activities. E-D.
Advocate • Objective: Convert • Attract patients to share their • Motivate patients who • Use total followers and
followers into E-D experiences by publicizing used E-D’s services to ER as metrics for
advocates. hospital-stay experiences of pa share their experiences assessing brand affinity.
• Identify topics that are tients through the Internet, TV on the Internet.
likely to resonate programs, and experience • Attract followers to stay
emotionally with past sharing activities. on fan page, read
customers. • Create posts to promote TV comments, and
interviews (with E-D’s experts) eventually make
and experience sharing activities. purchase decisions.
• Pin posts to top of fan page to
increase visibility of follower
comments.
Year period, the content of published posts contained content with visually appealing elements (e.g., current affairs, news, and videos).
Social media functions such as the emoji and hashtag functions were applied. Paid media (charged on the basis of cost per thousand
impressions [CPM]) were also used to improve the likelihood of reaching potential clients. Within 11 days of the start of the “aware”
stage, the SMMM solution enabled E-D to reach 11,185 potential clients and achieve a CRR of 2.29% and an ERR of 4.82%. (Table 4 and
Table 4
Results of implementation of social media marketing methodology solution for E-D hospital.
Aware Appeal Ask Act Advocate
posts 9 10 13 15 9
durations 2018/2/26~3/8 3/9~3/24 3/26~4/6 4/7~4/22 4/22~5/5
reach 11,185 5,107 24,244 49,274 11,532
clicks 2,301 742 2,917 7,112 1,123
likes 482 344 878 1,376 682
shares 44 22 35 216 30
comments 13 4 14 58 7
engagements 539 370 927 1,650 719
tagging friends 1 3 0 40 0
activity participants – – – 33 –
followers 318 48 248 367 458
total followers 318 366 614 981 1,439
10
Fig. 3).
During the “appeal” stage, the objective was to attract the attention of more followers and establish brand attractiveness. We
identified topics and content that were likely to attract followers. Ten posts that shared knowledge or news that were relevant to
patients were created and posted (e.g., World Kidney Day event news and posts about World Kidney Day, the E-D Nephrology Team,
diet for patients with kidney disease, the E-D Traditional Chinese Medicine [TCM] Team, TCM acupoints for improving diabetes
management). These posts encouraged E-D’s target audience (i.e., clients who had used E-D’s services or had a good impression of E-D)
to like and share them. Within 16 days of the start of the “appeal” stage, E-D gained 344 likes, 22 shares, 4 comments, and 48 followers;
it also achieved an ERR of 7.24% and a CVR reach to followers of 0.94%.
During the “ask” stage, the objective was to encourage E-D followers to leave comments and ask questions. The how-to-guide posts
on content such as cancer screening, TCM exercise prescriptions, and cancer prevention were created to increase client demand and
curiosity about E-D’s medical care services. Positive content attributes such as high readability, visual appeal, high relevance, and
educational value were emphasized. At this stage, paid media (charged on the basis of CPM) were again used to boost engagement,
reactions, and comments related to posts and fan pages. Within 12 days of the start of this stage, E-D reached 24,244 potential clients,
received 14 comments and 927 instances of engagement (i.e., likes + shares + comments), and achieved an ERR of 3.82% and an ER of
11.61%. The total number of followers increased to 614. Notably, limited by the resolution of the data, in this case the ER for each stage
was estimated by dividing the average engagements of total followers by the number of posts in that stage.
During the “act” stage, the objective was to engage followers through events hosted by E-D; therefore, various online and offline
activities were held, and incentives were provided to encourage followers to participate in these activities. In total, 15 posts about
event promotions, incentives, current affairs, and news reports (e.g., an E-D beauty photography event, a free E-D clinic tour, weight
health consultation, and children’s charity activities) were created. At this stage, paid media (charged on the basis of cost per click)
were used to encourage engagement with, reactions to, and comments on posts and fan pages. An activity involving beauty
photography content attracted 16 participants, and nearly 450 people participated in the voting process by liking the submitted
photos. Within 16 days of the start of this stage, E-D gained 216 shares and 367 followers and achieved an ER of 11.21%. The total
number of followers increased to 981. The CVR total followers to activity participants was 3.36%.
During the “advocate” stage, the objective was to convert followers into E-D advocates; that is, E-D aimed to build the loyalty of its
followers to the E-D brand such that they would recommend E-D to their friends and acquaintances. Topics that were likely to resonate
emotionally with past customers were identified as being highly relevant to the E-D brand image (e.g., the concept of free clinics
established by the hospital president and the training of medical personnel from Taiwan’s diplomatic allies), and the promotion of
sales-oriented brand concepts was avoided to build brand affinity. Incentive-based community engagement activities were held to
encourage followers to share their actual experiences. Nine posts were created to promote the TV interviews with E-D’s experts and
various experience-sharing activities. In addition, the pin-to-top function was used to increase the visibility of the comments of fol
lowers. Within 14 days of the start of this stage, E-D gained 30 shares and 7 positive comments and achieved an ER of 5.55%. The
cumulative number of followers increased to 1,439. It is worth noting that the estimated ER for the above five stages in this case (i.e.
5.55% ~ 18.83%) is much higher than the average, such as 0.19% in Taiwan (Kemp, 2021).
Fig. 3. Performance of social media marketing methodology solution for E-D hospital across 5A stages.
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4.2. Bassinet postpartum nursing home
Opened on October 19, 2018, the Bassinet Postpartum Nursing Home (hereinafter referred to as Bassinet) is affiliated with the E-D
Medical Foundation and has 120 maternity beds and 125 baby beds. Bassinet provides comprehensive maternal and infant care
services and facilities (e.g., baby rhythm sensors and lunar meal coordinators) that are supported by a competent and professional
medical team from E-D Hospital; the home also provides 24-h care and comprehensive services for pregnant women and babies at its
maternity, pediatric, TCM, and nutrition units and its slimming health centers. Bassinet’s Facebook fan page was its primary e-mar
keting channel, with a total of 1,282 followers. However, the interactions of Bassinet clients with Bassinet’s fan page were limited.
Therefore, a systematic social media marketing strategy was developed to increase the interactions between Bassinet and its clients.
Furthermore, key elements were incorporated into their posts to implement specific marketing strategies. Table 5 describes imple
mentation of the SMMM solution for Bassinet.
During the “aware” stage, the objective of posts was to promote Bassinet’s Facebook fan page and build awareness of the ad
vantages of Bassinet among potential clients. We identified Bassinet’s potential clients as pregnant women with postpartum care needs
(and their families), mothers who have stayed at Bassinet, and people who have heard of or received medical care at E-D Hospital. In
total, 11 posts that were highly relevant to potential Bassinet clients (e.g., pregnant women) were created; these posts included content
on the differences between a confinement center and a postpartum care center and descriptions of Bassinet’s staff and their daily work.
Table 5
Implementation of social media marketing methodology solution for Bassinet.
Aware • Objective: Build awareness of • Introduce equipment and • Build visibility of brand • Use reach and ERR as
advantages of Bassinet among services that are highly among nonfollowers metrics for assessing
target clients. relevant to client needs. through paid media. brand awareness.
• Identify potential clients of • Build awareness of Bassinet’s
Bassinet as pregnant women advantages among potential
with postpartum care needs clients by using comparative or
(and their families), mothers informative content.
who have stayed at Bassinet,
and people who have heard of
or received medical care at E-D
Hospital.
Appeal • Objective: Maintain • Attract attention of more • Encourage followers to • Use ERR, CVR reach to
attractiveness of Bassinet fan followers by posting and continue following fan followers, and ER as
pages to potential clients. sharing knowledge or news groups through topics metrics for assessing
• Identify health and medical related to mothers and babies. that interest them. brand attractiveness.
information and mother- and
baby-related topics that interest
potential clients.
Ask • Objective: Encourage followers • Motivate followers to react or • Build cordial • Use ER and CVR total
to react and ask questions. ask questions about Bassinet by relationships with followers to activity
• Identify concerns and issues of using posts to guide followers by responding participants as metrics for
Bassinet followers. conversations. to questions and assessing client
messages. curiosity.
Act • Objective: Engage followers • Develop in-person or online • Encourage followers to • Use ER and CVR total
through events or purchase- activities with fan-specific in engage further with the followers to activity
related activities held by centives to attract followers to brand by participating participants as metrics for
Bassinet. participate; the objectives are in activities. assessing client
• Identify motivations that are to build brand trust and commitment.
likely to evoke the intention of encourage followers to select
Bassinet followers to Bassinet.
participate in activities.
Advocate • Objective: Convert followers • Attract mothers to share their • Motivate mothers who • Use total followers and
into Bassinet advocates. experiences by publicizing used Bassinet’s services ER as metrics for
• Identify topics that are likely to home-stay experiences through to share their assessing brand affinity.
resonate emotionally with past the Internet, TV programs, and experiences on the
customers. experience sharing activities. Internet.
• Create posts to promote TV • Attract followers to stay
interviews (with Bassinet’s on fan page, read
experts) and experience comments, and
sharing activities. eventually make
• Pin posts to top of fan page to purchase decisions.
increase visibility of follower
comments.
12
Conversations were used to discuss the disadvantages of confinement centers and advantages of postpartum care homes and to
highlight Bassinet’s high-quality services. The created posts contained information tables and images to enhance their vividness and
readability. Their content also featured daily photos of staff highlighting the liveliness of Bassinet’s diverse and personalized services.
In addition, paid media (charged on the basis of CPM) were used to extend the reach of one post to more potential clients. In this post, a
“learn more” link was used to increase user interactions with Bassinet’s Facebook fan page. This post reached 4,425 potential clients
and gained 386 clicks and 276 engagements. Within 14 days of the start of the “aware” stage, Bassinet reached 10,775 potential clients
and achieved an ERR of 7.07% (Table 6 and Fig. 4).
During the “appeal” stage, the objective was to maintain the interest of potential clients in Bassinet’s fan page. We identified health
and medical information and mother- and baby-related topics that were of interest to potential clients; they mainly pertained to
various types of mother-, baby-, and health-related knowledge and current affairs topics. In total, 12 posts were created to share
magazine reports and present relevant content regarding current events (e.g., information on new viruses), how baby and family health
can be protected during the winter flu peak, and vaccination recommendations related to E-D Hospitals. Posters, information tables,
and images were used to emphasize Bassinet’s professional image. Within 15 days of the start of this stage, Bassinet achieved 843 likes,
45 shares, 107 comments, an ERR of 7.35%, a CVR reach to followers of 0.13%, and an ER of 6.25%. The total number of followers was
1,327. Notably, limited by the resolution of the data, in this case the ER for each stage was also estimated by dividing the average
engagements of total followers by the number of posts in that stage.
During the “ask” stage, the objective was to encourage Bassinet followers to respond and ask questions. After identifying the
concerns and issues of Bassinet followers, 10 posts were created; these posts, which covered content such as the needs of pregnant
women, equipment and service procedures for newborns, and maternal and postpartum care information, were designed to guide
conversations at this stage. An online question-and-answer event was held to attract the attention of followers, and questions about
newborn or postpartum care were posted to encourage followers to comment. Through the posted comments, we identified frequently
asked questions and responded directly. This strategy enabled us to obtain suggestions and ideas for future posts and demonstrate
Bassinet’s empathy and professionalism. In response to questions from followers, follow-up posts were created to highlight inap
propriate postpartum care behaviors and demonstrate the correct procedures. Posts were also created to provide postpartum dietary
advice, share photos of typical Bassinet postpartum meals, and provide tips for the proper execution of various procedures, and emojis
were employed to emphasize appropriate and inappropriate behaviors. Within 21 days of the start of this stage, Bassinet reached
15,794 potential clients, and it achieved 115 comments, 885 engagements (i.e., likes + shares + comments), an ER of 6.43%, and a
CVR total followers to activity participants of 3.34%. The total number of followers increased to 1,376.
During the “act” stage, we identified motivations that were likely to evoke the intention of Bassinet followers to participate in
activities, held various online and offline activities, and provided incentives to encourage followers to participate in activities. This
strategy further increased Bassinet’s engagement with its followers. In total, 10 posts were created to cover questions about the
challenges often encountered by novice mothers. Followers who answered the question were eligible to participate in a campaign.
Bassinet also provided various incentives to encourage its followers to participate in the event. The created posts included photos of the
incentives to remind followers to share them on their social networks while using emojis to qualify for participation. This activity was
promoted through paid media (charged on the basis of CPM). The corresponding post reached 6,161 potential clients and gained 461
clicks and 329 engagements. Within 15 days of the start of this stage, Bassinet gained 50 shares and 42 followers and reached an ER of
10.33% and a CVR total followers to activity participants of 1.41%. The total number of followers increased to 1,418.
During the “advocate” stage, the objective was to convert followers into Bassinet advocates. By identifying topics that were likely to
resonate emotionally with past customers, nine posts were designed to encourage Bassinet’s clients to share their actual experiences of
staying at Bassinet. The posts attracted mothers to share their actual experiences through TV programs and experience-sharing ac
tivities. Through TV interview programs and activities, potential clients could not only obtain official information but also learn about
the actual experiences of Bassinet’s clients. The posts increased the resonance of Bassinet with the mothers who had stayed at Bassinet
by reporting on the similar experiences of other mothers, and they encouraged followers to share interesting photos and invite their
friends to comment. The pin-to-top function and paid media (charged on the basis of CPM) were also used to attract the attention of
social media influencers and encourage them to promote Bassinet through their accounts. Within 19 days of the start of this stage,
Bassinet gained 20 shares and 46 positive comments and reached an ER of 5.16%. The total number of followers increased to 1,481. It
Table 6
Results of implementation of social media marketing methodology solution for Bassinet.
Stage Aware Appeal Ask Act Advocate
posts 11 12 10 10 9
durations 2020/1/1~1/14 1/16~1/30 2/1~2/21 2/22~3/8 3/13~3/31
reach 10,775 13,545 15,794 11,091 10,040
likes 694 843 710 1,163 622
shares 35 45 60 50 20
comments 33 107 115 252 46
engagements 762 995 885 1,465 688
tagging friends 7 0 0 61 0
activity participants – 6 46 20 –
followers 27 18 49 42 63
total followers 1,309 1,327 1,376 1,418 1,481
13
Fig. 4. Performance of social media marketing methodology solution for Bassinet across 5A stages.
is worth noting that the estimated ER for the above five stages (i.e. 5.16% ~ 10.33%) in this case is also well above the average, such as
0.19% in Taiwan (Kemp, 2021).
4.3. Quality evaluation
To better build a methodology that is relevant to our focus, we designed a set of interview questions and interviewed the operating
groups in charge of social media marketing from both healthcare organizations. In each studied healthcare organization, we inter
viewed three types of critical actors: (a) the Chief Administrative Officer (CAO, in Administrative Center) who was the sponsor and
endowed the project, (b) the leader who managed and executed closely the development of the post and had frequent interactions with
the CAO, and (c) post designers who designed and actively ran online marketing events and had frequent interactions with the leader.
We began each interview by asking the interviewee to introduce him or herself. For the CAO (2 persons), we used “why” questions
to clarify his or her motivation for the SMMM (social media marketing methodology) project. For the leader (2 persons) and post
designers (4 persons), we asked the interviewees to recall the development process of the post. We encouraged him or her to provide
detailed information, including necessary background information, how they conducted the SMMM, and the outcomes of the
implementation.
Echoing the implementing process of SMMM, the perceptions of SMMM usability took place at a different management level, as
they are able to offer feedback from alternative perspectives. The interview results are summarized as follows. To provide evidence
directly from the data, we present quotes taken from the interviews that support the findings. For both studied healthcare organi
zations, CAOs were happy to share, “The social media marketing methodology is great, our team members are happy to use it and
really made a great contribution to our marketing tasks.” The leaders noted, “The social media marketing methodology provide a clear
roadmap and is easy to implement. It fits our knowledge level.” PO designers shared that “Prior to this project, we designed posts with a
“rule of sum” manner. In this project, you taught everyone about the marketing process, major work for each process and their
associated KPI, and post design principles. These provide a good standard operating procedure for us to follow. We are happy to use it.”
The interviewees provided feedback on their experience of using the SMMM, including the process they followed and the outcomes
of the implementation. These insights serve as important evidence to support the usability of SMMM, as they provide a supplement to
existing research on the topic. In particular, the feedback offers valuable insights into how SMMM can be used to develop a roadmap
for designing and evaluating social media marketing campaigns, and can help to further demonstrate the value of SMMM as a tool for
improving social media marketing practices.
5. Discussion and implications
Previous studies have investigated the 5A framework, IDEA, and post design principles for marketing separately. The lack of studies
to connect the aforementioned concepts has limited the application of social marketing. In accordance with the DSRM (Peffers et al.,
2007), the present study developed a marketing methodology (i.e., SMMM solution) that integrates Kotler’s 5A framework, IDEA, and
post design principles as a whole to provide a clear roadmap and post design guidance to the implementation of social media mar
keting. Two cases are used to demonstrate and evaluate the usability of the methodology. The results indicate that using this meth
odology can facilitate the post content design and the enhancement of patient interactions with healthcare services and brand
engagement. Therefore, we confirm that the SMMM solution can be used to resolve the gaps in the application of social media
14
marketing and promotion of patient engagement in healthcare services.
5.1. Theoretical implications
Our study has two key theoretical contributions. First, it is among the first studies to develop a methodology that integrates the 5A
framework with IDEA to clearly depict marketing stages and the major tasks that must be performed to implement the IDEA processes
for each stage. The 5A framework can serve as the basis for explaining the various marketing stages and the major tasks, objectives, and
KPIs for each stage. IDEA provides key activities for identifying audience segments and developing the content and channels that they
require at each stage. Thus, we contribute to the understanding of the synergistic 5A–IDEA methodology that provides an integrated
structured methodology for social media marketing by (1) creating a clear roadmap for two crucial marketing elements (i.e., the
marketing process and the targeting of audience segments to provide what they need for each process) and (2) providing evaluation
criteria for each stage to evaluate the performance of the solution, thereby improving the usability of the methodology within a social
media marketing context. These findings extend our comprehension of the synergistic 5A–IDEA methodology in social media mar
keting within a healthcare context.
Our second theoretical contribution is the further integration of design principles for content elements into the post design
component of our 5A–IDEA methodology. For each of the 5A marketing stages, specific content elements must be used to optimize the
depicted content and its meaning. The integrated content design principles provide useful guidelines for designing various content
elements that enhance the validity of post content representation and, consequently improve marketing performance (e.g., conveying
high-quality information to patients or increasing the interactions between patients and healthcare organizations). These findings
extend our understanding of the usefulness of the content design principles in post design for social media marketing within a
healthcare context.
5.2. Practical implications
The results reveal two key practical implications for practitioners who implement social media marketing within a healthcare
context. First, the integration of the 5A–IDEA framework with design principles provides a roadmap for social marketing. Practitioners
can use this methodology to design a systematic marketing strategy that is based on the brand that they intend to promote through
social networks. For instance, the application of the proposed methodology to Bassinet’s fan page provides practitioners with a clear
example of the processes, evaluation criteria and design guidelines for implementing social media marketing. From a practical
viewpoint, we argue that practitioners can follow the process in identifying stage objectives, solutions, and KPIs for each of the five
stages that form a complete client journey that is better able to understand the actionable client needs.
Second, the present study provides comprehensive and pragmatic design principles for post development. The design principles
systematically indicate the key elements and characteristics, content design, typesetting formats, and types of content that can be used
in a post design. First, a post should present topics that are highly relevant to followers. Second, a post should be designed carefully to
generate curiosity and resonance. Third, interactive elements and dialog texts should be extensively used in a post. Fourth, videos and
images are useful tools for attracting the attention of followers. Fifth, the publication and promotion of a post should be appropriately
timed to increase the likelihood of it being read by its target audience. Practitioners can apply this principle as a guideline when they
are designing a post to achieve social marketing objectives. In sum, practitioners can apply this 5A–IDEA framework with design
principles for commercial benefits to create better marketing performance.
5.3. Limitations and future research directions
The present study is the first to integrate the 5A framework with IDEA and content design for social media marketing in a healthcare
context. Its findings can be expanded in various directions. For instance, future studies should extend our content design framework to
other healthcare knowledge domains to improve user access to other types of healthcare knowledge. To increase the applicability of
this integration, intelligent methods should be developed to ensure that the knowledge-acquisition pathways of online information
seekers are compatible with various knowledge structures and content representation mechanisms. The integration of other tools or
mechanisms to expand the capabilities of this integrated methodology should be explored, and the usability of the resulting meth
odology should also be evaluated.
Author statement
Mr. Chih-Lung Hung initiated the research project and coworked with professor Wu to discover the idea of the study.
Professor Jen-Her Wu had the idea of the study and design methodology development. He also helped in finishing, interpreting the
empirical results, and approving the final version of the manuscript.
Miss. Pei-Yu Chen helped in research design and sampling and taking the integrity of the data and the accuracy of the data analysis.
Associate Professor Xiaoyu Xu helped in preparing the initial draft, taking the integrity of the data.
Miss Wan-Ling Hsu helped in sampling and taking the integrity of the data.
Assistant Professor Li-Min Lin helped in sampling and taking the integrity of the data and the accuracy of the data analysis.
Associate Professor Ming-Che Hsieh helped develop and refine the design methodology, validated the analytical data, and critically
revised and approved the final version of the manuscript.
15
Data availability
Data will be made available on request.
Acknowledgments
This research was supported by the E-DA Healthcare Group, Taiwan under operating grant EDATD107030 and was partially
supported by the National Science and Technology Council of Taiwan under operating grant MOST 105-2410-H-110-072 MY2.
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Enhancing Healthcare Services and Brand Engagement Through Social Media Marketing Integration of Kotler's 5A Framework With IDEA Process

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Information Processing and Management 60 (2023) 103379

Contents lists available at ScienceDirect

Information Processing and Management

Enhancing healthcare services and brand engagement through

2.1. The 5A framework in the marketing 4.0 era

2.3. Design of post elements in social media marketing

3.1. Integrating Kotler’s 5A framework with IDEA

Fig. 2. Social media design principles.

3.2. Social media design principles

(1) Effective content types

(2) Good content attributes

(3) Proper use of social media functions

• Effective content types: FAQs and how-to guides.

• Effective content types: incentives.

Focus on social media design principles:

3.3. SMMM solution

3.4. Data collection and analysis

3.4.1. Data collection

3.4.2. Data analysis

4. Case demonstration and evaluation

4.1. E-D hospital

4.2. Bassinet postpartum nursing home

4.3. Quality evaluation

5. Discussion and implications

marketing and promotion of patient engagement in healthcare services.

5.1. Theoretical implications

5.2. Practical implications

5.3. Limitations and future research directions

Data will be made available on request.

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