Twitter for Health

When I first read about Twitter last year, I scoffed. Who cares what other people are doing, thinking or eating every waking moment of the day? I don’t have time to pay attention to random bits of information or to post my every passing thought. For those of you not up on the latest shiny object to be embraced by the neterati, Twitter is a microblogging application that asks you to answer the question, “What are you doing?” in 140 characters or less. People use it to do everything from detailing the minutiae of their days to engaging in witty banter to promoting their latest blog posts and sharing useful resources.

While I was on my blogging hiatus, I found that I had a lot of thoughts I wanted to share, but no time to put them into a blog post. I decided to try out Twitter on a short-term basis to see if I thought it was worthwhile. After a few days of using it, I was hooked. I found that Twitter was a great way to have ongoing conversations and build relationships with colleagues, get quick answers to questions and get pointers to useful links. It sometimes feels like I’m drinking from a firehose, but I’m learning to identify the people who consistently have the best tweets. I’ve been on Twitter for a couple of months now (follow me at @Nedra), and I can see many potential applications for organizations promoting health and social issues.

Some of the ways nonprofits and government agencies could use Twitter in their work, along with real examples and ideas, include:

Since Twitter can be used via mobile devices as well as computers, many of the same concepts behind using mobile phones and SMS for social change are applicable as well. In fact, this Friday (2/29) there will be a conference on Texting 4 Health at Stanford focusing on using SMS to improve health behavior. Though it is not explicitly on the agenda, I would hope that they will also be discussing how Twitter can be used to facilitate this approach. Does anyone know if someone will be livetweeting the conference?

Nate Ritter lays out some of the benefits and limitations of using Twitter that you should take into account when determining whether the tool will work for your purposes:

  1. Speed Using twitter, you can very easily publish information more than once per minute. If distribution speed is critical, regardless of the information being distributed, Twitter may be the tool for you.
  2. Non-website (source) based alerts Instant messaging, SMS/text messages on cell phones, RSS/Atom feeds, email alerts, badges/widgets on other sites, and other methods of distribution are available. If your community can’t be tethered to a website for it’s communications, Twitter can provide other methodologies to get that information out to them.
  3. Community publishing There are a few (slightly more technical) ways of aggregating a group of twitterers posts, which means you could have more people — even your community — pitching in to help publish pertinent information.


  1. Only text and links can be posted. No maps. No photos. No videos. Text and links are all you get.
  2. 140 character limit. URLs will get shortened wherever possible, but 140 characters is tough to get used to.
  3. No conversation threading. This can be tough to deal with when you’re used to discussion forums and such. Connecting with your community in this way is almost limited to real-time dialogue, which can limit the conversation’s depth and longevity.
  4. The API has a 70 post per hour limit. Note that from what I could tell, the web UI doesn’t have this limit, but I’m sure they wouldn’t like you posting more than that unless it was an emergency anyway.

For still more ideas on how nonprofits can use (and shouldn’t use) Twitter, see NetSquared’s Net2ThinkTank round-up.

So, for some, Twitter will always just be a place to tick away the moments that make up a dull day, to fritter and waste the hours in an offhand way. For smart social marketers, though, Twitter can be a powerful tool for education and action. How will you use it?

(If you have additional ideas or examples, leave them in the comments and I will add them to the list.)

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Suicide Prevention Advocacy via Facebook

I’ve been spending more time on Facebook lately, getting to know how it works so I can use it when I have an appropriate project. The opportunity just presented itself in the form of an advocacy campaign headed up by my blog friend Jeff Harrell. A couple of years ago, Jeff wrote a moving article about a young woman named Suzanne Gonzales.

Suzy was a bright, bubbly young lady with a quirky sense of humor from a small town in California. After she went off to college, she became depressed and turned to the Internet for support in January 2003. Unfortunately, rather than finding people who wanted to help her recover and live a long, healthy life, Suzy posted a note about her suicidal feelings to the Usenet group She was met with relentless discouragement against getting help, and over the following months was encouraged by members of the group to go ahead and commit suicide. This included providing specific details on the best method of killing herself and helping her come up with a plan to carry it out. On March 23, 2003, Suzy took her own life, alone in a Florida hotel room. She was one of many such “successes” to come out of that online group.

Yesterday, Jeff announced on his blog that he would be spearheading an advocacy campaign to help pass the bill currently before the House that was inspired by Suzy’s story. H.R. 940, the Suzanne Gonzales Suicide Prevention Act of 2007 (Suzy’s Law), would make it a crime to use the Internet to promote or encourage suicide.

It’s a very narrow and specific law, designed not to abridge freedom of speech or trample on state-specific laws related to suicide. Telling someone how to commit suicide is already against the law in all 50 states, but there is a need for a federal law to take into account the interstate nature of the Internet. A person can only be convicted under this law if they provided information on how to commit suicide to a particular person whom they knew to be contemplating suicide, and when that information was not generally known. The bill is currently in the House Subcommittee on Crime, Terrorism and Homeland Security, and requires approximately 50 Congressional co-sponsors to make it to the next step in the process (it currently has 3 co-sponsors).

Jeff has created a striking website to serve as a home base for this advocacy effort (all work on this campaign by Jeff and others is on a volunteer basis). He has made it very easy for people to learn more about the issue, the legislation, and how to help. The main push right now is for people to call to urge their Representative to sign on to H.R. 940 as a co-sponsor of the bill. He provides a zip code look-up to find your Rep’s phone number, along with a two-sentence script that you can use if you’re not sure what to say.

I suggested to Jeff that he use Facebook to get the word out about this campaign quickly and efficiently. It seems like the kind of issue that Internet-savvy, particularly college-age, Facebook users would be interested in supporting and sharing with their friends. When I found out that Jeff was not on Facebook, I decided that this would be a good opportunity for me to set up a Facebook group and learn more about promoting a campaign via a social networking site. The page went live this morning, and includes:

  • an introduction to Suzy’s Law
  • campaign contact information
  • an action request to call Congress
  • a pointer to the National Suicide Prevention Hotline for people who might find the page because they or someone they know is suicidal
  • additional resources about suicide prevention
  • photos of Suzy
  • links to the story Jeff wrote about Suzy and to the website her family created in her memory
  • a discussion board with the starter topic of “Have you ever had a friend who was suicidal? What did you do?”
  • and a post on the Wall about National Depression Screening Day, which is tomorrow, Thursday October 11.

I invited my Facebook friends (almost 50 people) to join, and Jeff posted a link to the group on the campaign blog. I left messages on about 8 or 9 other Facebook groups related to suicide prevention, depression and mental health inviting their members to join our group. By the end of the day, we had 17 members in the group — the majority of whom were not from my own network. It’s not a huge number, admittedly, but I will be watching with interest to see how quickly it increases. I’ve had my jealous eye on the “Support the Monks’ Protest in Burma” group, which currently has a whopping 397,000 members and increases by about 17,000 a day (if that’s how often the “new members” feature is updated). I’m looking to that as an example of how to get a group to spread.

If you are on Facebook, please join our “Support Suzy’s Law for Suicide Prevention” group and invite your own friends to join as well. If you’re not on Facebook, it’s free, quick and easy to become a member, and then you can join the group. You can also add me as a friend (here’s my profile – viewable once you have a Facebook account).

Let’s make sure that other young people like Suzy are not persuaded by sick strangers that suicide is the best answer, and then coached on how to take their own lives. If you live in the U.S., I hope you’ll get involved by making that quick and easy phone call to your Representative. And if you live outside the U.S., you can help us by spreading the word to your American friends. Thanks!

Reaching Bloggers

Even blogs with a relatively small readership like mine have become the new holy grail of marketers because of the fact that the audience is so targeted to a particular niche. While a mention from an A-list blogger is certainly a coup, sometimes you can be even more effective by getting your message out through smaller blogs that have the very specific audience you want to reach, making up for quantity with quality.

I often get emails from PR firms, publishers, and individuals with something to promote asking me to cover their product/book/website/etc. on my blog. Sometimes I will immediately say yes because it’s clear that the information is of interest to me and/or my readers (and hopefully both).

Other times the pitch is so poorly done that it’s a waste of my time and theirs. It’s clear that they have no clue what I write about even though they say that they love my blog. Or they send me email after email to try to convince me of the merits of their product.

Blogger relations has emerged as a tactic of its own, similar to media relations but not the same. Bloggers generally do not consider themselves journalists, so a somewhat different and more informal set of guidelines apply from standard media outreach practice. But that doesn’t mean that your approach doesn’t matter. In fact, you may need to put more time into cultivating blogger contacts — it’s all about building relationships.

Others have created excellent lists of suggestions for how to pitch bloggers (see Toby, CK and Rohit), as well as examples of what not to do, so I am not going to cobble together my own list here.

The folks over at Ogilvy have recently developed a Blogger Outreach Code of Ethics, and they are asking for feedback to help refine it. Here it is:

  • We reach out to bloggers because we respect your influence and feel that we might have something that is “remarkable” which could be of interest to you and/or your audience.
  • We will only propose blogger outreach as a tactic if it complements our overall strategy. We will not recommend it as a panacea for every social media campaign.
  • We will always be transparent and clearly disclose who we are and who we work for in our outreach email.
  • Before we email you, we will check out your blog’s About, Contact and Advertising page in an effort to see if you have blatantly said you would not like to be contacted by PR/Marketing companies. If so, we’ll leave you alone.
  • If you tell us there is a specific way you want to be reached, we’ll adhere to those guidelines.
  • We won’t pretend to have read your blog if we haven’t.
  • In our email we will convey why we think you, in particular, might be interested in our client’s product, issue, event or message.
  • We won’t leave you hanging. If your contact at Ogilvy PR is going out of town or will be unreachable, we will provide you with an alternate point of contact.
  • We encourage you to disclose our relationship with you to your readers, and will never ask you to do otherwise.
  • You are entitled to blog on information or products we give you in any way you see fit. (Yes, you can even say you hate it.)
  • If you don’t want to hear from us again, we will place you on our Do Not Contact list – which we will share with the rest of the Ogilvy PR agency.
  • If you are initially interested in the campaign, but don’t respond to one of our emails, we will follow up with you no more than once. If you don’t respond to us at all, we’ll leave you alone.
  • Our initial outreach email will always include a link to Ogilvy PR’s Blog Outreach Code of Ethics.

It’s a great start, and I think it shows a great deal of respect for the bloggers they are contacting. I would suggest that they add that they will only contact a blogger after having read enough posts to determine whether their information or product is relevant to the topics that blogger writes about.

If you’re a blogger, or someone who wants to work with bloggers to get your messages out, what do you think of the code of ethics?

Photo Credit: ~Aphrodite

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Why Web 2.0 Matters to Social Marketers

Recently on the Social Marketing listserv, we’ve had an interesting discussion of Facebook and other social networking sites. Brian Cugelman, who is with the Statistical Cybermetrics Research Group at Wolverhampton Business School in the UK, made what I thought was the best case I’ve seen for why social marketers need to consider using these sites in their programs. I asked Brian if he would do a guest blog post on this, and he graciously agreed…

Why Web 2.0 matters to social marketers
Some quick thoughts by Brian Cugelman, MA

I’d advocate using FaceBook, along with a few of the other Web 2.0 sites for the simple reason that they provide a small number of websites with the largest outreach potential. In fact, Alexa ranks YouTube, MySpace and FaceBook in the top 10 of all websites in the world.

Moreover, by moving through networks of friends, interest groups and geographic cliques, it’s possible to zero in on target audiences in ways that are not as easy in regular Web 1.0 environments, unless of course, you’re paying for advertising. Newsweek recently published an article about a research project, by Danah Boyd, that showed some demographic differences between FaceBook and MySpace. In short, FaceBook has an older and more educated network (the reason why it’s worth so much to potential buyers), while MySpace has a younger, more sub-cultureish network with many musicians having their online presence there.

The Tipping Point/Linked/Viral Marketing/Word of Mouth/Dell Hell/6 Degrees of Kevin Bacon fad has created interest in any online environment that allows people to directly connect to others, be it email, blogs, or social networking sites. The idea is that the people become the media–so it’s not MySpace that is the media per se, but rather the people themselves. The sites just connect people and reduce the social transaction costs required to interact, which means it’s easier for people to share digital objects of interest. No doubt, by building a large network of social media relationships for any campaign, campaigners will be able to better increase their chance of triggering a viral buzz, which amounts to your message being spread further—which saves you time and money. And by being sent through personal networks, it is perceived to be more credible, and consequently, I believe this can fast-track the formation of social norms while increasing the odds that people act on the messages.

If the medium is the message, then it’s worth considering the media effect of having an online presence in these major online networks. I think the media artifact of social media is the appearance of cool and hip, which you may wish to present depending on your target audience. I suspect in a few years, this media effect will be negligible as the competition has been swooping in on these popular sites for some time and they’ll soon become commonplace.

It’s one thing to set up a FaceBook account and quite another to do the leg work to engage your constituency. The question of whether or not to use these sites is a quantifiable one: is the effort worth the impact? Though it may not be easy to answer this question, it’s possible for campaigners to test out their online campaigns by tracking the impact of their Web 2.0 outreach, and measuring online behavioural goals against references in order to start evaluating the gains versus resource expenditures.

An ethical consideration that faces Web 2.0 social marketers is the question of whether they’re being intrusive or dishonest. Although some social networking sites have policies against companies advertising, a number of organization operate on these sites; they’re upfront about who they are and what they stand for, without any hidden agenda. Several months back, I met a number of Greenpeace activists at FairSay’s eCampaigning Forum. One coordinator told me she had volunteers working around the clock to build relationships on MySpace, and she was working on trying to move the relationships from MySpace to offline activism–they have over 67,000 friends. And it’s not just activists—I believe all the US presidential candidates have MySpace accounts and a few months back, reports emerged about ‘who had the most friends in MySpace’. These well run social media campaigns provide a good template for how to conduct business in these sites in an up front way.

Also, an interview by Andy Sernovitz, the Word of Mouth Marketing Association’s CEO provided a number of insights about trust, ethics and spreading word of mouth messages. He distinguished between word of mouth marketing and stealth marketing, drawing an ethical line between honest and dishonest e-marketing. On the honest side, Andy’s description of word of mouth marketing boiled down to all the techniques companies employ to respectfully engage customers by joining the online conversation about their brands, products or services. In practice, this means representatives have to respect netiquette conventions and honestly declare who they are. On the dishonest side, he described stealth marketing as the unethical practice of deceiving customers by inserting their views into customers’ online conversations through misrepresentation and forcing their way into the conversation.

By reading a social media’s terms of use; examining the practices of well established and respected organizations; being upfront about your campaign and who you are; following conventions of netiquette; and respecting the golden rule, you’ll be acting in an honourable way and chances are, your potential audiences will respect you for it. And if your message rings with their values while meeting their needs, chances are you’ll be social marketing online.

Welcome, Mr. Secretary!

Remember the HHS Pandemic Flu blog? Today I learned two interesting pieces of news related to that daring Federal experiment in citizen engagement. First, that Admiral John Ogwunobi, the Assistant Secretary at the HHS who had incurred the wrath of flublogia for his perceived cluelessness when writing on the flu blog, has left his government post to go work at Wal-Mart. (No, he’s not a greeter.) I guess fending off hordes of enraged flubies got to him after a while.

The other bit of news is that none other than Secretary of Health and Human Services Mike Leavitt, who got a taste of blogging as a headliner at the Pandemic Flu blog, has now started his own blog. He says up front that he’ll try out blogging for a month or so to see whether he is able to continue the time commitment long-term, as he intends to write the entries himself. He also plans to read comments — which will be moderated — as often as possible and try to reply when he can. It’s clear with his second post that he did read the first set of comments (many of which were by holdovers from the flu blog continuing the conversation), as he responded specifically to some of the questions posed by commenters. Kudos to you, Mr. Secretary, for recognizing the value of blogging for engaging the public and for not being scared off by the passionate response to the earlier flu blog.

I will be speaking on a panel at the upcoming CDC Conference on Health Communication, Marketing & Media about the role of blogging to engage your audience, using some of the lessons learned from the HHS flu blog experience. The fact that the Secretary came back to blog another day will be a nice postscript to the case study.

Thanks to Greg Dworkin for the tip and links.

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Blog Therapy

While looking at headlines on Reddit, I came upon a link to a post from a blogger and talented writer named Jeff Harrell of The Shape of Days blog. In this post, Jeff reveals that he has borderline personality disorder. While he has apparently alluded to having some type of mental problem in previous posts, it has not been a focus of the blog, and this announcement is the first time he has publicly talked about the issue besides to a couple of his friends.

The post is dead honest, heart-breakingly open and was probably incredibly scary to write. In it, he shares what borderline personality disorder is and how it affects him. It’s also a plea for help:

So why am I doing this? Why am I “coming out” like this? The honest answer is that I don’t know what else to do any more. I’ve tried everything I’ve ever known how to try. I’ve gone to the emergency room seeking admission as a psychiatric inpatient. (I do not recommend this, by the way, unless you think spending twelve hours handcuffed to a chair next to a drooling meth addict is lots-o-laffs.) I’ve attempted to confide in friends. I’ve been on drugs — the prescription kind, I mean. I’ve seen therapists. I’ve even prayed, back before the Almighty — if He even exists — stopped taking my calls.

So now I’m screaming in the dark.

Maybe there’s somebody out there. Maybe there’s somebody out there who’s like me. Somebody who’s learned to live and function with this … ugh. This handicap, for lack of a better word. Maybe that person will send me an e-mail with a magic incantation for surviving with this.

Or maybe I’ll be that person for somebody else. Maybe some twenty-year-old girl is sitting out there right now, in the wee hours of a Sunday morning, crying in her dorm room and wondering why she can’t be like everyone else. To that person, whomever and wherever you are, I don’t have any answers. I’m sorry. I don’t really believe, deep down, that anyone does. I probably can’t be your friend, just like you can’t be mine. People like us can’t really have friends, not in the long run. But understand that you are not alone. I’m in this too. Right there with you.

The comments that he received from the post were a mix of support and “me toos.” This one was particularly touching:

So, I’m that 20 year old girl you were talking about…though not in her dorm room, but her apt. Something about your article just hit home. I feel the same way you do a lot. I go through numerous mood swings for no apparent reason and I know they’re going on, but I cannot control them. So many people say “just be happy” but that’s impossible when you can’t control yourself. Oh what I would give to be able to just snap out of this. To feel the love that everyone DOES have for me. To feel like I’m actually worth something would be amazing! But there’s something that does not allow it. I know it’s there, but there’s no way to get rid of it. I try to overcome it, but it can’t be overcome.

So thank you for letting me know I am not alone in this world, and I hope you know you are not either…

Blogging is an incredibly powerful way to connect with other people — whether you are the blogger or the reader. When a blogger has built a following of people who read his or her words regularly, a bond can form that goes beyond the content of the blog posts, providing an instant support group. Others who have never heard of the problem get to learn about it vicariously and perhaps realize that someone they know might be affected, and those who suffer from it themselves can see that they are not alone. One blog post could change someone’s life. I hope that it’s changed Jeff’s for the better.