ASHLAND — There was no social media during the last major pandemic in recent United States history, influenza in 1918. The public received information from advertisements, newspapers and flyers.
Today, almost two years into the COVID-19 pandemic, social media is flooded with information from people’s personal accounts, health departments and anyone who would like to contribute to the online conversation. The U.S. messaging and public health entities’ guidelines have been criticized as inconsistent, although that criticism is not unique to today’s situation.
Health officials and the public have voiced concerns about the presence and spread of misinformation and disinformation on social media platforms, as well. Misinformation is false information, whereas disinformation is false information spread specifically with the intent to harm or deceive.
The impact of social media’s changes to public health communication have been seen with the recent decision by the Ashland County Health Department to disable its Facebook page, at least in part because of comments on the page public health officials called inaccurate and having “crossed the line.”
Local health officials and communications researchers vary on what health departments’ roles in using and monitoring social media should be.
The view of local health officials
Health board president Ron Puglisi does not think it is the health department’s role to monitor comments on Facebook, he wrote to Ashland Source in an email.
“The health department and board of health should be putting out the best and most accurate info,” Puglisi wrote. “Monitoring the posts of others is not a role of a health department.”
Puglisi wrote he is unconcerned about the health department not using Facebook.
“Our website has all the information and contact information on it,” Puglisi wrote. “There is much more information on it than was (on) the Facebook site. People just need to go there for info now.”
Ashland county commissioner Jim Justice disagreed. Justice said he was concerned by the health department’s decision to disable its Facebook page.
“I really believe people should be able to reach the health department by phone, by Facebook and all the other things,” he said. “It’s a good way to keep the public informed as to what’s going on.”
Vickie Taylor, the department’s health commissioner, said she thinks social media is helpful for engaging with hard-to-reach audiences.
“But, I don’t think (social media) is effective during a pandemic,” Taylor said.
Social media sites can contribute to echo chambers, Taylor said, where beliefs are amplified or reinforced by communication inside a closed system and insulated from rebuttal, according to a definition by the Oxford Learner’s Dictionary.
Although Taylor thinks social media is not helpful during a pandemic, she thinks it could again be useful for spreading information not related to COVID-19.
Public health communication, then & now
Public service announcements looked entirely different a little more than a century ago.
For example, a newspaper in Celina, Ohio, published a health bulletin about the influenza pandemic in 1918, titled “Uncle Sam’s Advice on Flu.” The bulletin from the U.S. Public Health Service answers questions such as, “What causes the disease and how is it spread?” and “What should be done by those who catch the disease?”
Similarly, the Fulton County Tribune reported government-ordered closures of schools, churches and other businesses in its Oct. 18, 1918, edition.
Newspapers also detailed the conditions and symptoms of residents, including a Medina Sentinel newspaper edition from 1919. A year before, a Mount Vernon newspaper, the Democratic Banner, reported specific people who had fallen ill with influenza.
Information about the state of illness elsewhere in the country, and world, was often delayed. One article from the Democratic Banner’s October 1918 edition mentions that influenza in Burlington, Vermont, had become so severe volunteers were sent to help nurse soldiers who had fallen ill.
Gwen Hullman, chair of Ashland University’s communications department, spoke about how social media has changed public health communication, specifically that messaging at large has shifted from general public service announcements to tailored – and often personal – interactions on social media platforms.
Hullman’s research focuses include health communication and conflict, and she has worked on health campaigns for anti-tobacco issues.
Regarding public health communications today, Hullman said social media has advantages for health departments compared with bulletins and newspapers, including helping build more personal relationships with the residents it serves, gain public trust and share information more often — whether that is about COVID-19 or reminding people to wear sunscreen.
However, Hullman voiced concern that small-scale health departments may not have the resources or expertise to moderate the debates that often go on in the comments.
“It’s easy for an individual who will face no consequences to just start a barrage of counter attacks on an organization’s site,” Hullman said. “The person who manages the organization’s site is not only dealing with their own reputation, but they’re dealing with the organization’s reputation too.”
How health departments use social media should depend on the organization’s goal, target audience and resources, she said.
“If the information that you need to send is not sent well over that medium, or if you cannot devote enough resources to manage it, then you’re probably better off not having it,” Hullman said. “(In communications) you always want to think about how the information is going to be received and what goal you have in mind.”
Public health communication on social media is inherently flawed because of the platforms’ structure, she explained.
“I think that’s part of the problem, that we’re discussing complex issues that require us to show people pieces of evidence and explain them, but we’re trying to do that through a channel that doesn’t support that kind of communication,” Hullman said.
Regarding ways to prevent unruly interactions online, Hullman said it’s important for health departments to back up all statements with the sources. Hullman also suggested using short and clear phrasing on social media posts, rather than trying to cram all information into one post.
“Sometimes I see people posting these long, complex PDFs on social media that nobody can really see,” Hullman said as an example. “You want to lead people back to your website so they can view a document like that.”
Health officials beyond Ashland
The Ashland County Health Department is far from the only health entity grappling with how to use social media for public health communication.
Public health officials in Knox and Richland Counties said social media has both helped and hindered efforts during the pandemic. But officials from both said they think social media is an essential tool for public health communication in the digital age.
Knox Public Health has staff specifically dedicated to monitoring social media, with Alayna Mowry from marketing and communications heading efforts.
Mowry began her role in marketing and communications roughly a year before the onset of the COVID-19 pandemic. Mowry has noticed increased engagement on social media since the pandemic began.
“We are a public agency, so everyone has the right to post,” Mowry said, adding that there are exceptions including profanity and solicitations, among others.
Addressing misinformation and disinformation in comments is a key part of Mowry’s role. She said she starts every workday with comment moderation and then continues to monitor comments throughout the day.
Mowry said at the start of the pandemic, when information was rapidly changing, comment moderation was especially difficult.
“Someone may be asking a question on a post that’s already outdated,” Mowery explained. “So, we’d have to redirect them to our website or redirect them to a newer post where we have more detailed information about the changes.”
KPH started hosting Facebook Live events to answer community questions and address misinformation in real time, a tool public information officer Pam Palm explained KPH had previously used more so for promotional content than live conversations.
Palm said she thinks Facebook Live helped with transparency.
“We did get a lot of questions from people, you know, wanting answers, and sometimes we didn’t have the answers,” Palm explained. “So we were very honest in saying we don’t know, but we’ll find out.”
While Palm and Mowry view the Facebook Live events as a success, they did note other aspects of social media have had negative results.
“It’s an unchecked medium in that it’s so easy to put misinformation or disinformation out there,” Palm said, adding KPH is left to fact check and combat inaccuracies posted.
Mowry and Palm said how KPH responds to misinformation and disinformation online is also important, albeit another challenge. Mowry said she almost always consults with other staff members before crafting responses and does not leave responses at “No, that is wrong.”
“I always try to provide a very thorough response to try to help tackle maybe even a few questions that came along in that thread as well,” Mowry explained.
Responding in a timely manner is also a challenge for Mowry.
“A post might take off with that type of information, misinformation, and it might have 20 comments on it, but if it happens at 11:21 p.m., sorry guys, I’m not on social media monitoring,” Mowry said.
Despite the negatives, both Palm and Mowry said they believe social media is a crucial part of a health department’s work.
“If I had to put it in one word, transparency is the best thing that’s come from social media,” Mowry said.
Her work monitoring social media during the pandemic has shown her the importance of showing the human side of KPH.
“I think social media — by commenting back, by answering questions directly — has really given us that personalized view of the agency,” Mowry said.
Palm said another benefit is being able to receive instant feedback from the community, and for KPH to provide quick answers by way of social media.
“(Social media) is part of an essential service of public health,” Palm said. “It’s communicating information, making sure that our community is educated about public health issues — whether it’s COVID-19 or radon or immunizations or smoking cessation or car seats or whatever.”
Richland Public Health commissioner Sarah Humphrey said not using social media would be a disservice to the community the agency serves. Humphrey assumed her role at RPH right before the pandemic in February 2020, after previously working as health commissioner for Ashland County Health Department.
“By not engaging on a social media platform, it really limits your ability to reach diverse populations,” Humphrey said. “Because as we know the digital era has really taken storm and (social media) is a lot of the ways individuals obtain their news, their health information, stay connected to one another.”
Humphrey said social media use goes beyond RPH being a purveyor of information. It’s an outlet for community members to directly ask questions.
Similar to Knox Public Health and Ashland County Health Department, RPH must continuously work to combat misinformation on its social media sites, Humphrey said.
“We do feel fortunate that we have individuals who stay on top of current and ever-evolving information and share that as quickly as they can,” Humphrey said.
RPH’s public information officer Reed Richmond recently retired. Currently, community health and prevention sciences coordinator Shannon Nelson and PIO Renda Cline handle day-to-day social media needs, Humphrey said.
“I could see that being a difficulty for smaller health departments or even smaller agencies who definitely during staffing difficulties cannot completely focus an employee on doing those type of social media messages.”
In Humphrey’s view, RPH has seen the most success with clear public health communication by partnering with other organizations to put out shared messaging on vaccine safety and preventative health measures, rather than RPH trying to craft its own distinct messaging.
Local health departments in Ohio are independent subdivisions of the state, so the Ohio Department of Health declined to comment on Ashland County Health Department’s social media policies because it is another governmental agency.
However, Ohio Department of Health spokesperson Michelle Fong wrote to Ashland Source with insight on how ODH approaches its own social media.
“It is the policy of the Ohio Department of Health to not delete comments or posts unless they violate a social media platform’s policy,” Fong wrote. “Social media platforms do have their own policies on comments as well as content, and reserve the right to remove content that violates their policies. Any content that appears on our page would be subject to those policies.”
