The efficacy of the Internet and Social Media as Medical Marketing Tools

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The efficacy of the Internet and Social Media as Medical Marketing Tools

Efthymios Constantinides

University of Twente

School of Behavioural, Managerial and Social Sciences / NIKOS PO Box 217, 7500AE, Enschede

The Netherlands e.constantinides@utwente.nl

Kalipso Karantinou

Athens University of Economics and Business

Department of Marketing and Communication, School of Business 76, Patission Str. 104 34 Athens, Greece

kkarantinou@aueb.gr

Maria Alexiou

aleksiou.m@gmail.com

Athanasia Vlachaki

athvlachaki@gmail.com

Abstract

The role and efficacy of online marketing in healthcare remains underexplored. The present study, focusing on one medical specialty, investigates the perceived role of the Internet and social media as marketing tools from the perspectives of both healthcare providers and patients. It assesses their role as communication and customer acquisition channels and identifies differences in perceptions between providers and patients. The findings suggest that the role of the Internet and social media as patient acquisition channels is limited but presence of healthcare providers in these channels is considered as important for reassuring customers. The results indicate that the online presence of healthcare providers in a web site is considered as a given fact by patients (a hygienic factor in Herzberg's terminology) while the presence in social media has a reinforcing impact (a motivating factor in Herzberg’s terminology) with important effect on trust and long-term relationships.

Keywords: Online Marketing, Social Media, Healthcare Track: Online Marketing and Social Media

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1. Introduction

The growing importance of the Internet as a commercial channel and the increasing popularity of social networking sites among consumers present businesses with significant opportunities and challenges. An important challenge for marketers is to harness the so-called Interactive Web, widely known as Web 2.0 or Social Media, as marketing tools; understanding consumer attitudes and behavior when using social networks as communication and commercial channels is of particular importance for marketers.

There are numerous studies looking into consumer behavior in social networks within the airline industry, education, retailing, tourism and other commercial or non-profit domains (Cοnstantinides & Stagno, 2012; Garín-Muñoz & Pérez-Amaral, 2010; Grahl, Rothlauf, and Hinz, 2013; Hu & Yongjian, 2010; Toh, Dekay, and Raven, 2011) but limited attention has been paid by researchers on the use of social media and social networking sites as marketing tools in the healthcare industry. Studies in this domain - mostly conducted in the US - examine the impact of Internet and social media on patient discussions in forums and discussion boards. Topics discussed are usually focused on types of treatment and health services associated with serious illnesses, such as cancer, heart diseases and diabetes (Lymberis & Rossi; 2004; Stevenson, Kerr, Murray, and Nazareth, 2007), with one study also focusing on postnatal mental illnesses (Moore & Ayers, 2011).

The health industry appears to be an interesting domain for investigation, not only due to the scarcity of research in this area, but also due to the nature of health services: the credence aspects of medical services and the asymmetry of information between providers and patients in areas like diagnoses, diseases, treatments and treatment risks, make the search for medical information an imperative for many patients. In this context, the Internet has become a popular platform for information search for the worrying patient (Engelen, 2009; Van De Belt, Engelen, Berben, and Schoonhoven, 2010).

The purpose of this study is to examine the use and impact of the Internet and social media (the social networks in particular) on consumer behavior in healthcare in Greece. The study is focused on the obstetrics/gynecology (OB/GYN) domain since this is the most popular medical specialty with the largest number of patient appointments in Greece (doctoranytime.gr). We address the extend of use of Internet and social media by gynecologists and patients and the benefits they provide to both sides, with the main focus on the role of social media on the choice of a gynecologist.

2. Literature Review

In the digital era, and especially in the era of interactive Internet (Web 2.0 or Social Media), there is a power shift from providers to customers (Constantinides & Fountain, 2008). One important effect of customer empowerment is the unlimited access to information sources and customer-generated content produced by users of services and products, based on hands-on customer experiences, in the form of product or services reviews and recommendations. Social Media also allow different modes of interaction going further than the informational role of the “classic" websites. This trend is evident in the healthcare domain: the popular social network Facebook has become a new significant source of patient information about diseases, healthcare quality and healthcare facilities. Blogs and forums have also become powerful communication tools disseminating healthcare information and engaging patients in decisions regarding their care (Rozenblum & Bates, 2013).

Many professionals and healthcare organizations have embraced social media as a way to reach more patients effectively and efficiently and build stronger relationships with them (KPMG International, 2011). Social media can be used to provide contact information of the physician; information on the types of services offered; general and customized healthcare 2

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information; and also to share patients’ experiences. The capacity of Social Media to allow one-to-one, one-to-many and many-to-many communication makes interaction and engagement with patients easy in cases like booking appointments, dispatching reminders and communicating diagnostic lab test results (Backman et al., 2011; Chretien & Kind, 2013; Fisher & Clayton, 2012; Otto, 2012; Vikram, 2010). Many healthcare organizations also build online interactive platforms where patients can share their experiences and personal stories helping other patients find answers to their questions and decide where to obtain their healthcare services (Backman et al., 2011).

In order to understand patients’ needs for searching online health information, it is important to identify the types of health information that are sought online, along with why, when, where, and how, and the performed activities (Lee, Hoti, Hughes, and Emmerton, 2014). Coulter, Entwistle, & Gilbert, 1999 classify patients’ online information needs as: gaining a realistic idea of prognosis, making the most of consultations, learning about available services and sources of help, identifying self-help groups and preventing further illness. Patients do not tend to customarily surf the web for general health-related issues, but they instead prefer to visit destinations offering particular information (Gunter, 2005), in order to get better informed on how they could handle a specific condition. Among the most dynamic users in healthcare are support groups of patients who share a diagnosis or treatment (Heldman, Schindelar, and Weaver, 2013).

3. Research Questions and Methodology

The purpose of this research is to investigate the overall role and impact of the Internet and social media on gynecological and obstetrical (OB/GYN) healthcare services in Greece both from the doctors’ and the patients’ perspectives, in order to identify commonalities and differences between the two groups. We looked into the extent to which OB/GYN physicians make use of the Internet and social media, the type and intensity of use, the perceived benefits, as well as the effectiveness of internet and social media tools as judged by customers.

The investigation focused specifically on the following research questions:

1. What are the primary roles of the Internet and social media from the point of view of physicians and patients?

2. What are the most popular social media platforms for physicians and patients and how are they used?

3. What are the benefits of the use of social media for physicians?

4. What are the differences between the perceptions of physicians and patients with regard to the role and use of the Internet and the social media?

5. What is the impact of the Internet and social media on the choice for a physician in the case of OB/GYN services?

The study involved both a qualitative and a quantitative stage. Data collection took place in Athens, Greece, between November 2014 and March 2015. The analysis of the qualitative part of the investigation informed our understanding of the phenomenon and formed the basis for the overall direction of the quantitative study and the questionnaire development. The qualitative stage involved eight structured interviews with physicians and eight semi-structured interviews with female patients/users of gynecological services. For the quantitative stage of the investigation, OB/GYN physicians were randomly selected using the register of the Medical Association of Athens. Of the 1.240 registered physicians, 670 received the questionnaire via email and 64 of those responded. For patients, given that the target group was women over 18 years old, the method used was non-probability snowball sampling, which resulted in 342 usable responses. The administration of the questionnaires was done online using the Survey Monkey software and the participants were invited to participate via email. The statistical program SPSS was used for the analysis of the data.

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4. Results

In an effort to optimize the use of the available space, results are presented as answers to the research questions. Due to space limitations, supporting quotes from the qualitative stage of the investigation could not be included in the presentation of the findings.

1. What are the primary roles of the Internet and social media from the point of view of physicians and patients?

More than half of the physician who participated in the study (52,1%) stated that they use social media for professional purposes. In order of descending importance, gynecologists indicated that they use the Internet and social media technologies for sending test medical results, publishing articles and answers to medical inquiries, providing information about their clinic, posting CVs and photos but not for booking medical appointments. On the patients’ side, approximately 90% of the patients have searched the Internet for information about gynecological issues, mainly about a specific gynecological problem followed by search for information about general gynecological issues. Patients resort to the Internet first to look for information on their symptoms and condition before visiting the physician. Patients search on the Internet also after visiting the physician to learn more about their condition and understand better the physician’s diagnosis.

2. What are the most popular social media platforms for physicians and patients and how are these used?

For physicians, Facebook is the most popular platform followed by blogs; most participants also use LinkedIn as a professional network and have an active profile. YouTube is next in popularity for viewing video material but Twitter, Instagram and Pinterest are not popular among these professionals. Patients evaluate the gynecologists’ presence on social media as marginally important. Facebook is the only social platform that can affect their attitude and the patient-physician relationship. Blogs and forums seem to no longer have a significant allure for customers, as there is a shift towards Facebook groups. Articles of physicians published on social media platforms can entice patient interest and perceptions about medical providers. It is interesting however, that overall the website is seen as the most valuable source of information about the physicians’ practice, contact details, access map, CVs, photos and informative articles.

3. What are the benefits of the use of social media for physicians?

Physicians indicated that the use of social media enable them to project a modern image, offer access to their target group effectively and efficiently, allow two-way communication with customers, contribute to relationship building, increase awareness and play an increasingly important role as promotional tools. Social media enhance the effect of the traditional online communication via the website.

4. What are the disparities between the perceptions of physicians and patients with regard to the role and use of the Internet and the social media?

Physicians rightly presume that patients use the internet and social media in order to be better informed about health issues and to gain support from other patients. Physicians also believe that women evaluate positively their web presence and can be influenced by forum discussions on the choice of a gynecologist. However, contrary to what physicians think, their internet presence - website and social media - has a limited impact on patients’ choice of physician. The positive influence of the web presence is in most cases mediated by personal experiences from earlier contacts with the doctor. Communication via e-mail is positively evaluated by patients. The possibility of online communication, specifically informing patients about test results and answering questions, influence positively the patient’s perception about their gynecologist/obstetrician.

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5. What is the impact of the Internet and social media on the choice for a physician in the case of OB/GYN services?

The overwhelming majority (92%) of gynecologists believe that recommendations from family and friends remains the most important influencing factors. This perception is in agreement with the patients’ view (87,4% agree). From the practitioners’ perspective, the website comes second (44%) and recommendations in forums (40%) follow. Social media networks are considered important by 32% of the patients and advertising on search engines or other sites by 24%. More than half of the patients (57.6%) indicated that they do not use the Internet to search for an OB/GYN physician and a surprising 80% indicated that they would never contact a physician they learned about online. It is evident that in Greece the Internet is not yet significantly effective in attracting new patients who are not already familiar with the physician. 5. Discussion and Conclusions

The study confirmed that the decision for the selection of a gynecologist/obstetrician is not dependent upon the presence of the physician on the Internet or on social media. A significant selection criterion for a physician in this specialty in Greece is still the recommendation by family or friends and the personal contact with the doctor plays a key role. However, internet presence of the physician in the form of a website is something that patients have come to expect and take as granted. The existence of a well-maintained website adds to the visibility and the credibility of the physician. On the social media front, even though social media presence does not influence the patients’ choice for a gynecologist, this also importantly acts in a reinforcing manner, increasing visibility. In terms of Herzberg’s (1966) theory of motivation, the Internet presence in the form of a website can be defined as a “Hygienic Factor” and the social media presence as a “Motivating Factor”.

From a managerial point of view, gynecologists in Greece seem to believe that new media technologies can be used as a great supportive tool for promoting themselves and advancing their work. From the clients’ point of view, the study shows that the website is the most valuable channel of information about physicians, containing the physician’s CV, information about their specialization and practice, and providing access details to their private practice. For those physicians who choose to have an Internet presence (website), it is important to invest in writing articles or reports about gynecological matters, as well as providing general or customized advice. Articles and photos are also important as they add directness that go a long way towards reducing the intangibility and ambivalence of the service and act reassuringly, reducing the perceived risk.

Concerning Facebook (which is by far the most popular social network in this industry), the postings of health professionals choosing to promote their work via this medium should be such that provide value to their public. One way to achieve this is via the use of articles and advice. Attention should also be given to the writing style since Facebook is in principle not seen as a promotional channel in the eyes of the users. In all communications through Facebook physicians must also keep in mind the emotional status of the patients, which is a significant factor impacting upon patients’ perceptions and behavior.

The presence of a gynaecologist /obstetrician in other social media (LinkedIn, Twitter, YouTube) does not seem play a significant role in the patient-physician relationship. Finally, the internet as a communication channel scores high in our study when it comes to email: communication between physicians and patients via e-mail can be an important element in the patient-physician relationship used as an efficient way of informing patients about test results.

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6. Limitations and Directions for Further Research

A limitation of the study is that it was conducted in one market (Greece) and within one medical specialty, limiting the generalizability of the findings. Concerning the physicians sample, it was random, but limited to 64 respondents, while the patients sample was based on a non-probability snowball sampling method, posing concerns regarding the representatives of the sample. Future studies in this domain should look into more medical specializations, involving both male and female respondents, and spanning across a number of countries. Furthermore, given the importance of recommendations for medical services, a possible direction of interest could be the role of e-word of mouth (E-WOM). Given the increasing role of social networks and social media, it would be interesting to examine the impact of online peers in the choice of physician. Moreover, it could be interesting to investigate the key features a Facebook page should have in order to elicit interest and gain broad response. Finally, another venue for further investigation could be to study the impact of the Internet and the social media on the patient-physician power balance and relationship, which seem to be significantly affected as a consequence of the perceived empowerment of the patient.

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