The widespread use of the Internet, smart phones, and other mobile digital devices has created a unique opportunity for public health.1–3 Moreover, social media platforms and a wide and burgeoning range of available applications have demonstrated significant capacity to reach millions of people with health information and advice.4,5 Despite growing evidence that supports the promise of digital communication in health promotion, there has been limited exchange and integration of data and information across the public and private sectors about how it can be maximized to improve public health.6,7
The inaugural Digital Health Promotion Executive Leadership Summit (for the summit’s program, see Supplement, available in the online version of this article at http://www.ajph.org) was undertaken in an effort to showcase innovative case studies and discuss tangible opportunities for collaboration across the public and private sectors in applications of digital technology to improve public health. Convened in Washington, DC, June 5–6, 2018, the summit brought together 30 expert speakers and more than 75 national leaders from the academic, government, nonprofit, and technology sectors in the United States and other nations working in digital health communication to do the following:
discuss digital technology’s role in addressing cutting-edge public health issues such as opioids, suicide, mental health, as well as its impact on children and adolescents;
explore case studies of successful uses of social media in public health interventions;
address issues related to digital health and confidentiality, patient protection, and data sharing; and
examine future directions for the use of digital technology to improve individual and population health.
The summit thus sought to establish a foundation for developing a common agenda to maximize both the opportunities and uses of digital technology for advancing the goals of public health. All summit participants received a draft common agenda before the meeting and were asked to reflect on the proposed recommended principles and related actions, based on the various presentations and panel discussions. The summit’s closing session provided an open-ended opportunity for participants to comment on the draft common agenda and recommend changes, which were then taken under further consideration by the authors and writing group.
INTENDED AUDIENCES
This editorial, and the common agenda it reports, is intended for those who are engaged in the creation, dissemination, and study of digital health communication: researchers and academics in public health, behavioral medicine, health promotion, and health education; policymakers and decision-makers in government and nongovernmental entities; stakeholders in social media companies; and those in international organizations and other institutional authorities who have a stake in promoting the health of the public through digital information and communication technologies.
ASSERTIONS
In this section, we assert what we believe underlies and informs the common agenda, based on the existing contemporary scientific literature and summit presentations (for references, see the online Supplement). Although these assertions reflect the current literature on the state of understanding and applications of digital technology for health promotion, we recognize that the field is dynamic and will continue to advance and evolve, and thus recommend that these assertions be revisited periodically and revised accordingly.
Health communication has been defined by the Centers for Disease Control and Prevention and the National Cancer Institute as the “the study and use of communication strategies to inform and influence individual decisions that enhance health” (http://bit.ly/2zV6jOk).
Well-designed health communication can attenuate barriers and thus can improve health literacy and numeracy to empower individuals and populations—especially underserved and vulnerable audiences—for improved health decision-making and the promotion of health equity.
Digital health communication encompasses information and programming made available by both the public and private sectors via Web-based platforms, social media, and mobile technologies, including cell phones, smart phones, and other personal devices, some of which have demonstrated a growing evidence base that supports their use for health promotion.
The Internet and digital information are now frequently the first sources consulted by the public to obtain health information and for help with health-related questions or problems.
The pace of collection, dissemination, and exchange of population-wide and personal health data is expected to exponentially increase in the future years through innovations and rapid advancements in new technologies and devices, population growth, research in personalized medicine, and growth and analysis of health information, and this portends that future generations will be increasingly reliant on technology and global connectedness.
The digital divide in access to digital technology is decreasing, whereas the digital divide in access to socio-culturally relevant health information is increasing.
Some digital technologies and applications have been demonstrated to contribute to the promotion of public health and effectively used in disease self-management, whereas the majority are yet to be fully tested and their credibility with different audiences may vary because of a complex array of factors.
Most of humanity’s data created through digital media have been collected in the past two decades, primarily through the Internet.
Digital health communication projects and programs can be improved by further cross-sector coordination, collaboration, and research.
PRINCIPLES AND RELATED ACTIONS
We recommend that the academic, government, and technology sectors commit to the following common set of principles and related actions:
People should have access to health information that is timely, credible, and valid.
It is the responsibility of individuals and organizations that intentionally or unintentionally create and disseminate digital health communications to provide access to accurate health information.
Timely, credible, and valid data should be used to create evidence-based health communications.
Enhanced digital technologies are needed to reach at-risk populations with health information that is accessible, persuasive, relevant, and culturally and linguistically appropriate so as to be responsive to the socio-cultural context of communities.
Digital health information campaigns and programs should be formatively evaluated to measure reach and effectiveness. Additionally, individuals and organizations planning or conducting health communication initiatives or interventions should ensure that these initiatives are empirically supported and rigorously evaluated in a timely, responsive manner consistent with the rapid advances in digital technologies.
Individuals and organizations planning or conducting digital health communication initiatives or interventions have a responsibility to anticipate potential unintended consequences (i.e., misconceptions or missed vulnerabilities) that the provision of health information might create. Thus, existing and future digital communications should be evaluated for their unintended and intended health consequences, especially for marginalized, vulnerable, or at-risk populations.
Individuals and organizations conducting health communication initiatives should work to safeguard and ethically protect the privacy of personal data and information, consistent with all applicable US and international digital data privacy laws.
The academic, government, and technology industry sectors engaged in digital health communication should collaborate where possible to increase the reach and effectiveness of health communication information and programs.
SUPPORTING THE AGENDA
These recommended principles and related actions constitute an aspirational agenda that we believe can advance a spirit of partnership and commitment to digital health communication that has potential to contribute to improving public health and promoting health equity. Having reached consensus on this common set of principles and related actions for digital health communication, we urge the academic, government, and industry sectors engaged in digital health promotion to support this agenda and to take all necessary national and global actions that can fulfill its intended promise.
ACKNOWLEDGMENTS
We gratefully acknowledge the following organizations for their support and sponsorship of the Digital Health Promotion Executive Leadership Summit: SAGE Publications; Society of Behavioral Medicine; Society for Public Health Education; Milken Institute School of Public Health at The George Washington University; The Public Good Projects; The University of Maryland School of Public Health; and Tumblr.
We also thank Thomas J. Chapel, MA, MBA, chief evaluation officer for the Program Performance and Evaluation Office, Centers for Disease Control and Prevention, who served on the Summit planning committee, and the Summit participants for offering helpful comments on the draft common agenda.
In addition to the authors, the statement was reviewed by the following: Danielle Bartolo Perrella, MPH, Analytic Lead, Google, New York, NY; Gary G. Bennett, PhD, Department of Psychology and Neuroscience and the Duke Global Health Initiative, Duke University, Durham, NC; Jay M. Bernhardt, PhD, MPH, Moody College of Communication, The University of Texas, Austin; W. Douglas Evans, PhD, Department of Prevention and Community Health and Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC; Jon Fraser, BA, Government and Elections, Google, Washington, DC; Bradford W. Hesse, PhD, Health Information and Informatics Research Branch and Behavioral Research Program in the Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD; Boris D. Lushniak, MD, MPH, School of Public Health, University of Maryland, College Park, MD; Victoria McCullough, BA, Social Impact and Public Policy, Tumblr, New York, NY; and Ellen Wartella, PhD, Department of Communication Studies and Center on Media and Human Development, School of Communication, Northwestern University, Evanston, IL.
Note. The views expressed in this editorial do not necessarily represent the views of the academic institutions, professional associations, industry entities, or government and nongovernmental agencies with which the authors and writing group are affiliated or were affiliated at the time and are not meant to imply any official endorsement of the principles and recommended actions.
CONFLICTS OF INTEREST
L. C. Abroms has stock in Welltok Inc. and receives royalties from the licensing of Text2Quit to Welltok Inc., which was not addressed as part of the Summit. The other authors declared no potential conflicts of interest with respect of the research, authorship, or publication of this editorial.
REFERENCES
- 1.Patrick K, Hekler EG, Estrin D et al. The pace of technologic change: implications for digital health behavior intervention research. Am J Prev Med. 2016;51(5):816–824. doi: 10.1016/j.amepre.2016.05.001. [DOI] [PubMed] [Google Scholar]
- 2.Bernhardt JM, Chaney JD, Chaney BH, Hall AK. New media for health education: a revolution in progress. Health Educ Behav. 2013;40(2):129–132. doi: 10.1177/1090198113483140. [DOI] [PubMed] [Google Scholar]
- 3.Galea S, Vaughan RD. On the promise and peril of technology for population health: a public health of consequence, November 2017. Am J Public Health. 2017;107(11):1703–1705. doi: 10.2105/AJPH.2017.304046. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Pagoto S, Bennett GG. How behavioral science can advance digital health. Transl Behav Med. 2013;3(3):271–276. doi: 10.1007/s13142-013-0234-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Hesse BW, Moser RP, Riley WT. From big data to knowledge in the social sciences. Ann Am Acad Pol Soc Sci. 2015;659(1):16–32. doi: 10.1177/0002716215570007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Bennett GG, Glasgow RE. The delivery of public health interventions via the Internet: actualizing their potential. Annu Rev Public Health. 2009;30(1):273–292. doi: 10.1146/annurev.publhealth.031308.100235. [DOI] [PubMed] [Google Scholar]
- 7.Brabham DC, Ribisi KM, Kirchner TR, Bernhardt JM. Crowdsourcing applications for public health. Am J Prev Med. 2014;46(2):179–187. doi: 10.1016/j.amepre.2013.10.016. [DOI] [PubMed] [Google Scholar]