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Social network analysis provides a perspective and method for inquiring into the structures that comprise online groups and communities. Traces from interaction via social media provide the opportunity for understanding how a community is formed and maintained online.
The paper aims to demonstrate how social network analysis provides a vocabulary and set of techniques for examining interaction patterns via social media. Using the case of the #hcsmca online discussion forum, this paper highlights what has been and can be gained by approaching online community from a social network perspective, as well as providing an inside look at the structure of the #hcsmca community.
Social network analysis was used to examine structures in a 1-month sample of Twitter messages with the hashtag #hcsmca (3871 tweets, 486 unique posters), which is the tag associated with the social media–supported group Health Care Social Media Canada. Network connections were considered present if the individual was mentioned, replied to, or had a post retweeted.
Network analyses revealed patterns of interaction that characterized the community as comprising one component, with a set of core participants prominent in the network due to their connections with others. Analysis showed the social media health content providers were the most influential group based on in-degree centrality. However, there was no preferential attachment among people in the same professional group, indicating that the formation of connections among community members was not constrained by professional status.
Network analysis and visualizations provide techniques and a vocabulary for understanding online interaction, as well as insights that can help in understanding what, and who, comprises and sustains a network, and whether community emerges from a network of online interactions.
The use of social media has spread dramatically in the past few years, demonstrated in increasing numbers of users, types of media, mobile applications, and connectivity. This has stimulated growth in applying social media to matters of health and health communities: from work-based communities of practice [
Of the many approaches to community and online communication that have emerged, we highlight a social network perspective. This perspective looks at group or community interactions to determine what kinds of actors and ties make up the network; what exchange of information, social support, socializing, play, or other resources form the basis of the community; and what roles and cliques emerge that provide structure to the community. Social network analysis provides a vocabulary and set of techniques for examining interaction patterns between people and has proven useful for studying health (eg, [
In this paper, we first discuss social networks and then illustrate the kind of information that can be revealed about community from a social network perspective through a case study of social media use by the group Health Care Social Media Canada (HCSMCA). This case includes network analyses of the group’s structures as shown through a sample of Twitter messages using the hashtag #hcsmca. Results from the network analysis reveal a cohesive group consisting of one major component, including interaction across professional roles. The group founder and participants that are identified as social media health care providers are prominent in posts and in attention from others, and the network is sustained by participation from and recognition of a core set of actors.
The first section below reviews the background on online social networks and describes the HCSMCA group. The following sections describe the analysis of the #hcsmca Twitter networks and then discuss these in relation to previous research on online communities.
Of the many ways to look at the range and effects of social media on interpersonal and collective relations, one that has proved useful for online communities has been a social network perspective. This is not the same as “social networking”. It is instead an approach that considers the unit of analysis to be the connections between people and looks at how these connections—social network “relations”—form patterns of interaction that reveal how information and other resources flow in a network, as well as the structures that define the network [
Media use is just one aspect of this complex structure, but it has the potential to set context, add to a social support system, and touch individuals and their closely tied friends and family. From an analytical perspective, one of the advantages of taking a social network perspective is that the focus is on what people do with each other rather than the medium or face-to-face context through which they do it. This allows exploration of the types of interactions that create and define different kinds of relationships and communities [
Many years of research on social networks have provided evidence of social network principles as well as statistical and analytical techniques for understanding network behaviors (eg, [
Where bonds are strong, resources are shared generally around the network (generalized reciprocity). This creates the social capital of the network, that is, the accumulated resources held within the network rather than those held by any individual [
The configuration of connections is all-important in social networks. These structures show how actors are connected over the whole network, and thus what paths and obstacles there are for contact, information, and resource flow. Among popular aspects considered for networks are the
Our online interactions make these patterns more readily observable, and many examples exist now of how such patterns can be made visible, for example, in social network interaction patterns [
In this paper, we examine the social media traces from the #hcsmca Twitter posts. We examine what social network patterns are revealed and the implications these have for #hcsmca as a community. The following section provides background on the #hcsmca group and its operation.
As stated on the HCSMCA website, “#hcsmca is a vibrant community of people interested in exploring social innovation in health care. We share and learn, and together we are making health care more open and connected.” It is an example of how those with a common interest can meet and form community online through social media, in this case, in the interests of social innovation in Canadian health care.
The community was founded in September 2010, by Colleen Young, an online community manager and Toronto-based patient advocate and health writer [
Anyone and everyone delivering and receiving health care who is interested in open conversation to help improve quality, access, value and effectiveness of health care. This includes: patients, caregivers, patient advocates, health care professionals, not-for-profit health organizations, educators, health content providers, health institutions, health administrators, health systems and networks, government and health policy makers.
The community is maintained through four social media: Twitter, a LinkedIn group with 181 members, a Facebook page with 143 “likes” (as of January 8, 2013), and the blog maintained by the founder, Colleen Young. While maintained across these various media, the community relies on Twitter, the popular microblogging site, as their primary communication platform, operating with the hashtag #hcsmca. The community meets weekly on Twitter to discuss various topics relating to health care and social media.
To participate in this group discussion, a participant just needs to post a message on Twitter using this hashtag. At the time of this research, weekly chats on Twitter are scheduled for every Wednesday at 1 pm EST with the last Wednesday of the month being an evening chat at 9 pm EST. Weekly topics and guest moderators are announced in advance and listed in a public Google spreadsheet. For those who miss this real-time meeting, a transcript with messages is available, posted to the community blog by the group moderator. #hcsmca is a great case for study since HCSMCA has been active with this hashtag for over 2 years and generates very active weekly discussions that attract a wide variety of professionals and organizations.
One of the main goals of our research is to gain a better understanding of how social media–based information and communication technologies, such as Twitter, enable a distributed group of people to form and maintain an online community. In particular, we are interested in the following research questions regarding #hcsmca:
What accounts for the relative longevity of this particular online community? Is it because of the founder’s leadership and continuing involvement, or are there core members who are actively and persistently involved in this community?
What is the composition of this community in general? And, more specifically, does their professional role determine a person’s centrality within this community? This will allow us to understand generally how professional roles affect online conversational dynamics, and more specifically whether this online community is a welcoming place for a wide range of professionals or is, instead, dominated by professionals from a particular group.
The primary dataset for this research came from Twitter and included all public Twitter messages that included the #hcsmca hashtag, posted between November 12, 2012, and December 13, 2012. The dataset contains a total of 3871 tweets, posted by 486 unique Twitter users. The dataset was collected and analyzed using Netlytic [
As noted above, #hcsmca hosts a weekly discussion. Topics covered and the assigned topic moderators for the period studied are shown in
#hcsmca weekly topics (Nov 12-Dec 13, 2012).
Date | Weekly discussion topics | Assigned moderator |
Nov 14 | Challenge of engaging SM [social media] to inform a research agenda | @QuintePediatric |
Use of innovation, SM, and gamification to encourage uptake of self-care | ||
Nov 21 | Health care blogs should we or shouldn’t we, what have we learned, what are the benefits? | @JackieHickeyRN |
Are health care blogs a useful tool for education and knowledge transfer? | ||
Nov 28 | How has social media made you healthier? Unhealthier? Has social media made our health choices more numerous and this overwhelming? | @NaheedD |
What messaging would motivate you to make a positive health change? Who would you listen to? | ||
Dec 5 | What is needed to make cross-organizational collaboration via social networks more effective? | @WillFalk & @MarkCasselman |
In what settings / sectors are you seeing health care providers and patients interacting via social media? | ||
Dec 12 | How can SM support patient care in an ambulatory care setting? | @CraigTyyz |
How can SM help patients/families navigate a new/unfamiliar hospital/clinic/facility? |
Number of #hcsmca tweets over the studied period.
Twitter connections are maintained through the technical means of
Netlytic was used to discover the communication network among community members. In particular, to discover social connections among community members, the analysis relied on a type of network called “Name Network” [
The following sections show results from the analysis of the Twitter posts, with attention to aspects of community. Results address first, the discovery of key actors in the network and their potential influence on others and second, whether and how professional roles affect participation.
Twitter communication network among #hcsmca participants.
One way to learn how an online community operates is to find out about key members who have the potential to influence tone, topic, or policy for the whole community. A community organizer may be one such actor, but for a community to operate robustly, actions associated with keeping the community or conversation going need to be distributed to more than one person. Thus, in examining the #hcsmca community, it is of particular interest to see whether more than one individual is leading the discussion.
A brief examination of the community blog shows that, as expected, the founder of the #hcsmca group is heavily involved in planning and running the community. But who else is involved? Are there other members of this group who also take on a leadership role? This is important because the presence of a strong community core with a number of active members suggests a healthy online community that can persist without the presence of particular individuals (eg, as in the failure case described in [
Three social network measures were used to locate influential individuals in this community: (1) the total number of messages contributed during the studied period, (2) the number of times a person is mentioned or replied to, that is, their @username is used in a post by someone else (
All three measures are important in identifying prominent individuals in the community. An individual posting a high number of messages gains attention for the content they send to others and can add to the social capital of the community by bringing new information to the group as a whole. However, such information needs to be taken up and used by the community. Thus, a high number of posts, by itself, does not mean that the messages contributed are deemed important or interesting by other members of the community—hence the need to look at network structures of message uptake.
Any use of @username signifies a direct connection between the sender and another individual. Being mentioned by others is a case of
As well as the founder, there are a few other active participants who contribute heavily to the community, posting about the same number of messages each (approximately 10% of the messages posted by the top 10 posters all together). Among this group are people who moderated weekly chats, such as @JackieHickeyRN, @NaheedD, and @QuintePediatric. Such actors also contribute to the critical mass of the conversation, but the more important result is that there are several people the community can rely on to keep the conversation going, increasing the robustness of the ongoing activity.
However, not all of the moderators are active posters. For example, 3 out of the 6 moderators (see
Top 10 most active posters.
As noted above, the total number of posted messages indicates only the engagement level on the part of an individual rather than the uptake of their contributions by the community. To find out whether personal messages influence others and make them reply or retweet, we examined
In examining those on this list other than the founder, we noticed that they have something in common. Most of them have a very active online presence in social media in general, not just in this community. They are also very passionate and active commentators on health matters on Twitter. For example, the second most connected account is @cmaer. This username belongs to Pat Rich, who is an online editor for the Canadian Medical Association and has over 1000 followers. Shirley Williams (@williampearl) is a new media enthusiast and advocate at Strategic Leadership Forum and has over 3000 followers. Others on this list also have a considerable number of followers. In fact, there is a weak, monotonic (nonlinear) positive correlation between the number of followers and the in-degree centrality (Spearman rho=0.23,
One possible explanation of this could be that by participating in weekly discussions on #hcsmca, these individuals expose their followers to this community through their tweets on this topic (with the #hcsmca hashtag). As a result, their followers may also join #hcsmca chats and retweet or reply to them on this topic, thus increasing their in-degree centrality in this community. Future research is required to confirm or reject this preliminary supposition. If it holds, then one recommendation for growing an online community such as #hcsmca could be to find people who (1) are already actively engaged in online conversations in this area and (2) have a strong base of followers, and invite them to join the discussion. This is a reasonable recommendation in general as it brings in people who can act as bridges between separate networks and communities. People with high in-degree on this list are also good candidates for moderating future discussions as their messages are clearly resonating with this group.
Another observation that we can make about this group is that 6 of 10 people with high in-degree also posted the most number of tweets to this community (see
Overall, people with high values of in-degree centrality can be considered as trusted information sources whose opinions and comments are recognized as having value for the community, as evidenced by the frequency with which their messages are retweeted or they are frequently mentioned by others. These people are important for this community as they generate a lot of trusted, “sharable” information that generates discussion, but equally important, by being retweeted, also sustains conversational interaction and the life of the #hcsmca Twitter community.
Top 10 users by in-degree centrality.
Twitter handle | Centrality in degree | Centrality out degree | Twitter profile description (as posted by the user) |
colleen_young | 36 | 27 | Community Manager of Virtual Hospice | Portail en soins palliatifs (@VirtualHospice), Founder of #hcsmca, plain language writer, health literacy advocate |
cmaer | 33 | 10 | Online editor for the Canadian Medical Association. Views are my own |
williampearl | 26 | 4 | Facilitating & Finding Pearls in Strategy, SocialMedia & Healthcare, #ROTPt |
naheedd | 18 | 12 | Medical resident physician. #GlobalHealth+#SDOH advocate. #MedEd+#hcsmca enthusiast. RA @CRICH_StMikes. Writer @HealthyDebate. Humanist. Change agent. Optimist. |
infoway | 17 | 1 | News & announcements from Canada Health Infoway. Tweets by a team from Infoway. Check out our blog. |
rdjfraser | 15 | 1 | Nurse & Author. Digital Tool Strategist and Educator. Learn more, help others. Tweets are my own. |
anneccpa | 14 | 10 | Canadian Certified #PhysicianAssistant, practicing in #Orthopaedics - Sports Medicine & Trauma. Blogger & advocate for the Physician Assistant Profession. |
alainabcyr | 14 | 12 | Learn, share, create. Grow. Aspiring expert in patient education and health communications on the Web and in print. Opinions are my own. |
kathykastner | 14 | 9 | love listening learning sharing. appreciate humour happiness and eating chocolate covered almonds. End of life goal: a joyous exit. BestEndings.com |
symplur | 14 | 1 | Connecting the dots in healthcare social media. Curator of Healthcare Hashtag Project; Social Media Consultancy |
Another group of people who are important within any online community are people who monitor and retweet messages from others. To identify these individuals, we used the
There is a strong overlap in who is prominent in both the in-degree and out-degree lists. Accounts such as @colleen_young, @naheedd, @alainabcyr, @cmaer, @anneccpa, and @kathykastner appear in both lists and thus are prominent because of both their in-degree and out-degree network connectivity. This shows their relative importance in this community as their messages resonated within the community (as indicated by their high in-degree centrality) and as they actively engaged others (as indicated by their high out-degree centrality). The remaining individuals on this list also have relative high values of the in-degree centrality (10 or more).
One anomaly is the community’s account @hcsmca. A review of its recent tweets reveals the account primarily posts announcements about upcoming Twitter chats for this community, mentioning Twitter handles of moderators and other special guests, but with little follow-on interaction with others. This suggests a potential method for identifying such accounts in order to exclude them from analyses of social networks: stark differences between in-degree and out-degree centrality may indicate a non-human, or non-community participant within a conversation.
Top 11 users ordered by out-degree centrality.
Twitter handle | Centrality in degree | Centrality out degree | Twitter profile description |
colleen_young | 36 | 27 | Community Manager of Virtual Hospice | Portail en soins palliatifs (@VirtualHospice), Founder of #hcsmca, plain language writer, health literacy advocate |
natricer | 11 | 22 | retired PSW, family caregiver, passionate about elderly/vulnerable #hcsmca #dwdchat #eolchat #eldercarechat #caregivingchat #HCLDR #theWalkingGallery |
naheedd | 18 | 12 | Medical resident physician. #GlobalHealth+#SDOH advocate. #MedEd+#hcsmca enthusiast. RA @CRICH_StMikes. Writer @HealthyDebate. Humanist. Change agent. Optimist. |
alainabcyr | 14 | 12 | Learn, share, create. Grow. Aspiring expert in patient education and health communications on the Web and in print. Opinions are my own |
samdunsiger | 12 | 12 | Freelance writer. Communicator. Volunteer #PR director for @SOSheadoffice, @stuttersocial. Caffeine and sushi addict. |
hcsmca | 0 | 11 | Health Care Social Media Canada #hcsmca hosts a tweet chat every Wednesday at 1 pm EST (2 pm AST, noon CST, 11 am MST, 10 am PST). |
cmaer | 33 | 10 | Online editor for the Canadian Medical Association. Views are my own |
anneccpa | 14 | 10 | Canadian Certified #PhysicianAssistant, practicing in #Orthopaedics - Sports Medicine & Trauma. Blogger & advocate for the Physician Assistant Profession. |
craigtyyz | 13 | 10 | Communications professional: digital, online and social media specialist at Women’s College Hospital. Views expressed are my own and not those of my employer. |
kathykastner | 14 | 9 | love listening learning sharing. appreciate humour happiness and eating chocolate covered almonds. End of life goal: a joyous exit. BestEndings.com |
quintepediatric | 10 | 9 | We provide medical care to infants, children and adolescents. Healthy kids energize our community! Our account is managed by Sara. |
In the second part of the analysis, we were interested in learning more about the professional composition of this community and whether
Absolute counts of the number of members in a particular professional group do not necessarily reflect the importance of any particular professional group in the network. Thus, to see whether any particular group was especially important in this network, an analysis of variance was conducted comparing in-degree centrality by group. We found a statistically significant relationship between professional roles and in-degree centrality (explaining about 7% of the variance,
Next, we attempted to determine which professional groups were more or less likely to influence discourse in this group. Based on the average in-degree centralities for each of the 11 professional groups (see
The importance of this group in this network can also be visually observed in the graph representation of this community in
Interestingly, although there are fewer health professionals, educators, and health institutions in this community, their average in-degree centrality came in second, third, and fourth (see
Another important observation is that although there seems to be a relationship between professional role and in-degree centrality, there is no apparent preferential attachment among people in the same professional group. In other words, the formation of connections among community members is not necessarily constrained by their professional status. This finding was supported by an analysis of variance density test using both the Structural Blockmodel technique (it examines “whether the different classes have significantly different interaction patterns”), and also with the Variable Homophily model (which “assumes that each group or class of actors has a different homophilic tendency” [
Professional roles.
Category | Sample profile of a Twitter user classified under this category |
Advocacy | @PatientsAssocCa - The Patients’ Association of Canada promotes the role of the patient in all areas of health care. Follow: Donate: |
Communicators—health related | @Infoway - News & announcements from Canada Health Infoway. Tweets by a team from Infoway. |
Communicators—not specifically health related | @bobbigreenberg - Dynamic communications & public affairs consultant. Mentor & Coach. Passionate about learning new languages, travel, teaching yoga. Stop, pause and breathe. |
Educators, professors | @jendlake - Assistant Professor & Pharmacist. Collaboration/ communication will improve patient-care. Tweets are mine and include primary care, medications and good food |
Government and health policy makers | @healthcouncilca - The Health Council of Canada reports on the progress of health care renewal and on innovative practices in Canada. |
Health institutions | @QuintePediatric - We provide medical care to infants, children and adolescents. Healthy kids energize our community! Our account is managed by Sara. |
Health care professionals | @DrJenGunter - OB/GYN, writer, sex health expert, defender of evidence-based medicine. I wield the lasso of truth. Tweets are not medical advice. I speak for no one but me. |
Researchers | @CBoC_HIPE - Independent, leading-edge policy research from the Health Innovation, Policy and Evaluation team at the Conference Board of Canada. |
Social media health content providers | @HeartSisters - On women & heart disease from the unique perspective of Carolyn Thomas, a Mayo Clinic-trained heart attack survivor/women’s health advocate. Also |
Students | |
Unaffiliated individuals | @JEANIESBEACH - music, dance; fashion, women’s rights |
Average centrality per professional group.
Role | Average in-degree centrality | SD | Average out-degree centrality | SD |
Social media health content providers | 2.89 | 6.17 | 2.21 | 3.96 |
Health care professionals | 2.48 | 4.45 | 1.86 | 2.28 |
Educators, professors | 2.00 | 2.97 | 1.31 | 1.65 |
Health institutions | 1.65 | 2.51 | 1.23 | 1.71 |
Advocacy | 1.47 | 2.50 | 1.10 | 1.18 |
Communicators—Health related | 1.39 | 3.03 | 1.32 | 1.31 |
Students | 1.38 | 2.68 | 1.88 | 2.03 |
Researchers | 0.90 | 1.45 | 0.90 | 0.99 |
Government and health policy makers | 0.75 | 1.50 | 0.50 | 0.58 |
Communicators—not specifically health related | 0.68 | 2.18 | 1.34 | 1.67 |
Unaffiliated individual users | 0.08 | 0.34 | 1.06 | 1.11 |
Twitter communication network on #hcsmca colored by professional roles, nodes sized by in-degree centrality.
This and previous studies in this area have highlighted how online communication extends the possibilities of community, that is, bringing participants together to form communities of interest for those geographically remote from one another [
The current study highlighted some initial observations of the structure of the community formed around the #hcsmca hashtag. As has been asked in the past, how can a group of individuals who meet online, through the lean medium of Twitter, and the constraints of a 140-character posting, sustain and be considered a community? Results from our limited sample set suggest this has happened through a strong core of active participants including the group founder, who lead in posting and prominence in the network. Attention to others is an important aspect of community, and the measures of influence and prominence presented here show that attention to others in the group exists, with key players recognized through mentions and retweeting. The configuration of the community and communication by role suggests one major component connecting all participants, that is, the conversation is not fragmented into isolated cliques. Weekly discussions provide a boost to interaction that stimulates activity and provides a dependable rhythm to interaction patterns and a site to return to each week.
Many studies of community and online community have taken place before ours. The following are some of the observations derived from the results of this and related studies, with commentary on the impact in relation to the #hcsmca community studied here.
Some notable attributes of community reported from many studies and associated with both online and offline collectives are local language, shorthands and in-group signifiers [
In #hcsmca, the very use of Twitter is the community genre, shorthand, and local language. The weekly discussion gives promise of a shared future, as does the general attention to issues relating to health care in Canada and working in this area. While an analysis of tweet content is necessary to discover more about the relations connecting individuals, retweets have provided evidence of attention to others’ comments and thus an orientation to community members.
Developing community further depends on continuing attention to the kinds of outcomes that have been found to characterize community, both by design and by emergence from community interaction. Earlier work on online communities and virtual teams has revealed the way rules and norms emerge and evolve with community interaction, with the direction of emergence depending on both technological affordances and the salience to participants of social, informational, and technical features [
Altruistic, proactive use by the #hcsmca founder and by core users remains an important feature for building this community. In looking to the future, the community may face opportunities and challenges in incorporating more and new technology into its repertoire as it expands and as new needs arise that extend the reach and scope of the community. In each round of such expansion, core participants may again have to lead and stimulate contribution and participation as they help develop the character of their community.
Along with leading a community, there is also the experience of those who lurk, listen, join, participate, and depart from communities. Joining an online community is much like joining any community in the need to learn the norms of behavior, the language used, and who is who among members. Online, this is accomplished through observation and (usually) text-based communications. Joining entails phases. Studies of online learning communities revealed stages of
It is still a question of how, and why, community can be formed and sustained via text-based communications. Early opposition to the notion of “virtual community” pointed to the lack of nuance of face-to-face interaction and the “leanness” of text as a basis for interaction. Critics noted difficulties in conveying tone, emotion, intimacy, and complex information, and the lack of personal identity and accountability with anonymous participants or the use of pseudonyms (online “handles”). Yet, online communicators found ways around these shortcomings, quickly and easily adopting means of conveying information, enjoying their anonymity, and expressing emotion through texts (eg, with emoticons). Early explorers of these new regions were able to observe the reformation of social and communal ties through online means as these were “uncoupled” from face-to-face interaction (eg, [
Yet, another effect observed for these lean media has been the reduced inhibitions associated with communicating, for example, the ability to talk through text without face-to-face contact or the need for immediate response. This can be an important feature that encourages new career professionals to communicate (as in #hcsmca), or patients to discuss emotional experiences [
Although our analysis did not focus on newcomers, the results and overall structure of the network suggests that a significant number of isolates, not connected in the Name Networks that signify attention to others (see
While social media may be considered in their online context only, it has long been recognized that media are not used in isolation from offline interaction and that they are instead embedded in everyday life [
Media are not used in isolation but as part of a repertoire that affords connection to resources and to others. This repertoire also includes face-to-face interaction and can support blended learning [
Moreover, it is not just delivery of information that is involved in these collaborations. From considerations of community, attention has expanded along with new forms of social media to consider different forms of interaction, from the friend relationships of Facebook and other social networking sites [
Our analysis of HCSMCA did not focus on the multiple platforms that participants use for health care information and conversation, or the way #hcsmca fits with other parts of participants’ lives. As such, results about community based solely on Twitter interaction have the potential to underestimate the foundations for community that come from joint and shared interaction across networks and platforms. Again, this is something worthy of further analysis and of interest to community builders as they consider how Twitter works with other venues to help support their community.
We asked at the outset what accounts for the relative longevity of this particular online community and have found that it is based on interaction patterns of participation and prominence of the group’s founder and a small core of key participants who are heavily engaged in social media and health care networks. Longevity is supported by the structure of weekly discussions, which creates a communal structure for interaction. We also asked what constitutes the composition of this community and found that it consists of individuals who may be classified as belonging to a number of different roles, but that communication flows across roles and thus the network reveals a community of one major component. The network also shows a large number of individuals who are present in the community but not actively connected to others and who may be benefitting from observation of the conversations and are potential future active participants.
Our purpose has been to show how a social network analysis can reveal such patterns and how past work on online community can help in interpretation of such results for the creation and maintenance of online communities for health. In brief, the implications and recommendations are:
Leaders and core participants can seed a network by altruistic or proactive use that, initially, provides more benefit to others than they receive in return. However, for long-term sustainability that persists beyond leadership change, the network needs to grow in a way that distributes leadership and participation beyond single leaders.
Prominence in the network appears to be related to familiarity with individuals, for example, more active participants receive more attention in terms of mentions and retweets. Thus, a recommendation is that moderators of discussions build authority in the network prior to their moderation duties to be able to connect better with ongoing discussions.
More prominent actors are engaged in multiple networks relating to health matters. As these actors also bridge networks, they are able to carry the message of the network to others. Thus, a recommendation is to engage these types of actors as a way of increasing the reach and prominence of the network itself.
Peripheral participants represent untapped resources for the network. Finding out what motivates such participants can help identify those who will make contributions in the future and thus how to bring their participation into the community.
Network analysis and visualizations provide a set of techniques and a vocabulary about network interactions that can help both group leaders and participants to see the size, shape, and configuration of the network in order to gain a better understanding of its operation and the place of individuals in that operation. Attention to roles can reveal both emergent roles (eg, core participants) as well as show the influence of existing roles (eg, different medical or sector roles).
This analysis of one social media site highlights the way social network analysis can be used to gain an understanding of social media use for communication and conversation and how network formations support such communities. However, this example has barely covered the beginnings of potential applications. Some key questions that remain and can form the basis of future work are: How do we implement and measure the impact of social media on health for individual patients and for the general population? What single and/or combination of media provide interaction around health that is effective over the short and long term? What combinations of participation and contribution create interest and sustain communities that discuss and continue to apply better practices for health and well-being? The task is complex as it requires understanding the rapidly changing and expanding media options in relation to changing institutional and societal practices, yet the opportunity is there.
We believe the principles of social networks and the techniques of social network analysis provide a solid foundation for understanding relationships and their formation online and for taking that into social media practice for health. Attention to network relations emphasizes what we do together, rather than what medium or face-to-face venues we use. This approach has proved useful for understanding the societal turn to online communication, relational maintenance, community genesis, and sustainability. There are already studies and models that have addressed health from a social network perspective (eg, [
This paper was first prepared for the workshop
None declared.