IS researchers view value as the worth, desirability, or utility of IS artifacts [43], as happy endings in terms of system impact [45] or as the positive outcome that is created through user-system interaction [46]. In health care, however, value has been conceptualized as the health outcomes achieved per dollar spent [30,47,48] or as patient outcomes divided by total costs for providing care [49]. Value in health care is evidenced by the outcomes achieved [30]. However, some health care outcomes may not be immediate, and thus, they may be difficult to measure.

A good measurement criterion for health care social media should reflect its technological features and health care context. As an IS artifact, social media needs to be evaluated based on outcomes achieved after user-system interaction. However, given that the context is health care, these outcomes should be wellness. On the basis of this argument, the value of health care social media seems to be the positive outcomes it delivers to the intended recipient after interaction with the application.

Effective social media platforms are sticky, meaning that users visit them frequently and also spend a fair amount of time on them [50]. Continuing to use a social networking platform indicates that the user must experience some benefits or satisfaction from it [51]. After signing up for social media, the value of the services becomes a factor in their continued usage. Users must receive some perceived value or benefits for using the network, otherwise there would not be any motivation for users to continue using the network after joining [51]. The value users derive from using health care social media could reflect hedonic or utilitarian value.

IS value can be analyzed based on the type of value the IS artifact being studied delivers, that is, whether they provide hedonic or utilitarian value [43]. Hedonic value has to do with a product’s entertainment-related or emotional benefits, whereas utilitarian value has to do with what the product does or what it allows the user to do [52].

The literature reviewed suggests that users usually do not use health care social media for entertainment. Rather, they use the application because they see it as a medium to complete some necessary tasks, such as accessing or sharing health-related information. People that use social media for health-related activities have a clear intent for using the application; thus, they deliberately choose media that will satisfy given needs in terms of knowledge, social interactions, companionship, diversion, or escape [53]. In other words, social media is used in health care because of its functional value. Functional value represents value derived from effective task fulfillment [44].

The value of social media in health care settings can be considered either instrumental or intrinsic. Instrumental value is the property that allows something to serve as a means toward getting something else that is valuable [54]. A growing number of the literature [1,13,15] discuss how using social media in health care settings could yield value. Such uses can be said to be instrumentally valuable given that it serves as a means toward getting value. From this perspective, using social media in health care is not valuable in itself but valuable because it leads to other benefits. One way of measuring the instrumental value of social media in health care settings is to evaluate its capacity to develop engaged audiences in health promotion settings [24]. In this example, the use of social media is not valuable in itself, but a means to achieving the desired value which is an engaged audience.

On the contrary, intrinsic value is the property that makes something valuable in itself, as opposed to being a means to something else [54]. From this philosophical point of view, social media can be said to have intrinsic value in health care settings. In health care settings, the intrinsic value of social media can be measured by evaluating its impact on health care [22,55,56].

Value does not automatically arise from the properties of an IS, rather it results from the interaction of a user and a given IS in a particular context [44]. In IS research, technology is always linked with context. An IS such as health care social media can be used in different contexts; therefore, it is important to clarify what the use context is to ascertain its value [31]. To understand the value of an IS, it is essential to identify what is important to its users, that is, the value that users desire [44]. Clarifying the use case of an IS when studying its value yields clearer results [43,57,58]. That said, in health care, stakeholders often have numerous mutually exclusive objectives such as access to services, high quality, cost containment, safety, convenience, patient-centeredness, and satisfaction [30].

Although users’ objectives and contexts of use are relevant to understanding the value of an IS, many IS value research studies have failed to address the impact of contextual factors [58]. The literature exploring this subject as it relates to the use of social media in health care is scarce. However, a few studies [1,13,15] explored why social media is used in health care and identified 9 categories of reasons: public health promotion, organizational promotion, professional networking, professional education, patient care/education, research, peer support, crowdsourcing health initiatives, and harnessing patients’ feedback. This information is important because understanding what users are ultimately trying to accomplish is a prerequisite to defining the appropriate measurement criteria and which measurement tools to use [26].

Preadoption IS value research helps decision makers to understand which of the available IS options will most likely yield desired results. Going by the literature reviewed in this study, less or no research studies have focused on the preadoption of social media in health care, probably because trying to measure upfront does not yield much [5]. This suggests that many health care providers are adopting and using social media without knowing whether they are choosing the correct option for their context. If that is the case, then more research needs to be conducted in the area of preadoption of health care social media to help decision makers to understand which of the available social media options (eg, general purpose social media vs online health community) will most likely yield desired results.

Postadoption IS value research investigates the extent to which IS investments have actually yielded the desired value [43,58,68]. Virtually, all the literature reviewed in this study fits into this category. Most of the available literature examined the value of social media to health care providers that are already using the application. Postadoption value research is important because it yields information that allows health care providers to determine whether they have derived value from their social media initiatives.

When used for organizational promotion, the impact of social media on a health care practice can be determined using metrics that measure return-on-investment (ROI), that is, the gain or loss generated on the application relative to the amount of money invested [2,28]. Similarly, one can also measure the value of social media in health care by examining how social media compares with alternative mediums of professional medical education using cost analysis, that is, by comparing the ratio of benefits over costs [69]. Furthermore, medical literature [30,48,49] proposes that value be measured in health care settings based on outcomes achieved per money spent. This suggests that the value of social media in health care may be measured based on outcomes achieved from using the application per amount of money spent on social media initiatives. However, there is a need to distinguish between performance, which is measured by means of monetary indicators, and its (potentially different) values in terms of the subjective interpretation of (different) stakeholders [58]. In other words, the subjective nonmonetary perceptions of stakeholders are an element of value.

There are a wide variety of nonmonetary yardsticks that can be used to measure the value of social media in health care. For example, when used for public health promotion, the value of social media in health care can be measured based on its impact [70] and reliability [61]. Furthermore, the value of social media in health care can be analyzed in terms of its ability to capture patient-generated information [62] or based on health outcomes resulting from the use of the application [56,60,71] Other nonmonetary yardsticks for appraising the value of social media in health care include measuring its leveragability to drive health improvement [72,73], appraising the extent to which it increases outreach [74], or evaluating it based on the extent to which it facilitates audience engagement [24].

When measuring the value of social media, it is important to measure at different levels to see big picture results and see more granular results [26]. The value of social media can be appraised at the micro or aggregate levels [43].

Analysis of value at the micro level focuses on the individual or organization, whereas analysis at the aggregate level focuses on the network or society [43]. For instance, at the individual level, users’ perspectives are paramount when exploring the value of social media use [15,27]. At the organizational level, on the contrary, it is a bit more complicated to establish the value of social media use; thus, a taxonomic approach is recommended to facilitate a better understanding of the phenomenon [32]. Finally, at the societal level, the measurement complexity is more pronounced; thus, it is very difficult to measure the impact of digital artifacts such as social media on the society at large [75].

IS value research evaluates the worth, desirability, or utility of artifacts at various levels, such as the society, firm, organizational network, and individuals [43]. The value of an IS can be analyzed at the international, national, industry, organizational, and individual level [76]. Thus, the value of social media in health care can be analyzed at the international, national, industry, organizational, and individual level.

At the international level, the value of social media in health care can be viewed in terms of the ability of the application to support the creation of online health communities that allow health care providers from around the world to interact, without the limitation of geographical location [9]. At the national level, the value of social media in health care can be measured by, for example, evaluating the social media performance of hospitals in a particular country [77]. At the industry level, there are different plausible ways to explore the value of social media in health care, for example, by measuring to see whether hospitals’ social media ratings reflect their actual level of competence [66], by measuring to determine the value of social media to the medical profession [6], or by evaluating the potential benefits of using social media to facilitate continuing medical education[69,73]. At the organizational level, the value of social media can be understood in terms of its value in organizations [32], by, among other approaches, measuring the ROI on the application [2]. Finally, at the individual level, the value of social media in health care can be measured by, among other options, exploring the motivations and consequences of its use [27] or by comparing outcomes with the value users desire from the application [15].

The quantitative approach to measurement is the systematic empirical investigation of observable phenomena via statistical, mathematical, or computational techniques [78]. Most relevant theoretical and empirical research papers appear to be concerned with quantifying impact in health care settings. At the basic level, social media impact can be measured by quantifying the number of hits, page views, visits, return visits, unique visitors, cost per unique visitor, time spent, and interaction rate [79]. Some of the other quantitative methods suggested in the literature reviewed include calculating to determine the ROI of social media [2,28], determining the online influence of a health care provider that uses social media by calculating their Klout score [80], and using a cost-benefit analysis to determine the value of social media in health care [69]. Another quantitative metric for measuring value in health care settings is to calculate health outcomes achieved per dollar spent [30,48,49].

The qualitative approach to measurement is a systematic method of observation that is used to gather nonnumerical data [78]. This type of research identifies meanings, concepts, definitions, characteristics, metaphors, symbols, and description of things and not to their counts or measures [78]. The qualitative method is particularly relevant to measuring the value of social media in health care because its value may manifest in ways that quantitative metrics alone would be unable to capture. Intangible value created by IS artifacts is as important as other types of IS value [58]; therefore, relying solely on traditional measures such as hit counts or other quantitative methods to measure IS value may yield less accurate results than if some level of qualitative analysis is incorporated in the measurement process [40]. Some of the qualitative methods that have been used to explore the value of social media in health care include sentiment analysis [65], taxonomy [3,15], and analysis based on uses and gratification [53].

An alternative to both quantitative and qualitative methods is the mixed method research approach. Mixed method is a research approach that uses multiple methods—more than one research method or more than one worldview [81]. It may combine quantitative and qualitative research methods in the same research inquiry to develop rich insights into various phenomena of interest that cannot be fully understood using only one research method [81].

The review of relevant literature suggests that mixed method is relevant to investigating the value of social media in health care settings, especially in instances where one method alone may not effectively capture the outcomes resulting from using the application. For instance, using mixed method to research the value of social media in health care allows one to measure the level of audience engagement, determine what resonates with the audience, and changes resulting from behavioral and educational interventions [72]. Some of the ways mixed method has been used in health care social media research include combining social network analysis with content analysis [82], combining content, thematic, and comparative analysis [83], and combining experiment with qualitative analysis [84].

The nominal scale is an unrestricted assignment of numerals, words, or letters to events or objects simply as labels or unique identifiers to indicate distinct types [36]. The nominal scale is regarded as the most basic form of measurement and is used to categorize and analyze data in many disciplines. When measuring the value of an IS, the scale level of a value item does not necessarily have to be cardinal when it is difficult or even impossible to find reliable numerical data [58]; hence, an alternative yardstick such as the nominal scale could be used.

The literature review revealed that the nominal scale is relevant to appraising social media in health care, as it is used for categorization. For instance, health care social media can be grouped into 2 broad categories, namely, general purpose Web-based social networks and online health communities [3]. general purpose Web-based social networks are websites such as Facebook, Twitter, Instagram, and YouTube that enable mass collaboration. Although these platforms are not designed specifically for patients and health care–related communication, their features and functionalities make them suitable for health-related communication [3]. online health communities, on the contrary, are social media websites such as MedHelp and PatientsLikeMe, which are specifically designed for health-related communication [3]. Going further, the use context of social media in health care can be categorized into 4 broad categories based on participants: P2P, P2C, C2C, and C2P [3] At the granular level, the uses of social media in health care can be grouped into 9 contexts of use: professional networking, harnessing patients’ feedback, public health promotion, professional education, patient education, organizational promotion, crowdfunding health initiatives, research, and peer support [15].

The advantage of using a nominal scale is that it can help with classification of types of social media used in health care and the context in which they are used. It can be used to determine mode; for example, the most used type of social media (eg, general purpose or online health communities or Facebook, Twitter, and others) in health care. From reviewing relevant literature, it is apparent that general purpose social media are some of the most used type of social media in health care. The general-purpose social media most referred to in the literature are Facebook [56,66,83] and Twitter [24,65,82].

Ordinal level of measurement is the second of the 4 measurement scales. It is used to measure a categorical, statistical data type where the variables have natural, ordered categories but the distance between the categories is not known [36]. Ordinal scales are relevant to measuring health care social media in situations where there is a need to compare phenomena. For example, anecdotal evidence suggests that some health care providers use social media more effectively than others [31]. Going by that assertion, health care providers that use social media can be ranked based on how effectively they use the application: highly effective user, effective user, and ineffective user. This kind of ranking allows data regarding health care social media to be sorted; however, it does not allow the relative degree of difference between them to be determined. On the basis of the ranking, one can tell that one user is more effective than the other at using social media; however, the extent to which a highly effective user is better than an effective user cannot be described. Similarly, patients’ perceived quality of care could be measured based on Twitter data [65]. Speculating based on that assertion, patients’ perceived quality of care can be ranked based on quality level, for example, high quality, medium quality, and low quality. The median can be determined in this way, but the average cannot. The rankings indicate the patient’s perceived quality of care received but does not provide sufficient information to determine the exact difference in quality between the various categories.

The interval scale is a quantitative measurement scale in which the order and the exact differences between the values are known, but that does not imply the existence of a true zero point [36]. The interval scale allows for the degree of difference between items to be determined, but not the ratio between them, for instance, date when measured from an arbitrary epoch such as anno Domini (AD) or before Christ (BC. Using these scales, it may be misleading to say that one value is twice or some other proportion greater than another.

Interval scales are relevant for measuring social media in health care. Any measurement criteria that include time or date, technically include an interval scale, since hours and days are all interval measurements. For instance, interval scales can be used to identify optimal times for engagement and to tailor strategy so the right content is posted at the right time (when the audience is most active) and the best days of the week. Through Facebook insights, one can view their followers’ daily activity over the past week and can go further and narrow it down to individual days to see how engagement shifts by the hour. By being able to see how audience engagement with their social media changes over a designated period, one can determine which periods are best for bringing in new fans. Using an interval scale to measure social media, one could find that evenings are better than mornings or that weekends are better than weekdays when it comes to audience engagement. That would allow for the degree of difference between these periods to be known but not the ratio between them, given that terms such as weekdays, weekends, mornings, and evenings are ambiguous.

The ratio scale is a quantitative variable measurement scale that allows comparisons to be made between intervals or differences. Ratio scales are used to estimate the ratio between a magnitude of a continuous quantity and a unit magnitude of the same kind [85]. Unlike the interval scale, the ratio scale possesses a nonarbitrary zero value; thus, most measurements in the physical sciences fall under this category.

Ratio scales are widely used in social media measurement, and most social media metrics are examples of the ratio scale. For instance, ratio scales allow social media managers to measure the number of page views, visits, return visits, unique visitors, cost per unique visitor, time spent, and interaction rate [79]. Furthermore, when measuring social media performance, ratio scales can be used to calculate the impressions-to-interactions ratio [28]. Ratio scales can be used to determine how much (magnitude and amount) of something. In health care settings, for instance, the magnitude of a research recruiter’s influence can be determined by calculating their Klout score [80]. Influence in this context refers to a measure of a user’s ability to drive action from their posts or social interactions. In financial terms, ratio scales can be used to determine the amount of financial benefit a health care provider derives from using social media. For instance, a health care provider can use the ratio scale to calculate the ROI of social media to their practice [2,28].

Ratio scales can also be used to determine how many (count) of something. For example, ratio scales can be used to determine how many health care providers use social media or a particular type of social media [86,87].