JOFF.

The impact of social media on health communications in regional indigenous communities.

What are the challenges and opportunities to utilise social media networks to engage in discussions with remote indigenous communities to improve health outcomes and foster positive relationships with health practitioners?

When defining such a broad term as ‘social media’ it is essential to ‘draw a line to two related concepts that are frequently named in conjunction with it – Web 2.0 and User Generated Content’ 12 – the convergence of these two concepts creates ‘a platform whereby content and applications are no longer created and published by individuals, but instead are continuously modified by all users in a participatory and collaborative fashion’12. According to Aichner and Jacob, Web 2.0 essentially enables social media and serves as an umbrella term to describe the many different technologies running in the background of social media applications and platforms1. Social media is therefore not limited to social networks like Facebook but includes blogs, business networks, collaborative projects, enterprise social networks, forums, microblogs, photo sharing, product/services reviews, social bookmarking, social gaming, video sharing and virtual worlds 7. Evers, Albury et al. outline the ways in which social media ‘enable users to create a profile; define online a personal network; make visible their online connections to other people, communities, and organizations; engage in dialogue; and share, remix, and create media 11. Organisations seeking to drive outcomes through this new communication form need to find new methods of communication that drive engagement amongst their target audience. Baym provides a definition of online engagement that is ‘visible, traceable, and takes new forms, where online, engaged fans connect across time and space, build and sustain group discussion, create repositories of information and derivative works, and build new distribution networks amongst themselves, all of which become visible not only to one another, but also to industry and creators’ 7.

Engaging in various forms of social media is a routine activity that research has shown to benefit children and adolescents by enhancing communication, social connection, and even technical skills 15. Web 2.0, social media and the lexicon of new language used to describe online communications has driven innovation, shared knowledge across disparate locations and enabled interactions never before experienced by the human race. Benefits such as enhanced communication, social connection and the advanced technical capabilities – new domains of learning that seem so easily adopted by younger generations – has significantly enhanced communications, providing the consumer choice of device (phone, tablet, laptop, desktop or wearable tech), choice of connection (mobile service carrier, public Wi-Fi networks, home internet connections, Bluetooth connectivity), and choice of channel (social networking services such as Facebook, Twitter, Instagram, LinkedIn and a vast array of available networks). Social connections are fostered by group participation and activities, driving online collaboration using tools such as Trello, Asana, Google Docs, along with other tools that include real-time collaboration on documents, file sharing and more. Social communities form based on mutual interests through social networks such as Pinterest and Instagram, social competition turns to online channels in a concept known as MMORPG. MMORPG refers to ‘massive multiplayer online roleplaying games and their social communities, and it is closely linked to the broader MMO classification, referring simply to all massive multiplayer online games’ 2. Advancements in the technical capabilities of Web 2.0 have evolved over time driven by the growing psycho-social need for humans to have social connections, in whatever form they come.

Driven by the demand for mobile network connectivity, along with the availability of mobile phones for purchase in local post office or shops, communities have rapidly adopted the relatively affordable and easy to use technology for their benefit 13. Indigenous youth have turned to mobile technology and social media to communicate across vast distances between remote communities in the region where access by road is cut off during monsoonal rains, to practice culture, and to reinforce relationships 13. The excitement of mobile technology and social media had prompted many elders, young adults, and especially teenagers to see it as an organic element of their lived experience instead of a novel piece of technology 13. In the formative years of youth social inclusion plays a critical part in developing a sense of identity, both individual and group identity. Meyrowtiz claims that group identity is based on ‘shared but special information-systems’, further stating that ‘the merging of many formerly distinct situations through electronic media, therefore, should have a homogenizing effect on group identities’ 14.

Mental health is a term that has been used a lot, mainly by non-Indigenous people, to describe how people think and feel, and how they cope with and take part in everyday life 5. According to Edith Cowan university’s Australian Indigenous HealthInfoNet, Indigenous Australian’s prefer the use of the term Social and Emotional Wellbeing” stating the term ‘is used by many Aboriginal and Torres Strait Islander people to describe the social, emotional, spiritual, and cultural wellbeing of a person. The term recognises that connection to land, culture, spirituality, family, and community are important to people and can impact on their wellbeing. It also recognises that a person’s social and emotional wellbeing is influenced by policies and past events’ 5. Ersahin and Boz define communication as ‘the mean for creating connections, contexts, products, intertwined in our very existence. Communication also helps us to be successful in both personal and societal level. It is also a vital source for our wellbeing, mental health and quality of life in general’ 10. Social media communications have shifted cultural norms, identity and has a signifcant role to play in improving mental health amongst our indigenous first nations people. Social media and online communications tools are assisting organisations in developing health promotion through online communications channels, however Karlippanon and Senior espouse this is just an ‘ideological separation between the western biomedical model and Grounded Aboriginal Theory to create a neutral knowledge landscape as a compromise 13. Technological and digital innovations represent particular challenges for users and distributors of medical and health related knowledge and practices, but also for those governing and regulating the exchange of knowledge online 21. In the offline world, it is common that knowledge is exchanged among many participants, and three-dimensional communication models and spaces have already been discussed in various disciplines long before the internet era 21.

‘Humans have evolved to operate socially, from infancy, when the social connection to parents is critical for survival; to childhood, when learning is accelerated by the transmission of accumulated human knowledge; and to adulthood, when access to food and mating partners depends on social inclusion’ 23. Meyrowtiz states that ‘new access to information will not necessarily affect social interaction unless everyone involved knows about the access. Or, put differently ‘knowledge of people’s access to information is itself a significant piece of social information’ 14. This definition touches upon the most important facet in communications regardless of medium when it references social connection, and the need for social inclusion. Kaplan and Haenlein argue that ‘while [social media] enables the detailed following of friends halfway across the world, it can foster a society where we don’t know the names of our own next-door neighbours’ 12. Effective health communication is ‘an essential tool for establishing good psychosocial conditions for the user, the professionals, and people in general’ 21. In addressing the objective of ‘targeted, evidence-based action that will contribute to achieving equality of health status and life expectancy between Aboriginal and Torres Strait Islander people and non-Indigenous Australians by 2031’ 3, the Australian Digital Health Agency claim to be ‘improving access to health information including eHealth, recognising that for many Aboriginal and Torres Strait Islander people, language or lack of transport may be an additional barrier to accessing health services 3. The agency also claim they ‘enhance health system performance in areas of access, coordination, integration, responsiveness and the use of technology where these encourage increased use by Aboriginal and Torres Strait Islander people, including those with a disability and those incarcerated 3.

But a communication strategy published by the Australian Digital Health Agency presents a slightly different story, claiming to drive communications ‘at a local level’ across the Public Health Network (PHN). The National E-Health Strategy published in 2008 outlines the significant challenges in delivering high standards of health outcomes, citing ‘significant differences between the health outcomes for advantaged and disadvantaged, particularly indigenous Australians’ 4 but makes no further reference to indigenous Australians throughout the remaining document. Despite the Australian Digital Health Agency failing to address any issue of e-health service delivery to indigenous Australians, the agency presented a submission to the Senate inquiry into the My Health Record program that listed a number of key strategic documents the agency plays a role in delivering outcomes on behalf of, for example the National Aboriginal and Torres Strait Islander Health Plan 2013 – 2023. The evaluation of this program paints a less rose coloured version of service delivery, with the report produced by the Department of Health and Ageing citing that ‘there is uncertainty at the peak body level about the value of telemedicine initiatives in Indigenous communities, as the face-to-face relationship with patients is of the utmost importance culturally and it can take a long time to establish trust and rapport. It is also important to seek the permission of tribal elders when entering a community to provide health services 9. It seems that despite the efforts of the Australian Government they still have not acknowledge the future direction for indigenous health as an indicator of cultural value and formation of identity.

The world has always been inhabited by diverse populations with their own unique sense of identity, spirituality and cultural traditions. The invention and development of new technologies have enabled us to communicate these identities on a global scale 24 with proliferation of mobile phones and social media into remote settings such as North East Arnhem Land made possible ‘as a result of telecommunication network provider Telstra’s increased reach of the 3G mobile network with Internet capability’ 13. ‘From the invention of the wheel to the development of smartphones, technology has influenced human culture just as much as culture has influenced the evolution of technology’ 24. Predating the adoption of the internet and Web 2.0, Meyrowitz (referencing television and radio at the time) stated ‘the flexibility and speed of “travel” through electronic media foster a trend toward flexibility and speed of access to physical places 14. The functionality of mobile phones and social media allows Aboriginal communities and families to overcome their lack of economic resources required to travel across vast distances for the maintenance of traditional law, ceremony, and the reinforcement of kinship relations 13. Spirituality ‘is often concerned with one’s existence in serving to an ultimate power, purpose, meaning; a value for life’ 10, needing ‘a holistic approach to health that goes beyond focusing on illness or specific parts of the body, but instead considers the whole person and how he interacts with his or her environment’ 10.

Svalastog et al consider the complex interactions between technology, knowledge, social contexts, stakeholders and their various agendas, policy, economy, and worldviews represent a future challenge for interdisciplinary elaborations 21. Karlippanon questions whether ‘the use of social media and mobile phones in promoting health messages can be designed to be more effective by drawing on the Groundedness of Aboriginal Theory through a process of reflexivity, ‘sittin telling story’ and performance, instead of a focus on the causality of mortality and morbidity associated with lifestyle choices’ 13. In the ‘Digital Age’ blog, the University of New South Wales state that ‘the relationship between technology and culture is a complex relationship, a figurative circle of influence, and it offers unprecedented opportunities for economic growth and community wellbeing. Australia can capitalise on these opportunities, if its willing to recognise that the future of arts and culture, is digital 24. Succinctly, the article on the ‘Digital Age’ blog states that ‘if the government intends to meet its ambitious goal of transforming Australia into one of the world’s leading digital economies, then it needs to get serious about investing in digital culture’ 24.

The effective translation of indigenous Australian cultures and our national identity is critical for the preservation of our national identity and developing a “digital narrative” of indigenous storytelling, driven by our indigenous youth seems the most forward-thinking approach to success. The use of technology clearly aligned itself naturally to the needs of a community separated by vast distances. Within the nexus of globalisation and an Aboriginal modernity in its early stages, health promotions and social marketing messages have taken on new technology and populated social media and mobile phones with Facebook posts and SMS text messages 13. The mobile phone had become the new ‘message stick’, but the novelty of this medium of communication is eclipsed by the primary practice of sharing and inclusivity in the observance of traditional funeral ceremonies 13. The technology that is available in the remote community of North East Arnhem Land enabled video material to be shared via video calls, posted and viewed online, or even shared over Bluetooth connectivity between mobile phones in close proximity. This also created a set of new health promotion opportunities for health services and for collateral communication channels between health services, the individual, and the community to be explored and subsequently forced upon the community 13. A report produced by the Department of Health and Ageing states limitations of e-health ‘include lack of familiarity/acceptance by Indigenous people, and the lack of funding through Medicare for telehealth and case management for allied health practitioners 9 and for the most part it seems health communication to indigenous Australians seems lost in translation. Indigenous Australian health issues are complicated by ‘differences in the definition of mental health concepts and associated terminology between Western and other (including Aboriginal) cultures’ 20. Karlippanon and Senior state that health professionals often presume ‘the production of social media messages, text messages, and video to engage Aboriginal community members, particularly teenagers and young adults, as effective translational tools 13.

Knowledge communication between different stakeholders is deeply affected by new online tools like internet homepages of medical and research institutions, patient interest groups, video-sharing websites, social media and blogs, digitalised health records and other registers, mobile devices and smartphones, etc 21. A report produced by the Department of Health and Ageing states that ‘shared EHRs like the PCEHR would be very useful for Indigenous communities due to the mobility of populations, but there is suspicion of systems where multiple people access the record because of privacy and confidentiality issues 9, doubting its application for indigenous Australians and unlikely to be acceptable ‘if it is provided as a videoconference, as concerns that this will be used by Governments to replace existing services that are working well, for financial reasons 9. Parker and Thorson state ‘the development and adoption of new digital communication technologies is changing the ways we access information, develop relationships, coordinate activities, and address social issues16. This technological shift has driven a fundamental change in society. Speaking on modernity, Ersahin and Boz discuss how ‘we utilise advanced technology in treating diseases, easing our challenges physically, acquiring higher levels of education, accessing opportunities to advance our prosperity and connecting with others and surroundings’ 10.

The homogenisation of identity driven by the formation of group identities in an online communications context can create concepts such as the ‘echo chamber’. Bessi defines a virtual echo chamber as ‘largely closed, mostly non-interacting polarized communities cantered on different narratives… where enclaves of like-minded people consume information in strikingly similar ways” 8, although Meyrowitz states that ‘the shared information environment fostered by electronic media does not necessarily lead to identical behaviour or attitudes among all individuals but does create ‘common awareness and greater sharing of options. The choice of dress, hair style, speech patterns, profession, and general style of life 14. Youth and adolescents are at greatest risk from the effects of social media. O’Keefe and Clarke-Pearson claim the risk to youth and adolescents are significantly greater ‘because of their limited capacity for self-regulation and susceptibility to peer pressure’ 15. Ersahin and Boz support this argument claiming that ‘the numbers indicate higher levels of stress and anxiety, loneliness and burnout, broken family ties, violence, hate and crime, suicidal rates, and so on 10. If electronic media leads ‘to a nearly total dissociation of physical place and social “place”, then when we communicate through telephone, radio, television, or computer, we are physically no longer determining where and who we are socially’ 14. At the same time, users are directly interacting with the online resource and are physically distanced from it, as it could be located anywhere in the world 21. O’Keefe and Clarke-Pearson identify a number of issues that are presented online in correlation with offline behaviours, from ‘clique-forming, sexual experimentation, cyberbullying, privacy issues, and “sexting”, internet addiction and concurrent sleep deprivation’ 15.

In Australia, mental health disorders affect an estimated 26% of young people aged 16-24 6. For 25-44-year old’s, the top 2 causes of death for men in 2011 were suicide and accidental poisoning 6. Health inequalities, including mortality inequalities, are driven by many factors including biological, lifestyle, socioeconomic, societal and environmental factors 6. Many efforts have been made by Australian governments and non-government organisations to improve health in disadvantaged groups and reduce health inequalities, for example the national Closing the Gap initiative, which seeks to reduce Indigenous health inequalities 6. In this report, Saunders, Naidoo and Griffiths state that despite welfare reform policy setting a goal of improving social participation much of the Australian debate ‘has been narrowly focused on employment to the neglect of the structures, processes and actions that are major contributors to exclusion’ 19. The report conducted by the Australian Institute of Health and Welfare concluded ‘Indigenous Australians are more likely to live outside metropolitan areas than non-Indigenous Australians and have higher mortality rates. Mortality inequalities by remoteness are likely a result of the interplay of many factors, worth further exploration in order to understand where actions could best be targeted to improve mortality outcomes in regional and remote areas’ 6. Furthermore, analysis by the Social Research Policy Centre revealed ‘the level of deprivation experienced by Indigenous Australians exceeds that of the non-Indigenous population by a factor of more than four-to-one’ 9. Further studies into indigenous health in regional Australia should examine the interplay of culture, identity and spirituality in the social and mental wellbeing of Australia’s first nations people.

An exploration of health communications to indigenous Australian youth through social media and digital communication channels‘ was written by Joff Crabtree as part of a research project on strategic communications in a digital age, during studies at Murdoch University in 2019.

Citations in this article

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