The Kids Are Alright

District health boards have a duty to promote immunisation against some common but serious diseases. As well as individual protection, immunisation provides population-wide protection, which needs a critical mass of immunised people for it to work. Achieving this level of immunisation benefits the population as a whole, reducing the incidence of the disease and preventing it spreading to vulnerable people.

In 2011, Waikato District Health Board (the DHB) used social media to try to minimise the spread of a measles outbreak.

Waikato District Health Board

The DHB’s mission is to build healthy communities. Health promotion and prevention are two ways that it does this. The DHB provides health services to almost 375,000 people living throughout a large and largely rural area. In 2012, the DHB’s budget was about $1.2 billion, and it had about 6200 staff.

Measles outbreak within the DHB's district

Waiting until school resumed was not an effective option.

In July 2011, the North Island experienced an outbreak of measles. Several cases were identified in Waikato teenagers who had recently travelled to Auckland, the centre of the outbreak. These cases were localised in the Waipa and Otorohanga districts.

Measles can be easily spread through contact with an infected person. In serious cases, measles can be life threatening, and about one in every six infected people requires hospital treatment. Once caught, measles is not easily treatable, so health professionals consider immunisation to be the best form of protection.

Not all of the teenagers in the high-risk areas (Waipa and Otorohanga) had been immunised. The DHB thinks this is due to anti-immunisation sentiment in the 1990s, around the time these children were born.

The anti-immunisation sentiment in the 1990s was not unique to New Zealand. In 2013, a measles outbreak in Wales led to more than 1000 cases reported in people not immunised due to anti-immunisation sentiment during the same period. Those aged 10 to 18 have been worst affected.

In the Waikato, the problem was potentially even more serious because the outbreak occurred during the school holidays. Normal methods of communicating with schools through the school nurse or visiting schools were not going to work. Because measles spreads very quickly, waiting until school resumed was not an effective option.

How did the DHB use social media to reduce the spread of measles?

In Te Awamutu, within the Waipa district, the DHB’s challenge was to prevent measles from spreading. It used social media to target teenagers and encouraged them to discuss immunisation with their parents.

The immunisation campaign attracted some negative comments.

At the time of the measles outbreak, the DHB had already begun to think about how it could use social media and mobile devices to deliver health services and important community messages. Given the urgency of the situation, the DHB decided to use several different ways to communicate its message. This ensured that people in the at-risk areas were aware of the measles outbreak, and what they should do to prevent further spread.

The DHB was keen to use communication methods that at-risk teenagers regularly used. It publicised the measles outbreak using Facebook and Twitter, giving details of the outbreak and directing people to the DHB’s website for more information.

The DHB didn’t have a large Facebook following at the time, so it identified various Te Awamutu and Waipa community groups that had Facebook pages it could post updates to.

The DHB also used other communications channels, including radio, local newspapers, and mailing residents in the affected areas. But the DHB considered Facebook an easier, more cost-effective way to quickly reach teenagers.

Dealing with negative comments

The immunisation campaign attracted some negative comments – they were not negative comments that appeared on social media, but negative comments about the DHB’s decision to use social media. Some anti-immunisation groups were opposed to the DHB’s measles message. They thought that the DHB was encouraging children to immunise without parental approval.

Public criticism was dealt with by releasing a statement reiterating the purpose of the campaign, encouraging discussion on immunisation, and explaining the reasons why the DHB used social media. The DHB told us that it didn’t have any significant issues with negative feedback or negative posts about the immunisation campaign through its social media channels.

The campaign was a success – there was no major outbreak.

The DHB’s approach in using social media was:

• to moderate all comments, mostly in business hours but sometimes, as required, outside of those times;
• to delete only unreasonable comments, such as nasty comments about individual DHB staff members - otherwise, all comments were to be left on the page, including criticisms of DHB policy or actions;
• that all comments, negative and positive, were to get a reply that would be recorded using screenshots;
• that staff would rely on informal guidance to deal with any negative comments (the communications team is small and did not consider lengthy protocols to be necessary, especially as the Director uses her judgement in dealing with any issues); and
• to not prepare answers in advance to potential questions about specific campaigns.

Was the use of social media successful?

The purpose of the DHB’s campaign was to prevent a major outbreak of measles. In that sense, the campaign was a success – there was no major outbreak. Beyond that, the urgency of the situation meant that the DHB did not spend very long thinking about how to measure success.

The DHB continues to refine its approach to social media use.

After the campaign, anecdotal reports from primary health organisations indicated a higher uptake of measles immunisation than had been seen in previous years.

How much extra did it cost to use social media?

The social media component of the measles immunisation campaign took about four hours of staff time. The costs of a major measles outbreak would have far outweighed any extra costs the DHB incurred by using Facebook and Twitter. For the DHB, counting the very low cost of using social media was almost irrelevant.

Applying the learning to other immunisation campaigns

The DHB has reflected on its social media use during the 2011 measles outbreak. Staff thought about what worked well and where they could improve. The DHB continues to refine its approach to social media use.

The DHB’s communications staff are responsible for social media and other online initiatives, such as website design. They also handle public relations and media liaison. The team’s use of social media is based on having some ground-rules in place, and a skilled team of people who work well together. The information technology used for the DHB’s social media and web-based work is supported by an external provider, reducing the risk of unauthorised access to other IT systems.

The communications team clearly led the use of social media, and was further supported by the DHB’s leadership team – particularly the Chief Executive. This working environment encouraged staff to think creatively about how to best use social media to communicate health-related messages.

Building on the success of the measles immunisation campaign, two further campaigns have used social media:

• The 2012 campaign for infant immunisation against whooping cough. This included a video clip of a child with whooping cough, which emphasised the consequences of not being immunised and was later used by national news media. The DHB posted regular updates to its social media pages as a reminder of the immunisation message.
• In 2013, the DHB partnered with the local “Super 15” rugby team, the Chiefs, to promote the ‘flu’ vaccine. The DHB used its social media pages to upload photos and videos of an event where the Chiefs were vaccinated, linking these posts to the Chiefs' Facebook page to try and improve the reach of the immunisation message. The event was covered by the national news media, and vaccination numbers were reported to be higher than previous years.

Overall, what did the DHB learn?

The DHB learned that strong leadership and trust are important, to be resilient when feedback is not always positive, social media has great potential for immediate messaging, and partnering with others can significantly increase the effect of social media.

The lessons Waikato District Health Board learned