The demographic focus of interventions also varies with the problem being addressed.

Although many
of them target young people, who are generally perceived as the major users and consumers of digital
content, many interventions target other population groups too. Based on the current trend there will
be an increase deployment of social media for health outcomes. However, it would be necessary to
consider their effectiveness and sustainability. Practical field experience seems to indicate that the
deployment of social media for public health delivery is being viewed as another ‘pet project syndrome’
of development agencies for their branding and visibility. Many of the interventions are branded for
specific agencies with limited linkages and coordination. It is thus critical for development institutions to
ensure greater coordination of social media programmes to enhance their effectiveness. Strategic
alignment of social media interventions will be more impactful rather than the current fragmentary
efforts supported by different development agencies. This will ultimately reduce transaction cost and
achieve more mileage.

A Flood of Messages

The overall goal of health communication is multifaceted: addressing the information gap on specific
issues, changing social norms and promoting a positive attitude among the target audience. However,
the use of social media seems to be more for ‘information blast’, ‘message storm’ or ‘buzz creation’ or
‘noise’ around specific health issues. Most of the projects attempt to deliver messages, while some focus
on group conversation. How such conversation is converted desired behaviour and social change is
unclear. Conceptually, social media devices and platforms are largely used for sharing, networking, and
connectedness [47]. It is thus essential to underscore the need for a stronger conceptual underpinning
of E-Health communication interventions in relation to the pathway to social and behaviour change for
different demographics and audience segmentation. While social media platforms are appropriate for
message internationality in health education, they may not be particularly effective in addressing
underlying structural issues and deep-seated cultural practices. Also, social and behaviour change is a
complex process and merely reaching specific individuals with information will not result in behaviour
change. To this end, it is critical to consistently apply a theory of change construct to each social media
intervention in order to determine their level of social and behavioural outcomes.

Focus on Digital Innovation

From this study, it is apparent that development agencies have become so enamoured with social media
interventions. As demonstrated, the range of application includes mobile phone technology,
Thunderclap social media tools and web-based applications for information sharing, connectivity and
even for training. Yet, it is apposite to reaffirm the established notion that technology is merely a tool of
development and health communication [21,48]. Having the gadget is not the same as using it for health
outcomes or for predetermined behaviour by health communicators.
Inequity Amidst Social Media Ubiquity

Despite the avouched ubiquity of social media, inequities exist on several fronts. Although the reach of
digital interventions is significantly higher than the traditional Information Education Communication
(IEC) process of engagement, it still has limited coverage and access. Equity issues are not limited to
access but to utilisation. A study on young people in Kenya reveals disparities in access and utilisation of
social media by young people, consistent with earlier studies [49]. In addition, [50] highlights the issue of
exclusion and inequalities in digital communication while [51,52] underscore the need to redress the
digital divide that characterises access to and utilisation of digital technology. Thus, for effective
utilisation of social media for health communication, an equity-focussed perspective will be critical.

Experts-Driven Interventions

The role of meaningful participation of critical actors and target audience has been unequivocally raised
in development discourse [53,54]. But the extent to which their voice is framing social media
interventions is uncertain. Thus, for effective social media programming to achieve public health
outcomes, a stronger emphasis on the voice of the beneficiaries would be central [55,56]. A shift from
needs assessment to rights analysis, coupled with an adjustment from ‘information transmission’ to
‘participatory learning mode’, will be desirable. This also assists in eventually changing the narrative of
development discourse, which is still currently monopolised by experts.

Enhanced Partnerships

E-Health communication interventions have clearly demonstrated the power of creative collaboration
among different stakeholders such as government institutions, development agencies and the private
sector. Many digital service providers in the E-Health communications sphere are mobile phone
companies investing in products and solutions to avail the population with health services and health
education platforms. Such collaboration has been recognised as indispensable to achieving development
outcomes [57]. However, additional strategic thinking around sustainable relationships for public good
will enhance the role of the private sector in health communication and overall international
development. Also, widening the focus of partnership beyond corporate institutions to networks and
communities helps in community E-Health communication approaches.

Conclusion

Advancements in digital media have led to significant enthusiasm on the use of digital technology for
health and development communication. Multiple interventions have been instituted using different
social media tools, platforms and devices for health promotion. However, in view of the functional and
dysfunctional potentials of social media in society, a pragmatic perspective of their role is necessary.
First, this requires questioning their underlying assumptions and avoiding the tendency toward ‘magical
effects’ syndrome that currently characterises the deployment of social media for public health. While it
is important to celebrate the potential and impact of social media in health communication, arrogating
“unlimited - uber-effect” to them takes the discourse on media effects back to the era of hypodermic
needle model, which is out of tune with reality. Second, technology is a tool of development not an end
 in itself. Thus, we need to be mindful of a drift toward “new media utopianism” or “social media-
centricism”. As [58] rightfully suggest, it is important to bridge the potential of E-Health communication
with its reality in view of challenges associated with limited access, linguistic, cultural and literacy
barriers. Therefore, a more pragmatic perspective of the promise and performance of social media
technology in health and development programming and a full appreciation of their limitations in health
communication are called for. Third, the author argue for a holistic approach to social media
programming in health communication with the leadership of national partners. As currently structured,
many of the interventions reflect the interests of various agencies and end up as pilot projects and
hobby ideas of such institutions.

Implications for the Study and Practice of Communication

In view of the relative novelty of the devices, the speed and scale of new social media interventions will
likely increase. As a result, communication education in a social media age needs to consider their
implications for communications theory, practice, policy, research and training.

i. Theory: Of particular importance is the need to generate and widen theoretical insights on how
social media respond to the pathway of change in a social and behavioural context. Media use in
health communication is intended to contribute to specific or overall areas of change, such as risk
perception, vulnerabilities, individual agency and levels of influence in social change. Thus far,
substantial theorising is lacking or weak in the literature. Hence, developing appropriate theories of
change for effective grounding of social media interventions is of utmost urgency in maximising the
power of social media in health communication.
ii. Practice: A more robust interdisciplinary framework in designing and implementing social media
programmes for public health delivery is called for. Health promotion has always required insights
from different intellectual domains, but in the digital age, heightened engagement of various
professionals is all the more crucial for effective delivery of social media interventions. A wider
space for critical users of social media needs to be created for effective design and execution of
such programmes. This will also eventually influence the current development discourse, which is
still largely driven by experts.
iii. Policy: Systemic policy and programme framework for effective mobilisation of the power of social
media for wider development outcomes is paramount. Although many African countries have put in
place policies to harness ICT for the continent, they need to respond to the social and behavioural
dimensions of the overall health and development context. More investment is needed in E-health
communication policy design and implementation from our communications institutions.
iv. Research: Additional research, meta-analyses and analytical studies with strong evaluative and
comparative perspectives are necessary to generate evidence for effective programming in this
area. After several years of pilot studies, more cutting-edge perspectives and evidence to advance
current thinking have become increasing fundamental. The research agenda should include impact
and outcomes of interventions and greater hybridization of platforms. More amenable and
accessible monitoring and evaluation skills and insights are required for effective e-health
communication programming. Training: Communication institutions need to continuously reinvent
their curricular and teaching methodologies to be ahead of the current international development
and public health discourse. Courses that integrate informatics, data sciences, epidemiology, social
marketing, philosophy, communications and human rights might need to be considered to provide
the development industry with inerrant combinations of insights, perspectives and skills. Non-
traditional frameworks that connect even disparate domains of knowledge will be necessary in
formulating social media programmes for scale and agility in a highly contested and rights-oriented
digital world. In essence, a more nimble approach to the study and practice of communication is
desperately needed in an ever changing digital world.