The know-do gap: does social media help change things?

This post is prompted by a Facebook post from Connor Gleadhill asking “in what way is SoMe contributing to knowledge translation (KT)? I’m interested in the experience of those tagged and if anyone is aware if it has been rigorously tested. As far as I’m aware it hasn’t. Is it simply a confirmation bias arena? We are humans after all, and we curate our experience on SoMe.”

Oh such a great question and one reason I still hang out on social media!

I’ve been blogging since 2007, two years before the famous Body in Mind (who have just announced they won’t post any more content). Over that time I’ve risen to the top of the blogs, then plummeted down to my current level. Yet I still have a passion for doing this (usually) weekly post.

One reason I post is in answer to Connor Gleadhill’s question: one method for translating knowledge from journals into clinical practice is through online content. Content that’s accessible (not behind a paywall). Content that offers an opinion. Content that (hopefully) translates a-contextual information into a context more familiar to clinicians.

Is there evidence that knowledge translation occurs in this space or is it all a vast echo chamber where we listen to ourselves and pretend that everyone who is anyone agrees?

Well, in the pursuit of understanding this phenomenon, I’ve been researching the research looking at the effectiveness of one form of social media: the community of practice. A community of practice is a concept developed by Wenger yet one that has (probably) existed since humans took up tools and started learning from each other. It’s a place where “groups of people … share a concern or a passion for something they do and learn how to do it better as they interact regularly.” Senior or recognised “expert” members of the group provide experiential knowledge to guide junior or “apprentice” members as they learn how to … the “how to” depends on the group. In my case, it’s a group devoted to learning how to apply a multifactorial model of pain into diverse areas of clinical practice.

The group I’m part of is unusual in that it has emerged organically, not having been established artificially for the purpose of studying it. I’ve written a paper on the findings from a study of this group, to be submitted shortly. So when I talk about “effectiveness” I have to refer to artificial studies where communities of practice have been examined. One integrative review by Rolls, Hansen, Jackson and Elliott (2016) found 77 studies consisting of 44 qualitative papers, 20 mixed methods studies, and 8 literature reviews. The range of social media used was wide and included Listservs (remember them?), Twitter, “general social media” (not sure what that really means!), discussion forums, Web 2.0, virtual communities of practice, wiki, and Facebook. The clinicians involved included medical practitioners, multidisciplinary specialty group, health care professional “in general”, midwifes, nurses, and allied health professionals. The study found that:

…social media use is mediated by an individual’s positive attitude toward and accessibility of the media, which is reinforced by credible peers. The most common reason to establish a virtual community was to create a forum where relevant specialty knowledge could be shared and professional issues discussed (n=17). Most members demonstrated low posting behaviors but more frequent reading or accessing behaviors. The most common Web-based activity was request for and supply of specialty-specific clinical information. This knowledge sharing is facilitated by a Web-based culture of collectivism, reciprocity, and a respectful noncompetitive environment. Findings suggest that health care professionals view virtual communities as valuable knowledge portals for sourcing clinically relevant and quality information that enables them to make more informed practice decisions.

Rolls, Kaye, Hansen, Margaret, Jackson, Debra, & Elliott, Doug. (2016). How Health Care Professionals Use Social Media to Create Virtual Communities: An Integrative Review. Journal of Medical Internet Research, 18(6), e166. doi: 10.2196/jmir.5312

Heidi Allen and colleagues (2013), from Body in Mind, found that by releasing papers on social media, there was an increase in dissemination of those papers. Chan and colleagues (2018) also identified that there was much “scholarly engagement” through online interactions. There are detailed analyses of the social construction of knowledge online (Gunawardena, Flor, Gomez & Sanchez, 2016), studies of how acceptable social media knowledge translation is amongst health researchers and clinicians (Tunnecliff, Illic, Morgan, Keating, Gaida, Clearihan et al 2015), and examination of patient’s use of social media (Antheunis, Tates & Nieboer, 2013).

Social media can “democratise” information. Because social media is readily accessible across so many forms and devices, and because there is greater opportunity to interact with authors, and the numbers of people seeking health info, social media allows more information flow than journal articles or conferences. There’s always a risk in that: loud voices, those with marketing smarts, those with a punchy delivery and especially those with a controversial message will attract more attention than, for example, my long form writing on complex topics.

Reader beware must also be the motto. Info dumping a load of references tangential to the actual topic, along with little, if any, critical analysis of that material, can lead to what appears to be authoritative content, but may perpetuate unhelpful and outdated ideas.

I continue blogging because it helps me sort my ideas out. I find it helps me “construct” and assemble what I know into something I can then apply. It helps me sift through the overwhelming wealth of research pouring out of Universities and research groups everywhere around the world. As I look at the over 1100 posts I’ve written, I can see the issues I’ve pondered, and the stance I take on issues such as communication, respect, thinking before adopting a new treatment, clinical reasoning, collaboration. Many of these are attitudes towards people who live with pain.

The things I most appreciate about social media are that I have a network of people with whom I can nerd out. People who do “get it”. People who may not agree with me but who are willing to entertain alternative views. People who push me to learn about areas I wouldn’t normally. People who live with pain who inspire me. People for whom I have great compassion because of their personal stories. I have a sense of community. A real assemblage of people I can turn to when I have questions.

In answer to the question “Does social media contribute to knowledge translation?” I would say it is as effective as the readers and contributors make it, possibly more effective than attending a conference (the best part is always the social isn’t it?!), certainly more useful for generating clinical discussion than a publication locked up in a journal, and as long as conversations remain respectful and discuss ideas and not personalities, it’s an effective way for clinicians to construct knowledge for their practice setting. I’m still going to blog even if my average reader numbers in the last week were a measly 100 people.

Allen, Heidi G, Stanton, Tasha R, Di Pietro, Flavia, & Moseley, G Lorimer. (2013). Social media release increases dissemination of original articles in the clinical pain sciences. PloS one, 8(7), e68914.

Antheunis, Marjolijn L., Tates, Kiek, & Nieboer, Theodoor E. (2013). Patients’ and health professionals’ use of social media in health care: Motives, barriers and expectations. Patient Education and Counseling, 92(3), 426-431.

Chan, Teresa, Trueger, N Seth, Roland, Damian, & Thoma, Brent. (2018). Evidence-based medicine in the era of social media: Scholarly engagement through participation and online interaction. Canadian Journal of Emergency Medicine, 20(1), 3-8.

Gunawardena, Charlotte N, Flor, Nick V, Gómez, David, & Sánchez, Damien. (2016). Analyzing social construction of knowledge online by employing interaction analysis, learning analytics, and social network analysis. Quarterly Review of Distance Education, 17(3), 35.

Tunnecliff, Jacqueline, Ilic, Dragan, Morgan, Prue, Keating, Jennifer, Gaida, James E, Clearihan, Lynette, . . . Mohanty, Patitapaban. (2015). The acceptability among health researchers and clinicians of social media to translate research evidence to clinical practice: mixed-methods survey and interview study. Journal of medical Internet research, 17(5). – megalist of the top healthcare blogs

Healthcare 100 -

Take a look at the list and see where your favourite blog is ranked!
I’m actually about #339 currently (I often get ranked between #250 and #350) of the 1027 blogs that are rated on the site. Not that it’s about the numbers (yeah, right!)
For some of the FAQ’s especially about the features of this site, go here .
Some of my favourites are ranked on this site including Bad Science, PsychCentral, BrainBlogger, Musings of a Distractible Mind, and Dr Deb.

I’m definitely NOT in this business to be ranked or rated or for awards. If I was, I’d spend a lot more time writing on popular topics, for patients instead of therapists, and I’d post shorter posts! I write because I enjoy sorting things out in my own mind, exploring things I’ve pondered about, and because I can’t see anything else quite like this on the net.

I originally started posting as part of my rehabilitation for postconcussion syndrome (it really helped me learn to paraphrase and integrate new information!), and it’s become a place where I encounter people working in the field of pain management, can file (for free!) lots of the resources I use each day in clinical work, and it’s been an incredible way to document my own learning and values.

Some of you might have seen the survey to the left of this post – it’s about what you might like to see me write about. At the moment it looks like writing about how I apply theory to clinical cases is something you’d like me to cover. I want to do this, but I also want to link in to specific papers to make sure you have something to refer back to (don’t take my word without checking the original study).

Does this all take time? Well, yes. I blog often early in the morning, or in the evenings when everyone sane is watching TV. I could be watching TV or I could be processing some photography, reading, painting or sewing or even dancing – but for me, pain management is something that is incredibly fascinating, rewarding and stimulating. No I don’t really have a boundary between my ‘work’ and my ‘life’! One day maybe I can make a living out of writing this blog – until then, I’ll just do it for the reasons I’ve given above.

I love comments, I love debate and I would love you to make comments. I usually respond to comments (except the ones that lead me to a spam site, OK? I don’t need silicon implants, herbal remedies or a bigger… you know what I mean?!). So, if you’ve enjoyed something, or maybe you’re irritated, or curious, or have another site to share – let me know!

Pre-Christmas gratitude – 5 things I’m grateful for

In these couple of days before Christmas, it’s traditional to review some of the ‘best of’ 2008. It’s been just over a year since I started this blog, and the topic list and readership has grown a whole lot!

What am I grateful for in 2008?

  1. Teamwork – the people I work with are fantastic. You can’t work alone in pain management IMHO,  a team of like-minded people to support you both professionally and personally just can’t be beaten.  I take my hat off to the team at Burwood Pain Management Centre who keep me honest, deflate my ego (gently), cushion my falls, keep me standing and give me inspiration to keep on caring about what I do.
  2. Motivation – using motivational approaches like motivational interviewing to help people make their own choices rather than remaining ambivalent.  Whatever the choice, it’s easier to make changes once you’re moving than remain stuck.  I’m grateful for the sense of freedom that using motivational approaches has given me, and that I’ve been able to apply it in my work.  Now if only it could work with my kids?!
  3. The magic of the interweb – and so many dedicated bloggers. I find it unbelievable that there are so many people who spend time writing intelligent, interesting, provoking and inspiring posts on topics dear to my heart – and it’s all free (provided you can get on the internet).  There are so many topics to choose from, and the quality can be stunning.  I’m not a ‘Web 2.0’ kind of person, and I’m not about to rave about the wonders of interactivity, I’m simply awed at how many people spend time putting up resources so the rest of us can find them. (more…)

Why am I doing this?

This is not a whining post, just that I thought it was time I mentioned why I write this blog.

I looked on the internet for ages to find a resource that gave me good information about nonmedical approaches to managing chronic pain and other chronic disorders.

If you use a search engine to look for ‘chronic pain’ or ‘back pain’ you’ll find endless listings for organisations (I used Google just now and found 8,320,000 in 0.34 seconds!)  and many of them are designed for patients, but not a lot for the nonmedical treatment providers who work with them! And we need to remember that the majority of health care providers working with people with chronic pain are nonmedical. We don’t prescribe!

You’ll see I also wrote ‘good information’.  The problem isn’t so much the amount of information available, as the quality of it. When I searched using Google, the advertisements on the right hand column of the search field included: ACC’s page, Ehlers-Danlos, Quantum Touch, biomag, natural health, craniosacral therapy, herniated disc relief, electrotherapy… a bit of a mix.

I also found the same lack of good quality information for nonmedical health providers when I searched using Yahoo.

I enjoy working in the field of pain management, but I’m worried that with so many nonmedical health providers and so little nonmedical health information that is based on science (and what is there is relatively inaccessible) that the field is wide open for well-meaning but misguided people to tout treatments that simply don’t work. OK I’m being charitable, the field is wide open for quacks, ‘alternative’ therapists, and lazy health providers who don’t have time or skills to delve into the scientific literature.

In my own field of occupational therapy (all right, I’m heavily warped by psychology), I find therapists gladly prescribing adaptive equipment including vehicle modifications and ‘ergonomic solutions’ for office settings for people with chronic pain with not a scrap of evidence that this is effective in the long term.  Therapists suggesting ‘pacing’ is all about working within your pain limits (therefore progressively reducing activity tolerance).  Therapists being unwilling or afraid to ask people with pain to develop skills to tolerate pain while they carry out activity, and as a result unwittingly supporting pain-related anxiety and avoidance.  Teaching people that there is one ‘correct’ way to lift items or they may risk ‘injury’. (more…)