Recommendations

• Analyses identified that 4 to 7 posts per day were ideal to optimize reach, while 4 or more posts were ideal to optimize engagement.
• For each additional post, up to six, staff spent more time planning per day.

Staff should aim to typically post 4 to 5 times per day.

• Three out of the 18 OPHS themes are discussed every month.  These three are broad, which is likely why they are discussed regularly, but there are still many themes that are not covered as often as they could be. 
• The frequency of discussion of most themes is inconsistent over time.
• The type of audience who engages with specific themes is different.

Many themes could be covered more frequently. To aid staff in covering all themes across time, a method to track their usage in real-time should be built.

• Data quality issues within the Access database might be related to other staff covering for the lead PHN.
• Continuous monitoring provides recommendations for best practices in maintaining the Page.
• Previous recommendations have included changes to the Access database to capture more information and to improve quality.

Ongoing training and support is required for Reproductive & Child Health team staff to ensure they are up-to-date on best practices for posting and charting. How Page operation protocols and policies can be used most effectively to guide staff work should also be considered.

• Fans account for a majority of the reach and engagement.
• A significant majority of fans were recruited on days with paid advertising.
• Over the year, during periods of advertising, the daily fan growth had been decreasing. This may be an indication of saturation. If this is true, future Facebook advertising may be less cost effective.
• As the number of fans increases so does the reach, and to a smaller extent, the engagement.
• Residents of Kingston and females aged 24-34 within KFL&A are over-represented in the fans of the Page.
• Paid advertising was discontinued for four months when the Communications Specialist Position was vacant (who was the only person with the authority to facilitate paid advertising).
• After the unplanned, extended period without advertising, many additional monitoring analyses were possible, which allowed key questions to be answered.

Paid advertising through Facebook should be utilized to increase fans, and targeted advertising to under-represented populations should be considered. To ensure advertising can be responsive to the needs of the Page, staff other than the Communication Specialist(s) should be able to control advertising However, Facebook advertising should be continued in planned cycles to allow for continued monitoring of its' effectiveness. It may also be beneficial to investigate advertising the Page through other forms of media.

• Evaluations conducted as part of continuous monitoring have been able to answer some key questions about who uses the Page and how they use it, and identify factors which likely increase reach and engagement.
• There are a number of questions that would be answerable through employing 'experimental' conditions during the operation of the Page, such as:
  • Do different messaging styles have an impact?
  • Are non-public health promotion posts creating 'a Facebook community' that also interacts with promotion posts?

In the future, research and program staff should consider applying controlled 'experimental' conditions to test previously identified factors and to investigate as-of-yet unanswerable questions.

• Much of the audience of the CBFB Page will only view one post in any given time period. Many users will likely only engage with only one post in a lifetime. Currently, based on the number of posts that contain promotion messages, there are fairly equal odds that this post will or will not contain public health promotion messaging.
• The audience of the Page exhibits a wide range of behaviours, with a small subset of fans who view or engage with the Page with relatively higher frequency. However, all users engage with the Page unpredictably.
• Users of social media sites respond to a variety of visuals (photos, videos, etc). Currently, staff on the Page have to use photos from other sources, and have little capacity to embed videos in posts.

The content and quality of each post should be considered by staff maintaining the Page. Efforts should be made to improve levels of engagement. In order to increase the appeal of posts, the full range of visual media should be used. This requires support from the Agency in the form of graphic designers and approval to produce low quality videos on topics relevant to the Page.

• As of October 2 2015, the CBFB Page pilot has required 403 staff hours to plan, 538 staff hours to maintain, and 1059 staff hours to evaluate. The total investment into this  pilot program is estimated to be $103,374.95.
• By the end of the pilot year, after $1664 spent on paid advertising (over nine months), there were 809 fans of the Page.
• In the last quarter, the Page averaged approximately 400 regular viewers.
• In the final month, there were 85 users who actively engaged with the Page, of these, 31 did so more than once.
• There are no available benchmarks to compare the reach and engagement of this Page to other similar pages.
• Assuming that current trends in staff time stay the same, it is predicted that to continue to maintain the CBFB Page would require 410 staff hours a year (1 day per week). To conduct yearly evaluations would require 230 staff hours.

A cost-benefit decision must be made to determine what size of audience is required to justify continued maintenance and continuous monitoring costs of the Page, accounting for already invested costs. This decision should be informed by an outcome evaluation that can investigate the link between being reached and/or engaged with the Page, and health knowledge and/or behavioural change.

The CBFB Page is maintained by the Reproductive & Child Health Team whose topic areas cover, many, but not all health topics relevant to the target population. For example, the content experts on communicable diseases and immunizations are located in different teams in a different division within the Agency.

Within the Reproductive & Child Health Team, one staff member is designated as the lead for the Page. This staff member has developed expertise in social media communications, but is not the content expert for all topics within the team's portfolio.

Formal policies and procedures and informal supports are required across the team, division, and agency to support the sharing of all content relevant to the target population of the Page. Given the expertise required to craft social media messages, the current structure of the program is appropriate, but engagement from all relevant staff is required to provide post content. Additionally, understanding of the different approval processes required for social media is necessary across management levels.

The planning process for this Facebook page took 403 hours of staff time over three years. During this time, the Agency was reviewing their communications strategy and its risks.

Significant investment has been made in the protocols and evaluation procedures for a health promotion and knowledge exchange Facebook page.

Facebook, and social media more broadly, is a rapidly changing environment. For example, over the course of the protocol development and pilot year, Facebook made significant changes in data availability and methods for accessing them.

The usage of Facebook changed rapidly over the three years the Page spent in development, and in the future the changing demographics of Facebook may make it a non-ideal medium for health promotion and knowledge exchange, while other social media forms may become more attractive.

There is considerable risk in the investment in social media for health promotion. A key mitigation strategy is building a high level of adaptability into the operation and evaluation methods. This will likely require systematic changes in policies and procedures within the Agency. For example, mechanisms need to be in place to facilitate the sharing of training and lessons learned on using social media across the Agency to capitalize on previous investment and decrease the planning time needed for future programs. Stream-lined and modular approvals processes, alongside the ability to set priorities for time-sensitive changes, are required to allow staff to be responsive to changes in the social media environment. Finally, in order to optimize the use of resources required to develop and maintain social media presence in the changing environment, multiple platforms should be considered.