Social Media as a New Communication Tactic for Traditional Chinese Medical Doctors: The Case of Hong Kong

Traditional Chinese medicine (TCM) has been regarded as one of the oldest healthcare treatments [1]. More importantly, it is part of Chinese culture [3]. The doctrines of the practices, concepts and philosophies can trace their orient to the ancient publications such as the Huangdi Neijing (The Inner Canon of the Yellow Emperor, as part of the Book of Han completed in 111CE) and Shanghan Lun (the Treatise on Cold Damage by Zhang Zhongjing in around 220AD). The influences of traditional Chinese medicine have been disseminated into non-Chinese communities and the political and trade movement of the various Chinese Dynasties. There are discrete characteristics between TCM and its counterpart western medicine (WM), especially their approaches to illness and healing [4]. Using Hong Kong as a case for illustration, both TCM and WM co-exist as an alternative to healthcare. Since the beginning of the British colonial period, western medical care and services have been introduced as public goods and an option in Hong Kong. Over the years, however, WM has emerged as the mainstream for disease-targeted therapy, while TCM was regarded more as a form of integrative treatment and personal healthcare [5]. There seems to be a general tendency that WM was perceived as more effective in curing disease [6]. The holistic approach might affect TCM’s immediate effectiveness. TCM, therefore, is primarily regarded as a form of complementary treatment.

Nonetheless, TCM has continued to gain its prominence. (Figure 1), as cited below, clearly indicates the continued growth of Chinese medicine in China. From 2010 to 2019, a CAGR of 13.87% was recorded. In the single year of 2017, there were 2,642 million visits to traditional Chinese medical services in China Mainland, which accounted for 32.3% of the total market and year-on-year growth of 5.6% [2]. In a survey about the public trust in medical treatment in China, around 49 per cent of the respondents indicated their preference of Chinese medicine treatment over its Western counterpart. Although behind the Western biomedical treatment by two percentage points, it was evident that Chinese medical treatment has a stronghold amongst the respondents. The survey also indicated that Chinese medicine focused on optimising health by balancing the entire body system, which can detect chronic diseases earlier [7]. In [2] study, results identified a structural difference in TCM visitation among different age groups and zones of residence. The market landscape is changing. The promotion and development of traditional Chinese medical services have become an alternative to healthcare treatments worldwide. The professional practices, however, are facing the complication of new communication technologies and the changing preferences of the patients. This paper is part of a continuing study on modern TCM practices. It aimed at investigating the potential of social media as communication channels for TCM practitioners and the perceived barriers in related capitalisations. This study, as part of a more significant research project on the investigation of the development of traditional Chinese Medical services practices, is aimed at:
1. To explore the perceived utilities of social media for TCM
2. To analyse the barriers and backfire of social media application for TCM
3. To recommend strategic and tactical resolutions for optimising the values of social media communication for TCM

Figure 1:Turnover value of tcm in China.

Medical customer services & relationship

Among the various challenges that the healthcare sector has to confront, including staffing shortages, medical errors and burnouts, customer services is gradually catching the healthcare services providers’ attention [8]. Angemeier [1] concerted the importance of participative management initiative is positively correlated to practitioners’ commitment and productivity, and in turn, improve quality of patients’ care. Medical Customer. This finding, however, inspired the necessity of a participative relationship between medical practitioners and patients. Perhaps, the relative positions of medical practitioners and patients have been an issue in the study and pragmatic engineering of a meaningful relationship between them. Traditionally, doctors are perceived as authoritative, and patients should trust and follow the instructions from doctors without questions. (Figure 2) below is a generic conceptual illustration of customer relationships [9]. While the model is straightforward, it sheds some light on what the medical care services providers could and should consider when constructing their client relationship management mechanism. Winer [9] indicated that mass marketing approaches could not generate interpersonal connectivity, essential for customer relationship cultivation. He has suggested an operational framework that emphasised the selection of target group, customisation of offerings, building a customer community and personalised services to retain customers. His suggestions are meaningful to the discussion of this study as well. While medical practitioners might not see customer retention as their priority, the trust and relationship built would enhance patients’ adherence and obedience to the instructions by the practitioners. The improved relationship, therefore, could improve the effectiveness of treatments. Yet, the cultivation of a significant practitioner-patient relationship is not as easy. Given the lack of interactions and the sceptical mentality of some patients, relationship management is getting even more complicated. The traditional wisdom on CRM might not apply to TCM without refinement. Various research has indicated that CRM is multifaceted and that further research is essential [10]. The researchers have a proposition that in the digital era of the modern economy, the future patient relationship framework would strongly emphasise the capitalisation of online social media.

Figure 2:XX customer relationship management model.

What is social media

Social media are the contemporary internet-based sites and services that enable users to interact with participants to create and share information, ideas, interest, and expression [11]. Social media can be in various forms, such as discussion forums, blogs, wikis, podcasting, social network sites, and content sharing sites. More and more social media platforms were developed in the last two decades to allows participants to share and explore typed texts, video, photos, and animation, such as TripAdvisor (since 2001), Facebook (since 2004), YouTube (since 2005), Weibo (since 2009) and Instagram (since 2010) [21,11]. These online social media platforms are also called social network sites (SNS) [12]. In 2019, there were 3.484 billion active media users globally, which was equal to 45% of the whole population (Allen, 2020). With the public’s enlarging engagement of social media, the message posted on social media would influence participants’ perception and attitudes, even the brand loyalty [13]. With the development of social media, bloggers are subsequently formed, who regularly record and put someone’s sharing on the internet for other people to read (Anon, 2020). More and more bloggers have become popular with many followers who like to adopt or share their messages. World-of-mouth is one of the critical factors in the restaurant business, under the keen competition. Because of the rising of social media, customers’ selections of restaurants are affected by electronic word-of-mouth (e-WOM) (Pantelidis, 2010). Thus, the comments from internet celebrities are always under the restaurant operators’ concerns.

Difference between mass media and social media

Mass media refers to communication media with a large audience (mass communication) in a country or region. It also has the typical characteristics of the tertiary industry, the knowledge industry, and the information industry. Broadcast media transmits information through electronic channels; paper media uses physical objects to disseminate information; outdoor media are mainly placed on commercial buildings, stadiums, shops and buses [14]. Social media is different from mass media as social media is interactive between the deliverers and message receivers. In contrast, the information presented by mass media is unidirectional such as television and printed newspapers [11]. Statistics (Armstrong, 2021) revealed that Google, youtube and Facebook was the top three most visited websites in May 2021. In terms of monthly active users (MAU), Facebook, YouTube, Whatsapp are the top three, followed by Instagram and TikTok (Walsh, 2021). In Hong Kong, the popular social media platforms are Youtube, WhatsApp and FaceBook with 86.9, 83.6 and 83 per cent penetration as of 3rd quarter 2020 (Lai, Penetration Rate of Leading Social Networks in Hong Kong as of 3rd quarter 2020, 2021).

Importance of social media in Hong Kong

In Hong Kong, the favourite social media was Xanga ICQ, and MSN, where people connected with their family and friends a decade ago. The services were then extended to making friends with total strangers, reaching their real-life circle (Davis, 2018). With the invention of mobile devices and online networks, social media functions have broadened to instant and frequent communication to others effortlessly. In Hong Kong, the popularity of social media could be seen by the participation rate and the hours spent on using these media. In 2018, the time spent of millennials was the second-highest, with 17 hours per week, which was 0.7 hours less than the gen Z [15]. It shows that the millennials engaged 2.4 hours on such a platform. Social media is more popular with females in general. By comparing the millennial user gender of social media, the females were significantly more than males. This phenomenon was also happening in gen-Y and gen-Z [16]. It is easy to find internet celebrities for food on Youtube, Facebook, and Instagram [17]. These social media provide follow or subscribe function that alerts the participants to any public update from the internet celebrity. Once the participants follow or subscribe to the channels from the internet celebrities, they can effortlessly catch the new postings whenever available.

Influence of social media on consumers’ behaviour intention

Customer behaviour is the study of how individuals, groups or organisations choose, buy, see and dispose of ideas, goods, and services to satisfy their needs and wants. It also refers to the actions of the consumers in the marketplace and the underlying motives for those actions [18]. While behaviours varied from consumer to consumer and were influenced by different factors, they were influenced by marketing factors such as product design, price, promotion, packaging, positioning and distribution. Also, it is affected by personal characteristics like age, gender, education and income level. Psychological factors such as buying motives and situational factors like physical surroundings at the point of purchase also affect customer behaviour [18]. Researchers study consumers’ behaviour as customer engagement behaviours on social media. It can be defined as a “manifestation that has a brand or firm focus, beyond purchase, resulting from motivational drivers” [19]. It can be positive or negative. A study argues that consumer interactions with brands have a much more substantial impact on consumer behaviour than traditional forms of communication [20]. The result is that significant power has shifted from brands directly to consumers [20]. Social media has transformed online customer behaviour because people nowadays depend on commenters more than companies for information [21].

Research design

This exploratory study is qualitative. The views and insights were collected through in-depth interviews with selected key informants. The research design was chosen to identify the perceived value of social media on patient relationship management. Delphi technique has been deployed to verify the truthfulness of the inputs in the form of field notes, audio recording and transcripts. The selection of an exploratory approach and qualitative methods is based on the study’s objectives and the nature of the investigation. It is also related to the strengths of such design, which included the richer character of possible responses, the flexibilities in the study process to cater to the unanticipated reactions, and the ability to evoke meaningful and culturally salient responses. The study has adopted purposive sampling [22]. Respondents were selected according to preselected criteria. They included TCM and WM practitioners, patients and non-users. The sample size has not been pre-determined but rather determined by theoretical saturation. In other words, the collection process will be terminated when new data no longer offer new or additional insights to the research question. This study interviewed 45 respondents, including 7 TCM practitioners, 2 WM practitioners, 31 TCM patients (those who have received treatment from a TCM practitioner in the last five years) and five non-TCM patients (those who have not consulted TCM services in the previous five years). For the first three types of informants, the identification of respondents has been relatively simple and effective. For the last category, however, the research has encountered some difficulties. The challenge is perhaps because the majority of the local citizens were embedded with a positive attitude towards TCM as a healthcare option. The research did not invite non-Chinese respondents to participate in this study due to preference for a higher relevant group of users with better knowledge or experience using TCM services. This selection can be interpreted as a limitation of the study and a window for future studies. The interviews were conducted in Cantonese and Putonghua [23]. The field notes were analysed before being translated into English for the research accord. The analytical objectives of this study are to:
1. Describe variations, especially those between practitioners and patients;?
2. Describe and explain relationships between variables;
3. Describe individual experience, perceptions and expectations; and
4. Describe group norms, if any.

The research’s objectives were explained to the respondents. To avoid possible misunderstandings, a list of working definitions for various technical terms was prepared and presented to the respondents. Initially, the research was intended to tape-record the interviews. However, some of the respondents have indicated their objections to the arrangement [24]. The interviews, therefore, were recorded on written field notes, which were subsequently translated into research records for archival.

Findings

Virtually all respondents were affirmative on the utilities of online digital media for TCM. The general perceived areas of utilities can be summarised as follow. First, digital media is regarded as an efficient tool for disseminating information to and amongst users, patients and families. Critical data can be divided into technical communication and professional sharings. Technical communication includes logistical details such as service hours, locations, querying time, booking requirements, and fees. Professional sharing includes information regarding treatments and medications, such as medicines and treatments, advice on preventive health care, and suggestions on medical care. This information was deemed critical, meaningful and desired by both service providers and users. From the practitioners’ perspectives, the said communications could make logistical details clear and accessible [25]. It can save substantial human resources for answering frequent questions via e-messages. It could educate the patients on treatment details and engineer their expectations. These written messages could also enhance the credibility of the messages since the message would be regarded as direct messages from the TCM doctors rather than through nurses’ verbal communications where distortions and miscommunication might be involved. From the patients’ perspectives, information would be easier to comprehend at their convenience and pace. They would also find published messages to be more trustworthy. Those messages could be regarded as evidence and proof if needed. Patients found the e-messages very useful as the information with detailed explanation could be stored for future use and sharing with others who are in need. Besides, the popularity of TCM is increased significantly with social media, in particular to younger patients who did not consult TCM in the past. They have a positive attitude toward TCM as they could have information search easier to develop their practical but straightforward Chinese medical principles. With the knowledge enhancement, they have more confidence in TCM treatment. Second, digital media helps cultivate patients’ loyalty and trust towards the practitioner. Some key informants have indicated that it is relatively scant for clinic medical services providers to use social media as communication tools. While the conversation in person is still regarded as more convenient and of higher quality, patients can appreciate the limitation of practitioners’ availability. Digital media, therefore, can be the next best option for them to solicit additional information. With the information from social media, patients could contact the TCM doctor for online consultation. Such an innovative method is well received by the patients who cannot physically travel to the clinic for treatment. With the real-time online consultation, the transportation barrier is lessened. The more opportunities patients can gain access to communicate with the practitioner, the higher the level of their satisfaction and trust being built for the practitioner. These would, in turn, affect positively the revisit propensity of the patients concerned. According to some of the informants, it is critical to mention that TCM does not typically retain a systematic record of their patients and past treatments. They tend to believe that treatments have to respond to the current situation of the patient concerned [26]. Records, therefore, might not be as crucial as their western counterpart would be perceived. Thus, some respondents (patients) questioned whether the TCM practitioners should better understand their background before prescribing treatments. Both practitioners and patients (potential) were optimistic about using social media to enhance TCM services. They mentioned using social media to enhance communication effectiveness, especially those related to treatments. When there is ample provision of related information, patients would be better positioned to make informed decisions related to their treatments. It would relieve some of the practitioners’ workload and pressure to explain medication and treatments to their patients. Both practitioners and patients concurred that general consumer education is required to enhance potential patients’ interest and confidence in TCM. The public perceives TCM as supplementary medical support rather than the essential treatment for serious illness. This phenomenon might result from misunderstandings, lack of formal recognition for TCM or relevant knowledge. Respondents, however, have different opinions on the costs or negative impacts of social media. Respondents mentioned the issue of privacy. Users of a social media enhanced healthcare system might have to face the risk of disclosing their personal information. Some respondents also expressed their worry about receiving a lot of promotional materials. The medical practitioners’ concerns include the excessive workload on their already heavy daily routine, legal liabilities related to their online messages, and the escalation of patients’ expectations.

Strategic implications

It is apparent that social media was regarded as a powerful and valuable communication for the traditional Chinese medical arena. There is no concrete idea on capitalising on this powerful tool for meaningful utilities. In the discussion sessions, some directions are being identified. TCM should consider using social media to issue proactive advice and reminders to their patients. This approach contributes to preventive care for their patients and enhances their relationship with them. Personalized and instant responses on social media could effectively develop better relationships with the clients and obtain positive word-of-mouth. Patients also expressed their appreciation of information, professional services and connectivity with their TCM doctors. They suggested that personal contact and connection with the medical practitioners will enhance their trust and sense of loyalty. There is a higher tendency for them to revisit the concerned practitioner. The new social media marketing mechanism has to be uplifted to a digitalised customer services platform to make the system work more effectively and perform the updated functions. The updated platform should incorporate new features and functions, including blockchain analytics to extract insights from the database for the customisation of services to patients, monitor their health conditions and development of cases, and trigger alerts when needed. Private blockchain formation of cases shall include the self-assessment and reporting by the patient, the establishment of cases by the practitioner, and the subsequent management of the case through a continuing update of data. The system should be empowered to remind patients to take recommended action at a particular time or season and trigger alerts on critical cases. Blockchain can also facilitate the flow and exchange of data/records among medical service providers and related stakeholders such as insurance companies. These, however, would be a separate topic, which is beyond the scope of this paper.

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