Governments around the world are being challenged by increasing public demand for institutional transparency, involvement in decision making, and easier access to services, as well as by the financial imperative for greater efficiencies in the business of government itself [1]. To respond to these challenges, they have sought to harness the Internet and related information and communications technologies for sharing information and enabling transactions between governmental bodies, businesses, and citizens, as part of a broader “e-government” agenda [1,2]. One channel through which this is being approached is social media, including networking and dissemination platforms, such as Facebook and Twitter, and bespoke online tools for eliciting feedback and other e-government objectives [3,4]. According to a recent United Nations e-government survey, the use of social media by governments tripled from 2010 to 2012, and rose by another 50% in 2014 alone [1]. Because the public health sector represents a major area of government expenditure for most countries, and while the general literature on social media for e-government may contain transferrable insights, it is important to examine how the use of social media for e-government has been approached in this particular context.

Although e-government (or eGovernment) is often used as a generic label for digitally mediated government, there is some variation in the use of this term. For example, it has been described to as “analogous to e-commerce, which allows businesses to transact with each other more efficiently and brings customers closer to businesses” [2] and as a means to transform governments’ relationships with citizens (government-to-citizen and/or citizen-to-government), employees (government-to-employees and/or employees-to-government), nonprofit organizations (government-to-nonprofit and/or nonprofit-to-government), businesses (government-to-business and/or nonprofit-to-business), and other arms of government (government-to-government) [2,5,6]. The information flows depicted in parentheses above are derived from a taxonomy originally developed by Fang [7].

In 2010, Linders et al (as cited in [8]) suggested several dimensions related to the objectives and intended outcomes underlying the use of social media and how these might affect the work of governmental agencies. These are as follows:

Although variants of these taxonomies exist (eg, Linders [9] breaks down his co-production theme into “citizen sourcing,” “government as a platform,” and “do-it-yourself government”), these two broad frameworks [8,9] are useful for interpreting the results of our review and will be taken into account during this process.

Concepts such as “open government” and “e-governance” also overlap with e-government in important ways, such as through a shared objective for transparency [10]; however, each has somewhat unique connotations and communities of practice. For example, the former emphasizes online public access to government documents and statistics, whereas the latter emphasizes legal and regulatory requirements for effective digital services [11], including e-government [12].

Although there is a body of research describing the adoption of social media by public sector actors such as local authorities [13,14], central and federal governments [6,15], cities [16,17], and municipalities [18], many authors claim that little is known about how these technologies are used by public health organizations [19,20]. Moreover, to the best of our knowledge, no study has specifically investigated the adoption and use of social media by public health organizations, taking the perspective that they are also part of government [21].

Determining the scope of the public health sector, in terms of its relationship with concepts of government and e-government, is also challenging. Within medicine, public health itself is regarded as a distinct discipline, involving the delivery of population-scale health interventions, such as prevention, screening, wellness, maternal and child health services, surveillance of diseases and risks, and scientific research aimed at understanding and improving the health of populations. By contrast, the public health sector is a much larger proposition, encompassing government departments of health, special government agencies tasked with public health activities, health care delivery organizations operating within the public sector, and the networks of voluntary and private-sector organizations that contribute to these activities, also collectively referred to as the public health system [22]. Although most countries have an underpinning government health system, the private sector plays a more dominant role in some than in others, due to historical, political, economic, and philosophical differences, which have affected the prioritization of market choice versus social equity [23]. For example, definitions of public health arising from the United Kingdom (operating largely in accordance with the Beveridge Social Insurance Model) emphasize the role of the government, whereas those from the United States (operating to a Mixed Market-Driven Model) tend to place a greater emphasis on the private sector; however, the World Health Organization’s definition encompasses all varieties of health systems, as illustrated by the examples shown in Textbox 1. From the perspective of our review topic, this complexity presents a challenge for bridging concepts of “public health sector” and “e-government,” and is likely to affect both the description of relevant studies in the literature and our ability to interpret them within an e-government framework. Nevertheless, governments typically maintain oversight and governance of medicine and health care in most countries, through their legal and regulatory powers, and it may therefore be legitimate to include nongovernmental organizations within the scope of our review. This will depend on the extent to which it is possible to adequately differentiate between governmental and nongovernmental public health activities in the included studies, which have not yet been subjected to detailed analysis or critical appraisal, and the choice will be defended in the main systematic review report.

The literature on social media in health is large and growing: for example, in 2011, the number of social media-related abstracts in PubMed for the years 2002-2011 was 1471, whereas in 2012, there were already 2,330 returns, according to an analysis by Gholami-Kordkheili et al in 2013 [29], and is likely to be considerably higher today. Industry analysts are regularly charting the uses of social media for health-related purposes, indicating growth trends and their impacts on the health care business sector [30], while academic and policy conferences devoted to understanding the social Web and social media in health are proliferating (eg, [31,32]). Although some studies have clearly described the uses of social media for delivering public health services (eg, [33,34]), or for enabling e-government (eg, [35]), the conceptual links between public health, e-government, and social media have not been well described in the literature.

MEDLINE, Cochrane Library, Web of Science, and Scopus international electronic databases were searched on July 12, 2015, using the following search terms/query: (“e-government” OR “government” OR “department” OR “organization” OR “agenc*” OR “hospital*” OR “clinic*”) AND (“social media” OR “Facebook” OR “Twitter” OR “YouTube”) AND (“health” OR “Healthcare”). These databases were chosen for this systematic review because they cover a wide range of disciplines, including public health, medicine, technology, business, and social sciences. The search was not restricted to language, but the article selection was restricted to publication date; only studies published between January 1, 2004, and July 12, 2015, were included in this review. The year 2004 has been chosen as a starting point, since this was when Facebook, the most widely used social media website, was created. Relevant gray literature sources such as World Health Organization reports and working papers (searched via World Health Organization’s Institutional Repository for Information Sharing), and industry (eg, consultancy and marketing) reports (searched via Google search engine) were also searched to identify relevant publications.

One reviewer (AT) has independently screened generated citations with the help of EPPI-Reviewer 4 systematic review software (EPPI-Reviewer), and will extract the data from the qualified articles. Another author (CP) will then check this work to ensure accuracy. In case of any disagreement between reviewers during this stage, the arbitration of the third reviewer (MF) will be sought to resolve it. A PRISMA [37] flow diagram (Figure 3) will be created to track the study selection process and ensure transparency and replicability of the review. The final PRISMA diagram will specify the missing “n=” values, which will be the outcome of our analysis.

Public sector health organizations that have deployed social media as a part of their e-government strategy including, but not limited health agencies, governmental departments and ministries. Public (state-funded) hospitals (when defined as such by publications’ authors) will be also included in this review, to see whether there are any similarities or differences in how they use social media compared with other public health organizations.

This is not a review of clinical trials and our inclusion criteria encompass all types of study designs. However, based on our preliminary scoping work, we expect that most studies will be exploratory in nature. The inclusion and exclusion criteria are presented in Textbox 2.

We plan to narratively summarize and synthesize review results, taking into consideration the likelihood of heterogeneity of organizations and social media types studied, as well the designs of those studies. The following information is planned to be extracted from the studies that meet the inclusion criteria:

Critical Appraisal Skills Programme checklist [41] will be used to assess the quality of the included studies.