Mitigating Concerns and Maximizing Returns: Social Media Strategies for Injury Prevention Non-profits

Author Affiliation
Tressie McMillan-Cottom, BA  Emory University, Department of Sociology, Atlanta, Georgia


Injury prevention programs can use social media to disseminate information and recruit participants. Non-profit organizations have also used social media for fundraising and donor relationship management. Non-profit organizations (NPOs) with injury prevention missions often serve vulnerable populations. Social media platforms have varied levels of access and control of shared content. This variability can present privacy and outreach challenges that are of particular concern for injury prevention NPOs. This case report of social media workshops for injury prevention NPOs presents concerns and strategies for successfully implementing social media campaigns.



Non-profit organizations (NPOs) have used social media to develop relationships, disseminate information, and fundraise.1–2 Researchers have used social media to target hard-to-reach populations,3–5 and public health campaigns increasingly use social media to diffuse information.6–8 Injury prevention outreach could benefit similarly from using social media for information diffusion, public relations, and donor development.10 A 2010 study of social media diffusion among public relations practitioners in health departments found that just 17 percent use social networking sites,11 suggesting untapped potential for social media expansion.

Using social media to develop donor relationships can increase an NPO’s sustainability and profitability. M+R Strategic Services tracks electronic marketing and fundraising from a large sample of U.S. NPOs. Their 2013 report finds a downward annual trend in donations from email solicitations, which remains the preferred media fundraising tool among NPOs.12 During the same reporting year, median monthly giving from social media efforts increased. In particular, health NPOs saw a 12% increase in online donations in 2012 over 2011. Taken together, NPOs are seeing lower returns from email fundraising campaigns and greater usage of social media from constituent target audiences. This raises questions about how NPOs can integrate social media without increasing the risk inherent to increased scale of public engagement. This case report presents tactics for maximizing the potential of social media while mitigating its risks. The aim of the report is to present concerns from NPOs that provide injury prevention services for vulnerable populations and to present organizational tactics that address them. The findings are drawn from 2 social media training sessions conducted for Georgia NPOs in 2013. The workshop was promoted to the funding agency’s grant recipients as a training to use social media for organizational sustainability. Grantees were not compensated for their participation, but there may have been a willingness to participate to signal to a critical funder their commitment to sustainable management practices. All of the attendees were from NPOs with injury prevention-related missions. Eighty percent of the organizations focused on domestic violence interventions. Participant observation and pre- and post-workshop participant surveys found that there are social media concerns specific to NPOs that serve vulnerable communities: privacy and authorial content control. Developing clear social media protocols and targeted use of social media tools can minimize these risks. Workshop participants reported that developing a social media strategy gave organizational actors greater confidence with tools, a clearer organizational structure for campaign management, and increased awareness and donations.


Participants in the social media training sessions were from a diverse group of NPOs in the state. They spanned small, community-based organizations to non-profit auxiliaries of major medical and university centers. Workshop participants included executive leaders, marketing coordinators, donor management professionals, and administrative assistants. Participation in both sessions was voluntary, although most participants were recipients of a grant from a state agency. There were 41 participants representing 27 different organizations. Over 80% of the participants focus on domestic violence prevention and services (n=22). The remaining NPOs offer foster care services, teenage pregnancy, and community health programs.

Privacy and control of messaging emerged as 2 primary concerns. Both concerns were addressed through the “see us in action” exercise. Posting photographs can be a very effective tool in raising awareness with a social media campaign. Images have greater viral potential than text alone.12 Viral online content refers to an image, video, advertisement, etc. that is circulated rapidly on the Internet. A viral message can lower the cost of information diffusion for NPOs by lowering the expenditure to potential donor ratio. Sharing images of successful community events can also evoke an emotional connection with current and potential donors. However, the virality of photographs coupled with low platform controls (e.g., “tagging” photos feature on Facebook) can pose a safety risk to vulnerable constituents, e.g., domestic violence victims.

The facilitator used a Facebook and Twitter account created for the workshop to model how photographs and location information could be shared differently, considering privacy risks and audience. Using a cellphone camera, the facilitator snapped a photograph of the participants as they were brainstorming earlier in the workshop. The image conveyed that the event was well attended; the audience energetic, and the financial support for the event was justified. The photograph was a good example of allowing donors to see their investment in action. However, participants noted that the photograph clearly showed their faces and, in some instances, their name badges. Additionally, photographs taken with smartphones can have location data embedded in the file. They realized that an image intended to market a successful event could inadvertently release sensitive participant information.

This tension between maximizing the returns to social media with concerns about safety risks for NPOs and their constituent members and audiences can be navigated with a better understanding of content controls and platform differences. Twitter is a micro-blogging website that posts 140-character “posts” to followers. Twitter can be either asynchronous or synchronous, depending on how a Twitter user chooses to engage followers and other users. Content on Twitter moves fast and through rapid sharing mechanisms in the platform can easily be stripped of its context and originating source. Additionally, Twitter has only one level of content control. A user can be public or private. A public Twitter account better harnesses the message dissemination potential of the platform but also poses the greatest risk to NPOs with risk-adverse missions.

In contrast, the other largest social media platform, Facebook, can also be either asynchronous or synchronous. Posts can be longer and different types of content, such as surveys, graphical images, and even documents, can be uploaded to Facebook posts. Facebook posts are still relatively easy to share, increasing the viral potential of messages, but it is more difficult to strip posts of contexts or original sources. Additionally, Facebook offers a comparably vast array of privacy settings at the individual level (for each post) and at the account level. Because of these controls, media researchers consider Facebook’s platform a digital plug into pre-existing networks. Content shared on Facebook is more likely to travel through and engage with existing networks that have met privacy setting criteria, usually because of a pre-existing relationship. Although we often speak of social media as a single entity, there is considerable variation in how platforms are designed to capture, disseminate and preserve the intent of user content. NPOs should consider what content it shares within the context of the level of control, message intent, and outreach goals. The following chart outlines potential, risks, and considerations for content across 2 of the major social media platforms. (I include Facebook and Twitter in this analysis. However, while there is a range of other social media tools increasingly adopted by organizations (e.g. Pinterest, Instagram.), these platforms do not differ significantly in form or concerns from Facebook and Twitter, which remain the largest and most-used social media platforms.) (Table 1)

Table 1. Comparison of controls, concerns and tactics between social media platforms.
Table 1.
Comparison of controls, concerns and tactics between social media platforms.

The participants were guided through a 4-stage process designed to reveal the tensions of social media platforms and design strategies to mitigate them:

  • 1.
    A photograph of the event was shared on a projector. The participants brainstormed how images of faces and name badges might impact vulnerable groups that use their services.
  • 2.
    In pairs, participants used Facebook and Twitter accounts established for the exercise to explore different privacy controls.
  • 3.
    Participants assessed how social media engagement would benefit their organizational missions.
  • 4.
    Each participant drafted social media protocols to address organizational structure, content guidelines specific to each social media platform, and contingency plans for role transition.


Despite initial and emerging concerns about privacy and learning curves, all of the participants hoped that social media could increase donations, and for good reason. High-profile social media campaigns like a 2012 drive by For Love of Children helped the organization fundraise $114,000 in 1 business day. While that is likely an outlier, social media can increase donor participation in 2 ways. One, it can lower the barriers of participation with online payment tools like PayPal, which minimize the number of decision points a donor must make to complete the donation cycle. Two, social media can indirectly impact donations by raising awareness of an organization and its mission among likely donors.

To achieve either of these goals (and organizations should ideally aim to achieve both), research finds that NPOs should interrogate their organizational structure. Georgetown University’s Center for Social Impact Communication conducted a nationally representative survey of how social media has influenced how adults engage with social issues.14 The study concluded that social media users develop donor relationships with organizations at multiple points of entry, often simultaneously and not in a successive order from low engagement to high engagement. This model is at odds with traditional donor relationship organizational structures in NPOs. These models assume that donors progress successively from awareness to low engagement through financial involvement. NPOs generally understand each level of participation as discrete. The donor relationship manager role, wherein donor relationships are cultivated over time, emerges from this organizational model of donor engagement.

The Georgetown report’s findings do not suggest that NPOs abandon traditional donor relationship activities. However, they do suggest that a diverse portfolio of engagement activities is better matched to changes in donor behavior. Likely donors who use social media appear to do so with variable levels of engagement that “doesn’t stop and start with discrete levels,” suggesting for NPOs “it’s actually preferable for people to be engaged on multiple levels.”15

To inculcate engagement on multiple levels, NPOs must consider carefully their existing organizational structures. Fewer than 10% of the workshop participants had integrated its social media initiatives across organizational levels and roles. The most common organizational structure was the “lone ranger” model. In this model, a single organizational role is responsible for social media management. Larger NPOs had hired specifically for this role while smaller NPOs primarily relied on interest from an employee to assign social media duties. The lone-ranger model presents 2 concerns for using social media effectively. First, the model assumes that donors are engaging at discrete levels. That assumption runs counter to research. Second, this model presents challenges for sustainable online fundraising initiatives and social media protocols. Employee turnover, including promotions or realigning tasks and roles, can derail a successful social media campaign if the entire process resides with 1 person or job role.

To counter this problem, participants worked in pairs to write a social media protocol. The protocol assessed the NPO’s current organizational structure, identified all donor relationship and outreach activities for each role, and defined current social media engagement. Three quarters of the participants reported that only 1 staff member knew social media account passwords. One participant remarked that when she was hired to manage social media, she had to deactivate all of the organization’s social media accounts because the former employee responsible for them was the only one with access. This kind of misappropriation of information can disrupt social media effectiveness.

Social media protocols should diffuse responsibility for social media engagement across several organizational roles. Responsibility diffusion increases campaigns’ sustainability by minimizing account discontinuity from employee turnover and leaderships changes. By incorporating various organizational stakeholders, responsibility diffusion also increases organizational buy-in of social media campaigns. Protocols should also explicitly state appropriate tone and content for various social media platforms. As participants learned from the photograph exercise, all content is not appropriate for all platforms. And, misalignment between content and platform can expose NPOs to privacy-related risks. Committing these guidelines to paper and sharing them with all organizational actors minimizes risk.

Responsibility diffusion also creates a mechanism to integrate social media campaigns with existing marketing and outreach initiatives. Social media integration addresses the challenges of donor relationships that increasingly operate across multiple levels simultaneously. For example, appending all email signatures in an organization with a hyperlink to an online donation page maximizes multiple points of donor engagement.

Social media protocols are also a primary tool for mitigating concerns about social media usage. Workshop participants explored the architecture of each social media platform and designed a protocol specific to each. The consequences for the “see us in action” photograph exercise illustrate the importance of protocols for risk management. During the workshops, participants considered if the image taken during the event would be appropriate for Twitter. Twitter allows only 2 privacy settings: private and public. A private Twitter account prevents a user’s 140-character messages (“tweets”) to be viewed by any registered or unregistered Twitter user. This is attractive to organizations with privacy concerns. However, if an organization is using Twitter to increase awareness, a private account can be self-defeating, as engagement with the account requires pre-existing knowledge of it. As the virality of Twitter is one of its greatest attributes, this may not be ideal. When participants considered posting the same image to the group Facebook account, they realized the appeal of Facebook’s various privacy settings. Facebook allows a user to control the privacy of the overall account and the privacy of each post. A social media protocol would consider these platform strengths and weaknesses to provide guidance on posting an ostensibly innocuous photograph to the right medium, with the right level of privacy controls.

This additional level of control assuages some concerns about privacy that were raised by the photograph exercise. But, there are other tactics that reconcile the tension between serving vulnerable populations on the one hand and maximizing social media’s relationship building and fundraising potential on the other. One tactic is called “object messaging.” In the case of the photograph, the goal was to capture a successful event in hopes of eliciting an emotional connection with social media users. The tension arose from photographing persons. The same goal can be achieved by photographing non-human subjects. The facilitator modeled this by taking another picture taken from behind the participants as they faced the projector screen. The optics captured the same energy of the first photograph but neutralized concerns about identifying participants. Clear social media protocols should include guidelines on what content is appropriate for which social media platform. NPOs should consider the potential risk of releasing sensitive information or images of participants (particularly of minors). But, as in the case of object messaging, deliberate engagement can mitigate most NPO concerns. Social media content is best suited for a “bird’s eye” view of campaigns, engagement with public discourse, and profile awareness. Fortunately, all of these best practices allow NPOs to harness the potential of social media for volunteer and donor relationship development.

Integration and social media protocols increase the efficacy and efficiency of social media campaigns. There are 2 primary ways that injury prevention NPOs can use social media specifically for fundraising. There is the broadcast method and the engagement method. The broadcast method leverages online fundraising campaigns that mimic the structure of traditional fundraisers. Broadcasting is getting the word of your campaign out to as many potential donors as possible. A fundraising goal can be set for a specific period of time. Online tools from PayPal, Razoo and Causes have user-friendly interfaces to set up online payment accounts. Users can generate a donation link that can append to email, newsletter, and print materials. More sophisticated social media campaigns can use online scheduling tools like Hootsuite and Tweetdeck to pre-schedule Facebook and twitter posts in bulk. These content posts can include the donation link. Hootsuite also provides useful analytics of web traffic and engagement that allows users to schedule content at optimal times for maximum viewing. These analytics can also be included in campaign reports to granting agencies and stakeholders. (Table 2)

Table 2. Tools for efficiently managing social media campaigns.
Table 2.
Tools for efficiently managing social media campaigns.

Beyond broadcasting content and donation links, the engagement method proactively manages donation opportunities. Engagement is about an organization’s mission being so closely aligned with an issue that actors begin to think of them in tandem. This model requires that organizations have a clearly articulated mission statement, scanning relevant news events that align with the organization’s mission and linking the two in their social media content. For example, one participating NPO focuses on domestic violence awareness. At the time of the workshop the state legislature was considering a bill that would provide greater protection of victims of family violence. The executive director and donor relationship manager identified this legislation as key to their organization’s awareness campaign. The workshop activities helped them devise a social media campaign that used Facebook and Twitter to raise public awareness of the legislation. Because Facebook’s content is more static and has a longer engagement life cycle,13 they decided to post a sponsored petition to their Facebook page. They set the post to public but did not require names on the petition. This addressed participants’ concerns about privacy and maximized the post’s reach on social media. For Twitter, the participants opted to tweet link to newspaper stories covering the legislation, employing the engagement model of linking relevant content to organizational mission. They scheduled tweets at peak activity times and rotated tweets about the news story with tweets containing a link to a donation page that detailed how the organization counsels victims of family violence. In post-workshop communications, this organization reported that a state representative contacted them to thank them for increasing public support of the legislation. They also reported increased website traffic, online donations, and volunteer requests.

Social media is not a singular fundraising and communication tool but it can be a powerful addition to an NPO’s outreach toolkit. NPOs have successfully used social media to build awareness and develop beneficial relationships. NPOs with injury prevention missions, particularly among vulnerable populations, should consider carefully how they use social media. The organizations in this case study benefitted from reflecting on issues of privacy, control and organizational protocols. In post-workshop surveys participants commented that they developed greater confidence in using social media, had developed a system that would improve their organizational structure, and could articulate to donors and constituents how social media reflects the organization’s mission. Organizations that primarily serve young adults and low-income constituents cited high social media usage among their target populations as a reason to use these campaigns. Executives reported that social media analytics would enhance their organization’s positional value to donors and political supporters. Injury prevention missions benefit from proactive diffusion of awareness and information. Social media is well suited for these aims. If used with deliberation, a social media presence can increase an injury prevention NPO’s profile and bottom line.


Supervising Section Editor: Monica H. Swahn, PhD, MPH

Full text available through open access at

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.


1. Barnes NG, Mattson E. “Still setting the pace in social media: The first longitudinal study of usage by the largest US charities.” University of Massachusetts Dartmouth Center for Marketing Research. (2008)
2. Spencer T. The potential of the Internet for non-profit organizations. First Monday. (2002);7(8) no.
3. Stephenson J. Rural HIV/AIDS in the United States: studies suggest presence, no rampant spread.JAMA. 2000;284(2):167–168. [PubMed]
4. Stephenson R, Hall CD, Williams W, et al. Towards the Development of an Intimate Partner Violence Screening Tool for Gay and Bisexual Men. West J Emerg Med. 2013;14(4):390–400. [PMC free article][PubMed]
5. Lauren RJ, Berglas NF, Schwartz SL, et al. Finding teens in TheirSpace: using social networking sites to connect youth to sexual health services. Sex Res Soc Policy. 2011;8(1):38–49.
6. Bennett GG, Glasgow RE. The delivery of public health interventions via the Internet: actualizing their potential. Annu Rev Public Health. 2009;30:273–292. [PubMed]
7. Reynolds Barbara S, Galdo Julia Hunter, et al. Crisis and emergency risk communication. School of Public Health; University at Albany: 2004.
8. Ramo DE, Prochaska JJ. Broad reach and targeted recruitment using Facebook for an online survey of young adult substance use. J Med Internet Res. 2012;14(1):e28. [PMC free article] [PubMed]
9. Ingenhoff D, Koelling AM. The potential of web sites as a relationship building tool for charitable fundraising NPOs. Public Relat Rev. 2009;35(1):66–73.
10. Butcher L. Nonprofit organizations outpace businesses in use of social media. Oncology Times.2009;31(21):39–40.
11. Waters RD. Handbook of research on social interaction technologies and collaboration software: Concepts and trends. Hershey, PA: IGI Publishing; (2010). The use of social media by nonprofit organizations: An examination from the diffusion of innovations perspective.
12. Valverde W, Lefevre C, Hoehling A. 2013 eNonprofit Benchmarks Study. 2014 Available at Accessed January 3.
13. Mason H. Bitly You Just Shared A link. How Long Will People Pay Attention. Enterprise Blog. 2014Available at Accessed January 2.
14. Dixon J, Keyes D. The Permanent Disruption of Social Media. Stanford Social Innovation Review.2014 Winter 2013 Accessed from on January 8.
15. Smith P, Zook Z. Marketing Communications: Integrating Offline and Online with Social Media. Vol. 17 (Philadelphia: Kogen Page Publishers; 2011).

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