Reducing RSV through innovative messaging

Among pediatric populations, respiratory syncytial virus (RSV) is a seasonal and common respiratory infection that can be quite dangerous for infants, young children, and older, vulnerable populations. RSV infections are a leading cause of hospitalization for infants leading to the requirement of oxygen, IV fluids, and mechanical ventilation (25). Preventing RSV infections is especially critical in rural communities where hospital resources are limited (27) and higher rates of relevant comorbidities (e.g., congenital heart defects) can worsen symptoms and prognosis in young children (28). Fortunately, like other respiratory viruses, prevention is possible. Common strategies such as hand washing and social distancing are recommended for limiting the spread of RSV. Despite compelling evidence, vaccine confidence and uptake following the COVID-19 pandemic is worsened in rural areas (29,31). Higher rates of vaccine hesitancy and comorbidities in rural communities underscore the importance of effective behavioral change interventions. 

Proven models for educational intervention design, such as the Health Belief Model (HBM), emphasize the importance of both spatial components (e.g., community-specific demographics and psychological attributes, influencers, perceived barriers) and temporal factors (e.g., perceived susceptibility) (32,34). Also known as nowcasting (61-65), health communications can benefit from accurate synchronization with the rise of infection rates to motivate urgency using increased susceptibility and severity. Using both temporal and spatial dimensions, interventions designed using the HBM have proven successful for promoting behavioral change among rural populations for vaccine uptake (32,34,35,65) and infectious disease prevention strategies (36). Fortunately, local health organizations are already producing relevant, evidence-based content that can enable trusted community influencers (e.g., healthcare providers) to facilitate messaging coverage in rural areas.

However, while the content might be readily available, certain factors limit the effectiveness of infectious disease-related health campaigns. First, large-scale messaging to parents and caregivers of young children can be difficult as these children have yet to enter a common institution such as the public school system. Pediatric providers rise as a reliable proxy for information delivery given 1) 93% of children regardless of SES see a pediatrician at least once a year (55), and 2) studies have shown health-related messages delivered by providers are more effective with findings extending to rural populations (36,39). Yet, provider-led patient education is primarily restricted to in-person encounters with very little proactive communication happening beyond office walls. Therefore, enabling healthcare providers to employ digital communication channels serves to significantly impact the health and well-being of patients–an advantage particularly for rural populations where convening and reaching individuals in person is difficult (52,70). In our own customer discovery (120+ hours, N=46), providers cite time as the greatest barrier despite the availability of ready-made messages motivating the need for frictionless, research-based, AI-enabled solutions. Second, recent advancements in nowcasting models are rarely deployed equitably in rural areas. While large health systems are exploring the use of accurate nowcasting models with internal data professionals, smaller communities and independent practices have yet to capitalize on nowcasting abilities for more-effective health communications.

References for the entire submission can be found here. 

Social Cascade is a first-to-market solution to address market shortcomings in patient communication and education. Our evidence-based solution enables healthcare providers (HCPs) to cultivate an always-on, personalized communication strategy filled with credible health-promoting content. Social Cascade’s platform focuses on communication via social media within pediatric primary care clinics. To do this, content is brokered from a growing list of content partners–reputable community health organizations spanning national and local sources. Content is uploaded and tagged using Social Cascade’s topic taxonomy. HCPs select preferred content sources whose posts are then intelligently scheduled and pushed by the platform; therefore, HCPs do not spend any time managing social media.

Furthermore, Social Cascade integrates advanced, AI-enabled nowcasting techniques reliably predicting real-time RSV infection rates with ubiquitous, accessible digital communication channels already used by rural residents. As seen in prior work (56-59), hybrid machine learning techniques and composable diffusion models afford promise for dynamically reconciling masses of structured and unstructured data sources. Such algorithms can accurately predict infection rates for a specific community at a particular point in time. Ultimately, this work advances HBM-based interventions to more readily adapt to spatio-temporal community dimensions by democratizing advanced analytics to reduce health disparities in rural areas. 

Initially, we are targeting the families and caregivers of young children with a priority focus on on underserved, rural community members. Specifically, the team will focus within Wayne and Craven counties in NC. Product roll out will begin in eastern, rural North Carolina where affordable housing, homelessness, food insecurity, and interpersonal violence continue to widen health disparities. One in 28 children under the age of 6 is homeless, one in five experience food insecurity and one in 4 face adverse experiences at home. Unfortunately, like other states, health disparities in North Carolina disproportionately affect low-income communities of color where health literacy and medical trust are the lowest. Consequently, children within these communities are especially vulnerable (Halle, et.al., 2009) as children exposed to as many as three non-medical risk factors (e.g., low maternal education, medical mistrust) experience a greater likelihood of having one or more developmental delays (Barth, et.al., 2008). Therefore, Social Cascade enables pediatric healthcare providers to pull the levers known to increase medical trust and health literacy as a means to thereby increase health-promoting behaviors and services utilization within the families they serve. Through market expansion, the Social Cascade solution easily scales to communities across the country.

The founding team consists of career technologists bringing a combined 25 years of experience in early childhood education, as well as their personal experiences as parents of young children. We have assembled a board of advisors consisting of pediatricians working in distinct communities across demographics, nonprofit partner organizations working with the medical home, researchers studying health-promoting behavioral change, and business professionals from healthcare, education, and technology markets. We continue to expand our use of voice of customer interviews and survey instruments to understand the intricacies of the challenges facing our target population. 

Key personnel:

Scott McQuiggan, PhD, Co-Founder/CEO, brings startup and executive leadership experience with a 20 year career creating innovative technology solutions that scale. His graduate work on human-centered computing in intelligent learning applications fostered a passion for using technology to impact lives around the world. Scott has led work on educational technologies that have reached more than 7 million students in 100 counties. From this experience he has developed a deep understanding of the opportunity to reach children during 80% of their development in the first five years. As a father of two, Dr. McQuiggan has lived in both rural and urban settings and experienced the disparities that arise along such geographic dimensions.

Lucy Kosturko, PhD, Co-Founder/Chief Product Officer, brings graduate-level degrees in both computer science and educational psychology, uniquely representing the intersection of technology and behavioral change. She has15 years of experience advocating and solving for equity for our youngest generation. As a Social Innovation Director at a global analytics company, Lucy leverages her significant program and product management expertise collaborating with leading nonprofits to apply analytic solutions to some of the world’s most pressing issues. Most importantly, a mother of two herself, Dr. Kosturko understands the challenges facing new and young parents as they navigate the complicated first five years.

Casey Coleman, MS, Director of Health Media, brings a career and educational training in child development, family services, and health communications for both rural and urban populations. To date, she has authored more than 5,000 pieces of health education content for parents and caregivers all optimized for distribution on social media. Through her work at Social Cascade, leading organizations–such as Children’s National, Duke University, Vroom, Mt. Sinai Parenting Center, UNC Collaborative on Maternal and Infant Health–have trusted their brand and reputation to my team as we have repurposed their educational materials for use on social media. Similarly, I have co-designed, developed, and tailored community-specific resources for residents across North Carolina with fidelity. As a member of the eastern North Carolina community, I am uniquely qualified to tailor educational content for residents living in the rural communities in my region. In addition, my experience in healthcare settings across eastern NC, including Vidant Medical Center in Greenville, NC, is particularly applicable to the proposed work.

After more than 120 hours of customer discovery and consulting our internal pediatric advisory team, we released Social Cascade in August 2022. During a recent pilot investigation, the team deployed a mixed methods approach using patient surveys (N=742), health care provider surveys (N=172), and integration of the solution in the clinical setting. Of participating patients, 71.16% indicated their provider was not currently active on social media, yet all said they have turned to social media for health advice. 

As of April 2024, Social Cascade has acquired 65 customers who have posted more than 6,400 pieces of content reaching more than 500,000 families with a total of 26,935 post engagements (e.g., likes, shares, comments). Parents are enjoying the content with 89.3% of Social Cascade posts earning an engagement rate (number of post engagements as a function of views) above the industry standard of 5%. 

In addition, Social Cascade worked with a partner pediatric clinic in rural, central North Carolina to conduct an informal investigation. Using a wizard-of-oz-style approach, the project team manually scheduled RSV-related content sourced from a local community health partner. Post scheduling was performed in line with published health data and real-time clinical observations from staff members. Content included pre-peak information (e.g., recommendations for pediatric RSV vaccine) and peak information (e.g., FAQs about how to triage RSV at home, signs of respiratory distress, and prevention strategies). A total of 30 RSV posts were shared on Instagram and Facebook over the 4-month project period (November 2023-February 2024). Clinic staff anecdotally noted a noticeable decrease in calls to the nurse line/EHR in-basket messages and sick visits related to RSV compared to previous years–preliminary evidence for both societal and economic impact.

Scaling and partnering: Although Social Cascade is deployed through the medical home, the solution aims to solve across all social determinants of health which means the interdisciplinary nature of the Solve community can provide insights in guidance in all areas affecting today’s families.  

Networking and mentoring: We are excited at the opportunity to join an esteemed network of peer organizations focused on solving pressing challenges with solutions that impact society. We believe this network is filled with significant learning opportunities, advice, peer support, and collaboration.

Global expansion insights: We would welcome the opportunity to network and learn from partners around the world. Extending relationships into the peer network would enable Social Cascade to accelerate our growth as we engage in the broadened community of strategic and financial resources. While our immediate focus is on the US market, we believe our solution has global potential. Solve would give us the opportunity to establish key partnerships and relationships to support international growth and impact.

Social Cascade: a new approach, not new work. Social Cascade builds on evidenced-based strategies by layering state-of-the-field algorithmic models for the most sophisticated and effective delivery of health messages across SDoH. As detailed in the theory of change below in the next section, Social Cascade enables trusted messengers--like primary care providers--to meet patients where they're already looking for health-related messages with accurate and reliable information. Currently solutions to proactive communication are antiquated and do not take advantage of modern technologies. In fact, it can be argued that the most innovative thing to hit patient education in the last 40 years is the advent of the PDF document. 

While our pilot program will be conducted in the pediatric space, findings and deliverables will easily scale to similar communities around the country and service lines. Full-scale deployment and validation of the tool will provide understanding of the operational levers for impacting health-promoting behaviors in other population segments and health priorities. Ultimately, the commercialized version of Social Cascade will provide an opportunity to expand research activities aligned to MIT Solve's larger goals.

By integrating evidence-based strategies for behavioral change with advanced technologies, Social Cascade's Collective Impact Model is built on a novel three-pronged approach:

1) Disseminating content through accessible, high-use communication channels. One of the 5 apps smartphone users use on a daily basis is almost always social media (6). In fact, “90% of millennials say they use the internet as their primary – or only – source of health information, and nearly half of U.S. adults rely on social media for healthcare decision making” (5,19). This statistic holds for rural Americans who report social media as a top source for health related information (49,70). 67% of rural residents in the US use Facebook and 25% use Instagram (38). Social media is an accessible and acceptable communication platform allowing for two-way data sharing for more personalized interactions. Such platforms have been shown to be a powerful tool for rapidly disseminating critical care information (16,23,46) and improving patient-provider relationships (48). Most applicable is a recent meta-analysis reviewing more than 20 studies that found social media-based interventions based on theoretical models effectively increased vaccine confidence and behavioral change in a variety of settings including rural areas (66). 

2) Utilizing regional and local community health organizations for community-centric, reliable content. Well documented as a trusted source among rural communities (26), community health organizations' relatability, relevant lived experience, and connection to culture are a tremendous asset for patient education. Such organizations work to equip patients with the information necessary to make the best decisions for their family. As members of the target community, community health organizations have awareness of the perceived barriers preventing health-promoting behaviors and can message accordingly. Instead of recreating the wheel, our model allows providers to leverage such materials as a way to curate content for their own social media accounts to 1) reduce the time commitment required by clinics to maintain a social media presence, 2) utilize proven materials created by experts in the community, & 3) integrate diverse perspectives to outreach content.

3) Leveraging proven nowcasting techniques to more-effectively schedule content. Social Cascade seeks to build upon and integrate existing spatio-temporal nowcasting approaches by applying state-of-the-field generative AI techniques to the underlying content scheduling algorithm. Nowcasting for RSV and other respiratory illnesses (e.g., influenza, COVID) generally applies ensemble machine learning techniques combining multiple data sources such as Google Health Trends (64), syndromic surveillance from larger markets that commonly predict outbreaks in smaller communities (62,63), historical trends (64), and social media data (67). Advancements in generative AI provide an opportunity to pull in unstructured data sources from within communities (e.g., school calendar) to provide additional community-level context. Such evolved nowcasting promises to ensure the right message is being delivered to the right audience at the right time. Therefore, when community health threats such as RSV are ramping up, Social Cascade’s scheduling algorithm can prioritize content aligned temporally for the audience. 

The Social Cascade team is intentionally prioritizing the following impact goals to actively reduce health disparities facing our youngest generation and their families. 

1. Increase levels of medical trust and health literacy in the areas at highest risk. Over the next year we plan to reach 1,000,000 children and their families through the medical home via social media. Over the next five years we strive to expand that reach to 30,000,000 children and their families. With intentional, strategic focus on increasing trust within the medical home, we, ultimately, seek to push the needle of progress on closing health disparities.

2. Evaluate impact and elevate successes. In correspondence with the roll out of social determinants of health screening tools, Social Cascade will collaborate with public health officials to understand the tool’s formative impact and progress trajectory. Over the next five years we also strive to see a correlation with public messaging powered by Social Cascade and social determinants of health data from sources, such as the CDC, including the Area Deprivation Index and the Kids Count Data Center.

3. Contribute to the research community. Engage in strategic partnerships with community health organizations and public health researchers to understand the levers available through social marketing techniques for increasing medical trust among racial and ethnic minority populations. By widely disseminating such findings, Social Cascade hopes to accelerate progress toward a more equitable future.

Social Cascade is a web-based platform accessible from desktop and mobile computing devices. The core technology that makes Social Cascade innovative is the underlying AI engine that accomplishes 4 key features: 1) recommendations of health-promoting content automatically scheduled for publication on social media channels on behalf of healthcare providers, optimized for their community, 2) data and analytics that refine the recommendation engine and inform human intervention, 3) image analysis and text generation to create public health message variants customized for community culture and demographics, and 4) mitigating human biases through content recommendations and model refinement.

Social Cascade’s current AI model incorporates a spatio-temporal nowcasting capability. Modeling includes a series of known approaches for RSV nowcasting including ensemble models (61,62,65), harmonic regression (64), and dynamic downcasting (63). In addition, the team applies composable diffusion methods (56) to stitch together modeling techniques in order to accommodate a vast range of unstructured data source types (e.g., PDF documents). Models are trained using 10-fold cross validation from historic 20-week trailing windows from four previous RSV seasons randomly selected between 2010 and 2024 (64). Ultimately, this series of generative, hybrid machine learning methods (11,12) forecasts RSV infection rates in real time. Continuous model evaluation involves a comparative analysis using common accuracy metrics (61-65), specifically, root mean squared error (RMSE), Pearson correlation coefficient, and mean absolute percent error (MAPE). 

FTE: 3

PTE: 3

Contractors: 4

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At Social Cascade, we believe that every child deserves to grow, live, and learn in a supportive, nurturing environment. Therefore, our mission is to reduce health disparities by eliminating barriers through equitable access to health literacy materials, community resources, and other drivers for change. 

Social Cascade’s novel, yet simple, approach utilizes the medical home, the most consistent touchpoint for children and their families, to deliver valid, reliable information on the platforms parents and caregivers are already using everyday: social media. In fact, 90% of millennials, regardless of ethnicity or socioeconomic status, say they use the internet as their primary – or only – source of health information, and nearly half of U.S. adults rely on social media for healthcare decision making. Therefore, we provide software subscriptions and services to pediatric healthcare providers enabling them to meet parents where they are–and where bad actors are already populating feeds with medical misinformation and misguidance.

Social Cascade is a SaaS B2B software solution with optional add-on services for custom content development. Overall, we have 80-90% gross margins on both the product and services each month. 

96% of providers surveyed felt consistent patient education throughout the year is good for business; yet, 63% claimed to only communicate with patients on an annual basis. For this reason, 81.73% of respondents expressed interest in the Social Cascade solution. Providers participating in the full clinic integration expressed gratitude for the tool stating, “having Social Cascade post to my social media account takes a huge burden off my shoulders, and I feel confident in the material that is being posted.” Pricing for the platform is testing well at an average annual contract value of $5000 paid by the HCP/clinic and the company has achieved $175k in annual recurring revenue. Most notably, leading health systems including Cincinnati Children’s, Wellstar Health, Novant Health, Prisma Health, and UNC Children’s are all participating in pilots as they see Social Cascade offers significant promise to increase health-promoting behaviors, and, ultimately, empower parents to make informed choices for their family.

Since launch (August 2022), Social Cascade has focused on the 248k pediatric primary care providers int he US with an initail opportunity of $148.8M. We are beginning to scale through pediatric specialties extending the market to 375k epdiatric providers in the US with a market opportunity of $225M. After establishing profitability and geographic scale in the pediatric space, the team ultimately defines the TAM as the roughly 22M HCPs in the US all charged with educating patients on topics across Social Determinants of Health (SDOH)–a $13.2B market opportunity.