#DoctorsSpeakUp: Lessons learned from a pro-vaccine Twitter event

US State Public Health Agencies' Use of Twitter From 2012 to 2022: Observational Study

BACKGROUND

Twitter (subsequently rebranded as X) is acknowledged by US health agencies, including the US Centers for Disease Control and Prevention (CDC), as an important public health communication tool. However, there is a lack of data describing its use by state health agencies over time. This knowledge is important amid a changing social media landscape in the wake of the COVID-19 pandemic.

OBJECTIVE

The study aimed to describe US state health agencies' use of Twitter from 2012 through 2022. Furthermore, we organized our data collection and analysis around the theoretical framework of the networked public to contribute to the broader literature on health communication beyond a single platform.

METHODS

We used Twitter application programming interface data as indicators of state health agencies' engagement with the 4 key qualities of communication in a networked public: scalability, persistence, replicability, and searchability. To assess scalability, we calculated tweet volume and audience engagement metrics per tweet. To assess persistence, we calculated the portion of tweets that were manual retweets or included an account mention. To assess replicability, we calculated the portion of tweets that were retweets or quote tweets. To assess searchability, we calculated the portion of tweets using at least 1 hashtag.

RESULTS

We observed a COVID-19 pandemic-era shift in state health agency engagement with scalability. The overall volume of tweets increased suddenly from less than 50,000 tweets in 2019 to over 94,000 in 2020, resulting in an average of 5.3 per day. Though mean tweets per day fell in 2021 and 2022, this COVID-19 pandemic-era low was still higher than the pre-COVID-19 pandemic peak. We also observed a more fragmented approach to searchability aligning with the start of the COVID-19 pandemic. More state-specific hashtags were among the top 10 during the COVID-19 pandemic, compared with more general hashtags related to disease outbreaks and natural disasters in years before. We did not observe such a clear COVID-19 pandemic-era shift in engagement with replicability. The portion of tweets mentioning a CDC account gradually rose and fell around a peak of 7.0% in 2018. Similarly, the rate of retweets of a CDC account rose and fell gradually around a peak of 5.4% in 2018. We did not observe a clear COVID-19 pandemic-era shift in persistence. The portion of tweets mentioning any account reached a maximum of 21% in 2013. It oscillated for much of the study period before dropping off in 2021 and reaching a minimum of 10% in 2022. Before 2018, the top 10 mentioned accounts included at least 2 non-CDC or corporate accounts. From 2018 onward, state agencies were much more prominent.

CONCLUSIONS

Overall, we observed a more fragmented approach to state health agency communication on Twitter during the pandemic, prioritizing volume over searchability, formally replicating existing messages, and leaving traces of interactions with other accounts.

Shouts from the Void: A Mixed-Method Analysis Surrounding the Online Chronic Illness Community, NEISVoid

Chronic illness affects millions worldwide, rendering the life of those affected complex to manage. Extant research points to the need for effective and supportive care for the successful treatment, yet health care encounters for this population are often filled with negative experiences, ranging from discontinuity of care to disenfranchisement from providers. One such group dedicated to sharing struggles is the NEISVoid (No End In Sight) community on Twitter. Through the use of the hashtag, #NEISVoid, they come together to share what experiences living with chronic illness look like, in vulnerable and potentially unfiltered ways. The present study analyzes the discourse surrounding the hashtag #NEISVoid in tweets published from January 1 2020, until September 1 2022 (N = 450,914 tweets) using the mixed-method analysis of topic model network (ANTMN) approach. We identify and discuss four broad discursive themes: community experiences, symptom management, efficacy solutions, and biomedical health. We analyze this discourse through the chronic care model (CCM) and in light of research on hashtag activism. We discuss practical and theoretical implications for health communicators.

A taxonomy of anti-vaccination arguments from a systematic literature review and text modelling

The proliferation of anti-vaccination arguments is a threat to the success of many immunization programmes. Effective rebuttal of contrarian arguments requires an approach that goes beyond addressing flaws in the arguments, by also considering the attitude roots-that is, the underlying psychological attributes driving a person's belief-of opposition to vaccines. Here, through a pre-registered systematic literature review of 152 scientific articles and thematic analysis of anti-vaccination arguments, we developed a hierarchical taxonomy that relates common arguments and themes to 11 attitude roots that explain why an individual might express opposition to vaccination. We further validated our taxonomy on coronavirus disease 2019 anti-vaccination misinformation, through a combination of human coding and machine learning using natural language processing algorithms. Overall, the taxonomy serves as a theoretical framework to link expressed opposition of vaccines to their underlying psychological processes. This enables future work to develop targeted rebuttals and other interventions that address the underlying motives of anti-vaccination arguments.

Social Media and Vaccine Hesitancy: Help Us Move the Needle

With more than 75% of parents and pediatric caregivers getting their health-related information online, reaching families on social media is a powerful way to leverage the trust built in the examination room to address vaccine hesitancy. This article first reviews the ways the antivaccine movement has leveraged social media to expand its considerable influence, and why social media companies have failed to reduce antivaccine misinformation and disinformation. Next, it reviews the barriers to adoption of social media-based communication by pediatric health-care providers and concludes with action-oriented items to increase the adoption of this powerful tool.

Bots' Activity on COVID-19 Pro and Anti-Vaccination Networks: Analysis of Spanish-Written Messages on Twitter

This study aims to analyze the role of bots in the dissemination of health information, both in favor of and opposing vaccination against COVID-19. Study design: An observational, retrospective, time-limited study was proposed, in which activity on the social network Twitter was analyzed. Methods: Data related to pro-vaccination and anti-vaccination networks were compiled from 24 December 2020 to 30 April 2021 and analyzed using the software NodeXL and Botometer. The analyzed tweets were written in Spanish, including keywords that allow identifying the message and focusing on bots’ activity and their influence on both networks. Results: In the pro-vaccination network, 404 bots were found (14.31% of the total number of users), located mainly in Chile (37.87%) and Spain (14.36%). The anti-vaccination network bots represented 16.19% of the total users and were mainly located in Spain (8.09%) and Argentina (6.25%). The pro-vaccination bots generated greater impact than bots in the anti-vaccination network (p < 0.000). With respect to the bots’ influence, the pro-vaccination network did have a significant influence compared to the activity of human users (p < 0.000). Conclusions: This study provides information on bots’ activity in pro- and anti-vaccination networks in Spanish, within the context of the COVID-19 pandemic on Twitter. It is found that bots in the pro-vaccination network influence the dissemination of the pro-vaccination message, as opposed to those in the anti-vaccination network. We consider that this information could provide guidance on how to enhance the dissemination of public health campaigns, but also to combat the spread of health misinformation on social media.

COVID-19 Vaccine Hesitancy, Acceptance, and Promotion Among Healthcare Workers: A Mixed-Methods Analysis

Even with vaccine mandates, COVID-19 vaccine hesitancy remains a concern among healthcare workers, in part due to their role in promoting vaccination among patients and communities. To examine COVID-19 vaccine hesitancy, acceptance, and promotion among healthcare workers, we conducted a mixed-methods analysis of (1) survey responses about COVID-19 vaccination and (2) Twitter messages (i.e., tweets) relevant to COVID-19 vaccination and healthcare. A total of 540 hospital employees completed the survey. Those that completed less than 80% of the survey or did not endorse employment at the hospital were excluded, resulting in a total of 511 valid responses; 93.2% reported receiving at least one dose of a COVID-19 vaccine. Approximately 1/3 of vaccinated individuals indicated they posted about receiving the vaccine on social media. Simultaneously, we analyzed a sample of 3845 tweets; 2299 (60%) were relevant to COVID-19 vaccination and 1863 (81%) were coded as authored by an individual. Of tweets authored by an individual, 6% (n = 106) were authored by a healthcare provider/health sciences student. Among relevant tweets, the most frequent code across all sentiment categories was related to the pharmaceutical industry (n = 529 tweets, 28%; n = 33, 31% of tweets authored by healthcare workers). Triangulation of results found themes including vaccine access, trust, and vaccine safety or negative health impacts. Results suggest that promoting the sharing of COVID-19 vaccine personal narratives on social media, combined with interventions targeting specific reasons for COVID-19 vaccine hesitancy and emphasizing freedom from fear once vaccinated could be effective at reducing COVID-19 vaccine hesitancy among this population.

How Does Social Media Influence People to Get Vaccinated? The Elaboration Likelihood Model of a Person's Attitude and Intention to Get COVID-19 Vaccines

The global COVID-19 mass vaccination program has created a polemic amongst pro- and anti-vaccination groups on social media. However, the working mechanism on how the shared information might influence an individual decision to be vaccinated is still limited. This study embarks on adopting the elaboration likelihood model (ELM) framework. We examined the function of central route factors (information completeness and information accuracy) as well as peripheral route factors (experience sharing and social pressure) in influencing attitudes towards vaccination and the intention to obtain the vaccine. We use a factorial design to create eight different scenarios in the form of Twitter posts to test the interaction and emulate the situation on social media. In total, 528 respondents were involved in this study. Findings from this study indicated that both the central route and peripheral route significantly influence individually perceived informativeness and perceived persuasiveness. Consequently, these two factors significantly influence attitude towards vaccination and intention to obtain the vaccine. According to the findings, it is suggested that, apart from evidence-based communication, the government or any interested parties can utilize both experience sharing and social pressure elements to increase engagement related to COVID-19 vaccines on social media, such as Twitter.

Conflicting attitudes: Analyzing social media data to understand the early discourse on COVID-19 passports

In several countries, vaccine passports are being encouraged to hasten the return to some form of normalcy amidst the COVID-19 pandemic. Vaccine passport is a digital or paper document that may serve as proof of the COVID-19 vaccine, thereby allowing entry to public venues, sporting events, air travel, and unrestricted access to other facilities. This study explores how the COVID-19 passport is being discussed and perceived on Twitter and the prominent entities involved in the early discourse on the issue. Twitter messages were theoretically analyzed for Health Belief Model (HBM) and Theory of Planned Behavior (TPB) variables, as well as message source, engagement, and attitudes towards vaccination certificates. Using quantitative content analysis, tweets were coded on nine dimensions: account type, tweeter profile, tweet content, tweet modality, attitude, self-efficacy, perceived barriers, benefits, and action cues. Most of the tweets originated from personal accounts, followed by media organizations, media-related personalities, politicians, and the travel industry. A significant number of tweets were from male Twitter users. Our analysis revealed that most tweeters had a favorable attitude towards the COVID-19 passports. Unfavorable attitudes toward the COVID-19 passport were based on reasons such as a lack of common standard or consensus, and personal freedoms & human rights. Tweets highlighting the benefits of COVID-19 passports cited travel as the primary reason. Based on a combination of technical, legal, and ethical practices, our study offers a set of vital recommendations for governments, health organizations, and businesses that may help stimulate the acceptance of vaccine passports.

Social Media Discussions on the FDA's Modified Risk Tobacco Product Authorization of IQOS

Background: The U.S. Food and Drug Administration (FDA) authorized the marketing of the IQOS tobacco heating system as a modified risk tobacco product (MRTP) in July 2020, permitting its 'reduced exposure' marketing. This decision is accompanied by much controversy among the global health community. We provide a preliminary analysis of Twitter conversations regarding the MRTP authorization of IQOS by identifying the authors, valence towards the policy decision, source of cited link, and focused topic. Methods: We analyzed 548 tweets mentioning MRTP posted between July 2016 (when PMI submitted the proposal) and October 2020. Results: We found a higher proportion of pro-MRTP valence (25.4%) than anti-MRTP (16.2%). Nearly half of the tweets (47.2%) expressing personal opinions presented pro-MRTP valence (vs. anti-MRTP = 23.9%). The FDA website was more frequently cited in pro-MRTP tweets (30.8% vs. anti = 4.8%), while tobacco control advocates' websites were cited only in anti-MRTP tweets (77.4% vs. pro = 0). Pro-MRTP valence appeared more frequently in tweets mentioning health (53.1% vs. anti =38.5%) and cessation (100% vs. anti = 0). Nearly 42% of tweets showed a bot score greater than .43, indicating a possibility of automation. Conclusion: Continuous efforts are needed to surveil the industry's attempts to create a climate of false consensus and circulate misinformation regarding MRTP on social media, as well as to assist non-scientific audiences' understanding of MRTP.

Exploring Online Twitter Conversations surrounding National Healthcare Decisions Day and Advance Care Planning from a Socio-Cultural Perspective: A Computational Mixed-Methods Analysis (Preprint)

Background

Within the cultures and societies of the United States, topics related to death and dying continue to be taboo, and as a result, opportunities for presence and engagement during the end of life, which could lead to a good death, are avoided. Several efforts have been made to help people engage in advance care planning (ACP) conversations, including completing advance care directives so that they may express their goals of care if they become too sick to communicate their wishes. A major effort in the United States toward encouraging such challenging discussions is the annual celebration of the National Healthcare Decisions Day.

Objective

This study aimed to explore ACP from a sociocultural perspective by using Twitter as a communication tool.

Methods

All publicly available tweets published between August 1, 2020, and July 30, 2021 (N=9713) were collected and analyzed using the computational mixed methods Analysis of Topic Model Network approach.

Results

The results revealed that conversations driven primarily by laypersons (7107/7410, 95.91% of tweets originated from unverified accounts) surrounded the following three major themes: importance and promotion, surrounding language, and systemic issues.

Conclusions

On the basis of the results, we argue that there is a need for awareness of the barriers that people may face when engaging in ACP conversations, including systemic barriers, literacy levels, misinformation, policies (including Medicare reimbursements), and trust among health care professionals, in the United States. This is incredibly important for clinicians and scholars worldwide to be aware of as we strive to re-envision ACP, so that people are more comfortable engaging in ACP conversations. In terms of the content of tweets, we argue that there is a chasm between the biomedical and biopsychosocial elements of ACP, including patient narratives. If used properly, Twitter conversations and National Health Care Decision Day hashtags could be harnessed to serve as a connecting point among organizations, physicians, patients, and family members to lay the groundwork for the trajectory toward a good death.