How COVID-19 has changed infectious diseases communication on social media: Through the lens of @TheLancetInfDis

This is another post in an occasional series of social media analysis that didn’t reach the pages of peer reviewed journals. It was completed on 28 June 2020, rejected by Lancet Infectious Diseases on 16 July 2020.

Article, very slightly modified, follows…

So much has changed in such a short time. It is difficult to stand back and take a long view. In this article I explore the way that infectious diseases messages have been shared via social media over a period of over two years (11 April 2018 to 18 June 2020), including the pandemic. The detail is provided in two Wakelet summaries – one for tweets by the Journal, the other for retweets by the Journal. Briefly, I used a quirk of Twitter analysis that allows data extracts over a longer period than normal by looking at a single account (@TheLancetInfDis). The original NodeXL extract provided data centred on the Journal’s Twitter account. I remapped this to chart wider connections and updated the data a week later. This approach provided up-to-date information on 1,356 tweets by @TheLancetInfDis account and 1,840 tweets by 371 other accounts which the journal retweeted.

thelancetinfdis - user map via NodeXL
thelancetinfdis – user map via NodeXL

thelancetinfdis - network map after extracting details of other tweeters
thelancetinfdis – network map after extracting details of other tweeters

Prior to the pandemic the Journal covered a wide range of topics: an “angiostrongyliasis to zoster” of infectious disease, with TB, malaria, HIV, antimicrobial resistance and vaccination popular topics. Since January 2020 there has been a stark narrowing of topics, with COVID-19 related terms dominating: though the Journal continued to tweet about topics from anthrax to zika, two thirds of the hashtags used were COVID-19 related. Interactive word clouds provide detail and allow exploration of the individual tweets (you can access these by clicking on the images below, or fuller information in the Wakelet summary of tweets).

Hashtags in @TheLancetInfDis tweets prior to the pandemic - by number of tweets posted Hashtags in @TheLancetInfDis tweets prior to the pandemic - by number of tweets posted
Hashtags in @TheLancetInfDis tweets prior to the pandemic – by number of tweets posted Hashtags in @TheLancetInfDis tweets prior to the pandemic – by number of tweets posted

Hashtags in @TheLancetInfDis tweets during the pandemic - by number of tweets posted Hashtags in @TheLancetInfDis tweets during the pandemic - by number of tweets posted
Hashtags in @TheLancetInfDis tweets during the pandemic – by number of tweets posted Hashtags in @TheLancetInfDis tweets during the pandemic – by number of tweets posted

There has simultaneously been a step change in the reception of the Journal’s tweets, peaking in March. During the pandemic, tweets by the Journal received twice as many retweets as before and the content retweeted by the Journal reached a much wider audience (though that will be influenced by a range of factors as some of these retweeted posts were already “going viral”).

Number of tweets made and retweets received by @thelancetinfdis
Number of tweets made and retweets received by @thelancetinfdis

For the full 26-month period 42/100 of the Journal’s top tweets and 83/100 of the top retweeted posts were about COVID-19. It is not possible from these data to separate out whether these tweets – by the Journal or other tweeters – were shared by the general public or individuals and organisations with a specialist interest in infectious disease. Nonetheless, the individual tweets posted and retweeted provide an international view of the pandemic including research, ethics, public health, clinical, epidemiological, pharmacological, political and social dimensions.

Many of the lessons from COVID-19 are transferable to other infectious diseases. Hopefully the awareness, interest and connections generated during the pandemic can be converted into wider knowledge of infectious diseases among professionals and public after the pandemic.

Dr Graham Mackenzie, GPST2, Edinburgh, Scotland

16 July 2020.

graham mackenzie on twitter

Taking a long-view of tweeting – an example looking at @HelenBevan’s account

Introduction: A few days ago I contacted Helen Bevan to share a social network map of her tweets over a period of almost 2 years. Helen has been a great source of support over the past 5+ years after we met in social media discussions about quality improvement and then in person with the Q Community.

I had run this most recent map of Helen’s tweets as an experiment to look at long range tweeting. Usually it is only possible to look at a few days of tweets. However Twitter allows you to extract tweets over a longer period if looking at a single account, providing access to up to 3,200 tweets and retweets. Helen is well known as one of the UK’s top healthcare tweeters. She is also very supportive of colleagues from across the world, reading and commenting on others’ tweets and blogs and is quick to share useful content with her 86,000+ followers. Mapping her social network connections would help her understand her audience and the content that had most impact. Helen tweeted my map. The map intrigued and confused some of Helen’s followers, so I have posted a blog on this analysis. (The blog is also available as a PDF file; there is also a PDF version of the associated Wakelet summary).

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Finding the sweet spot in healthcare social media communication: A call for greater clarity in medical and science hashtags

Scientific communication relies on clarity, specificity and universality. In this blog I explain how communication between medical tweeters is held back by a lack of clarity in hashtag choice, and by the absence of a “fuzzy search” feature in Twitter. I explore lessons from the way that medical research papers are categorised (MeSH headings) and propose options for improving medical tweeting, helping people to look beyond their usual social media bubble.  I also demonstrate ways to visualise intentions vs reception for hashtags in two topical issues using word clouds.

I have written this as a blog, because I wanted to include a more reflective exploration of this topic than I could in a traditional medical paper. Hopefully, with the contribution of other medical tweeters, the ideas presented here can be developed into a peer reviewed paper in a medical journal.

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Health innovation and COVID-19 pandemic: Defining the need and understanding the response.

Health innovation and COVID-19 pandemic: Defining the need and response.

A question heard on the wards recently – how can we capture all the innovations that have emerged from the COVID-19 pandemic? I’m sure that there are similar questions in hospitals, GP surgeries and other organisations across the world.
In order to answer this question we need to start by defining innovation. The World Health Organization (which might want to drop the American spelling in light of recent political decisions) defines health innovation as follows:

“Health innovation is to develop new or improved health policies, systems, products and technologies, and services and delivery methods that improve people’s health, with a special focus on the needs of vulnerable populations.

  • WHO engages in health innovation in the context of universal health coverage
  • Health innovation adds value in the form of improved efficiency, effectiveness, quality, safety and/or affordability
  • Health innovation can be in preventive, promotive, therapeutic, rehabilitative and/or assistive care”

In classic Public Health style WHO identifies 3 overlapping domains necessary to capture health innovation fully – science innovation (R&D), social innovation, and business innovation – each of which we can see in evidence in the wider pandemic response.

This is a useful definition for a number of reasons:

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The Role of Patient Information Leaflets in the Treatment of Patients

A first year medical school report by Kirsty Mackenzie, University of Dundee, written as part of a Student Selected Component (SSC) on Human Factors (March 2018). This is also available as a PDF.


Over the past century and particularly over the last few decades, there has been a huge shift in the way in which patients interact with doctors. In the past, patients were given very little information about their conditions or their treatments. Medicine was very paternalistic and there was little room for patients to question the doctor’s decisions or to make choices for themselves. The public had very little scientific knowledge and blindly agreed to treatments that may not have needed or wanted(1). This was not in the best interests of patients because they had no control over their own health and this must have left them feeling less content and more anxious about what they were going through. The old model of ‘doctor knows best’ has in recent times been put aside in favour of ‘person-centred care’. The Royal College of Nursing states ‘[Person centred care] means that the person is an equal partner in the planning of care and that his or her opinions are important and are respected(2).’ This term was first coined by the psychotherapist Carl Rogers building on earlier ideas proposed by healthcare workers. Further building on Rogers’ ideas, the psychiatrist George Engel promoted ‘the move from a medical to a biopsychosocial the move from a medical to a biopsychosocial model of health(3).’ His ideas have been widely credited with being responsible for the shift in the model of care.

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One step beyond: Mapping older tweets and retweets

Over the past 3 years I have been studying social networks for health (e.g. public health campaigns, clinical conferences). I have been collaborating with clinicians and analysts across the world in this work, publishing some of the outputs in peer-reviewed journals as listed below, studying the content, influencers, components of tweets that could influence retweeting, commercial influences in conference tweeting, responses beyond the hashtag, and looking at hierarchy of tweeting. Some of these have been published already – e.g. most recently a paper with Muge Cevik and David Ong, available for a few more weeks in free full text. Look out for details of the remaining papers over coming months. Summary of social media work - papersOne area that I have been keen to explore, but have not been able to until now, is mapping older tweets and retweets. Twitter provides access to tweets and retweets over the past 10 days. Sometimes a network will take longer than 10 days to establish, at which point the data become difficult – or expensive – to extract. This blog explains how to extract older tweets and retweets manually so that they can be mapped well beyond the 10 day limit, using NodeXL. I have used the example of #CwPAMS (Commonwealth Partnerships for Antimicrobial Stewardship) following a request by Diane Ashiru. I have illustrated this using 30 tweets first, and then the retweets that followed. It would be possible with patience and time to map all the #CwPAMS tweets using this method.

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Reflections on live tweeting social media analysis from #RCGPAC.

The Royal College of General Practitioners Annual Conference (RCGPAC) 2019 has embraced the use of social media to disseminate information to conference delegates and a wider audience beyond the conference hall. In an experiment at RCGPAC 2019, social media analysis was shared live from the conference hall throughout the conference, summarising the top content, identifying the main contributors and encouraging delegates to use the conference hashtag (#RCGPAC) to aid identification and dissemination of tweets. This idea emerged after an analysis of tweeting from the 2018 conference showed that a substantial proportion of tweets had omitted the official conference hashtag and were therefore less likely to reach their intended audience. Throughout the conference I shared social media analysis in a tweet thread and an ongoing Wakelet summary capturing the most popular tweets. This analysis has, in turn, fed into GP Online articles.

Continue reading “Reflections on live tweeting social media analysis from #RCGPAC.”

Have we passed “peak tweeting” at medical conferences? (and other final reflections on social media analysis)

Conferences are an important way of sharing new medical and scientific knowledge. Twitter is an important way of summarising and sharing information from conference. This blog sets out to answer the question: “Have we reached peak tweeting at medical conferences?”. Popular social media tools produce quite misleading results, combining tweets and retweets, tweeters and retweeters, reporting potentially huge audiences based on questionable assumptions. Instead, this analysis uses raw data, breaking down results for tweeters and retweeters. It reports on 3 years of tweeting (2016-18) about four conferences (two public health, one anaesthetics, one quality improvement conference). The answer to the question whether we have passed peak tweeting is: “It’s too early to say whether we have passed the peak, but we quite possibly have, and conference tweeting is certainly evolving”.

Now of course 3 data points do not demonstrate a trend: you need 10-12 points or more for a run chart. Nonetheless, it is of interest that compared with 2017 there were fewer people generating original content at each of these medical conferences in 2018. These four conferences had quite different contributors and audiences, but the findings are consistent. Perhaps the pattern is real, and reflective of wider changes in conference tweeting. The number of tweets also dropped overall, but that may be explained by an increase in number of characters allowed in a tweet (from 140 to 280, November 2017). There was also less retweeting between 2017 and 2018 for three of the conferences.

Nonetheless, there is great content out there, and conference tweeting is maturing, and is likely to continue to evolve. We see the emergence of rapporteurs, specifically setting out to record the conference proceedings in imaginative ways. The Intensive Care Society State of the Art conference is leading the way in this area, and Helen Bevan and colleagues at NHS Horizons continue to generate fabulous content in their general and conference tweeting.

I also highlight that there are some limitations to current social network analysis:

  • Reports of conference audience/ reach on social media (Symplur, Twitonomy, Followthehashtag) are typically wildly optimistic and should be ignored. Their reports on influencers are potentially useful, but should be interpreted with caution.
  • Replies that do not use the conference hashtag are not captured, and sometimes include rich information. This requires more sophisticated tools and analytical approaches adopted from qualitative research methods.
  • Retweets are under-represented in NodeXL reports, and this can sometimes result in very odd results.

That’s me signing out of social media analysis for the time being. I’m off to retrain as a GP, returning to a clinical training grade for the first time in almost 20 years.

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Communication in a complex world – perspectives for Public Health/ NHS teams

Recently we had a discussion about communication in one of our teams. It’s a regular bugbear in any department:

  • Do we miss important messages in the dozens or hundreds of emails we receive in a day? (Disclosure – I have switched off emails when preparing this blog, so I can concentrate)
  • How should we manage circulars? (When I started work we used to have a paper system with sign off sheets that took many months to circulate around even a relatively small department. While we don’t have paper circulars any more, we still have plenty of emails with links to reports, conferences, consultations, and it remains difficult to keep on top of all this information)
  • Are meetings a waste of time? (They don’t need to be, but frequently are, usually because of problems with communication. Well described by Guy Browning).
  • How do we update colleagues about our work (i.e. internally)? (There are lots of different approaches – weekly information exchange, huddles, notice boards, posters, and of course quarterly and annual reports for corporate objectives)
  • How do we communicate with the outside world (i.e. externally)? (Many public services still don’t even have an up to date website, let alone a blog or social media feed; also peer reviewed journals, freedom of information requests, public committees and other forums).

A group of 3 team members met to discuss options. We weren’t all sure why we were there as the meeting invite hadn’t given context, or if it had it was hidden away. At least had managed to arrive, on time, with only one person missing. We started to explore options. In the spirit of better communication I have written up the meeting as a blog that can be shared on social media.

This blog is also available as a PDF to download.

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Who sets the health agenda in the UK and globally? An exploration of the early #FakeNews era

It is important for healthcare workers to understand how health news is reported. Social media provides ways to understand who makes and shares health stories, the potential audience, and the stories themselves. Back in January 2017 Prof Chris Oliver and I prepared a research paper on this topic which we submitted to two international medical journals in February and March 2017. It was not accepted for publication – perhaps it was too early for this important topic.

I came across the paper again recently when working through files as I prepare to move job (February 2019). The timing of this analysis – just at the point that Trump acquired the keys to the White House, and just when Chris and I were trying to work out what social network analysis reports could tell us – makes this a potentially important piece of work, so Chris and I have decided to share the paper in a way made possible by social media – a blog. Download the full paper here.

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