What’s in a hashtag? An analysis of tweets posted during World Antibiotic Awareness Week 14-20 November 2016

Antimicrobial resistance presents a major challenge, but simple steps can to minimise the impact. Social media has a role in disseminating information during antibiotic awareness campaigns: information can be shared rapidly, widely, and cheaply.

Hashtags are used to identify social media posts on a specific topic. The official hashtag for social media activity during the 2016 world antibiotic awareness week (14 to 20 November 2016) was #AntibioticResistance, with a separate hashtag for the official European campaign on 18 November 2016 (#EAAD or #EAAD2016).

However, numerous other hashtags were used quite widely during the week, including hashtags for established professional-focused national campaigns such as #AntibioticGuardian, which originated in the United Kingdom (UK), and an unofficial hashtag that reflected the purpose of the week – #AntibioticAwarenessWeek. There was also some tweeting without hashtags. There were many tens of thousands of tweets posted during the campaign week by tens of thousands of individuals and organisations.

It would not be possible to analyse this volume of tweeting using conventional methods. Accordingly, we extracted data using social network analysis (NodeXL) and Twitter searches to study the characteristics of tweeters and tweets using the most frequently used hashtags (official and unofficial) and without hashtags. An example NodeXL map is shown in Figure 1.

The quality of the most popular tweets was assessed by looking at use of hashtag, image or mention of another tweeter. These are components that boost the impact of a tweet as described in the previous ScotPublicHealth blog post.

The aim of the analysis was to identify whether there were differences in tweet content between the hashtags, to see if there is value in looking beyond the official hashtag, both for learning, networking and broadcasting.

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Increasing the quality and impact of Public Health tweeting – looking beyond #ScotPublicHealth

I’m writing this blog in preparation for the European Public Health conference in Stockholm, 1-4 November 2017 (#EPHStockholm). At the conference I will be presenting the #ScotPublicHealth work on quality and impact of tweeting during 2016 (read JPH paper here; please contact me if you do not have access to the article and would like a copy). I have recorded a dry run as a “video abstract” (far from perfect, but useful preparation for the presentation itself). Full slides are available too.

The #ScotPublicHealth work emerged from the Scottish Public Health conference in Peebles, November 2015. It was clear that we should be attempting to network and share better across the Public Health community in Scotland – it was not enough to meet at an annual conference. Colleagues spread across large distances in Scotland did not have an opportunity to meet and discuss topics of mutual interest. I set out to improve connections using Twitter, but quickly learnt that colleagues wanted more advice about tweeting (see write up of #ScotPublicHealth tweet chat January 2016).


The series of blogs and webinars that we ran around #ScotPublicHealth in 2016 has been described in a series of blogs on this page; these activities were an attempt to learn more about public health topics and social media and internet technology. We looked at physical activity with Prof Chris Oliver, assets based approaches to improving health with Glasgow Centre for Population Health, health inequalities with NHS Health Scotland and Institute of Health Equity, and realistic medicine with Scotland’s Chief Medical Officer and an expert panel.

I compared tweets posted about “public health” in Scotland between September and December 2014 and compared these with tweets using the #ScotPublicHealth hashtag Autumn 2016. There was an increase in the quality of tweets as assessed by the % tweets with an image, URL and/or mention.


There was also an increase in the impact of these tweets as assessed by the % retweeted (and the number of retweets achieved). The greatest impact was seen in tweets that used more than one key component (mention of another Twitter user, image and/or URL).


It is clear from the findings that while general “public health” tweeting has improved, conference tweeting remains an area for improvement. Some people will only tweet on professional matters when prompted, for example at conferences. In my study this group of “conference tweeters” was less experienced than colleagues who had engaged in the #ScotPublicHealth work throughout 2016. Conference tweets in the #ScotPublicHealth study were less likely to include an image (which draws the eye in), a URL (which provides further information), or mention another Twitter user (which helps sharing). There was only a modest increase in quality of tweets between the 2014, 2015 and 2016 conference (⬆pictures, very small increase in use of URL though remained a small minority at 12% in 2016; no increase in mentions of other Twitter users).

The low use of URLs in conference tweets is a feature of other Public Health conferences collected in the following Wakelet summaries:

American Public Health conferences: #APHA2016 | #APHA2017

English and UK conferences: #PHEConf17 | #FPHConf2017

Scottish conferences: #ScotFPH2015|#ScotPublicHealth (2016)|#ScotPublicHealth (2017)

European: #EPHVienna (2016) | #EPHStockholm (2017)

The under-utilisation of URLs at Public Health conferences is a missed opportunity. Microbiologist Jon Otter and colleagues have demonstrated that the URL is important in professional sharing, and this has resulted in very effective and informative tweeting at microbiology conferences (see summary in Lancet Infectious Diseases Media Watch article). If there isn’t a link to a paper, blog or video that explains the findings presented at a conference then people will be less likely to share it on social media. As scientists and clinicians we need to assess the credibility of information before we can assess whether we want to broadcast it.

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Maslow’s hierarchy of needs, rights of the child, and the joy of learning to play music

A policy post here (originally posted on the Get Healthy Start Facebook page, 22 Mar 2015): on helping Scotland to become the best place to grow up. I have been prompted to dig this out after seeing some recent tweets about Maslow’s hierarchy in the workplace and in schools. See these recent tweets here.

This post looks at UN Convention on the Rights of the Child (UNCRC), Maslow’s hierarchy of needs, article 31 of UNCRC, and the particular gains from teaching more kids a musical instrument. Sources at end of post.

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Quality Improvement explained in four everyday objects

Quality Improvement (QI) is a powerful approach for exploring and improving the way that healthcare is delivered. However, the technical terms surrounding the methodology can make QI seem inaccessible. This is a pity, as many of the techniques will be familiar to clinicians through their routine work. QI work is simply about making refinements to the way we work, one patient at a time, building a more reliable process, and keeping our sights on a bigger goal.

This blog explains some of the key principles and approaches of QI work, stripped of its jargon, using 4 common objects as an aide-memoire. The formal QI tools on which these objects are based are listed in the notes section at the end of this blog.

If you’d prefer a video summary then you can find a version here (Youtube).

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A summary of recent “physical activity” tweets taking a person, topic, organisation, network and campaign approach

Introduction: Readers of this blog will know that I have been looking at extracting public health content from Twitter over the past year. In this analysis I bring together a series of NodeXL social network analyses, extracted over the past 2 days, to look at what they can tell us about physical activity and health. I have termed this a “person, topic, organisation, network and campaign” approach (PTONC – pronounced Pétanque perhaps for this physical activity theme?)

This work was prompted by a request by Ann Gates at ExerciseWorks on Saturday 7 October 2017. ExerciseWorks is a prominent physical activity focused Twitter account based in the UK but with a global reach. Ann was interested in demonstrating her Twitter following to a physiotherapy audience and asked if I could produce a NodeXL map (figure 1). I thought it would be interesting from a CPD perspective to look beyond the interactions shown in figure 1 to look at the contents of the most shared tweets, for ExerciseWorks and other NodeXL searches.

Figure 1: @ExerciseWorks NodeXL map 27 Sep to 7 Oct 2017

exerciseworks to 7 oct.png

Source: NodeXL graph gallery

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Public Health advocacy in Scotland during 2017

This blog provides a quick summary of two health/ public health advocacy campaigns in Scotland, both launched at Scottish Parliament during 2017.

Advocacy is an important part of Public Health work. The Public Health Advocacy Institute of Western Australia provides the following definition in their advocacy toolkit:

The word ‘advocate’ actually comes from a Latin word meaning ‘to be called to stand beside’. Advocacy can be thought of as “the pursuit of influencing outcomes – including public policy and resource allocation decisions within political, economic, and social systems and institutions – that directly affect people’s lives.”

The “State of Child Health” report was launched by Royal College of Physicians and Child Health on 26 January 2017, with events across the UK, including a RCPCH Scotland event at Scottish Parliament. I have summarised the Twitter activity around that day here.

The “Fairer Lives Healthier Future” call to action was launched by the Faculty of Public Health in Scotland on 20 September, with events at the Royal College of Physicians Edinburgh and Scottish Parliament. Twitter activity during and after the launch is summarised here.

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Quantifying the reach and punch of a single BMJ article on social media

The BMJ cover story on 9 September 2017 explored a Twitter ban at a medical conference in the United States. The article included responses to the Twitter ban from two of the most prominent physician tweeters from the US (Prof Michael Gibson and Dr Kevin Campbell), a couple of comments from me, and social network analysis (SNA) that I had performed looking at the tweets that emerged from the conference.  The analysis showed that the ban itself was a much bigger topic of conversation on Twitter than any clinical or scientific learning from the conference. In this blog I explore the reach and impact of the BMJ article on social media in the days after publication.

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The twisty path from studying #Complexity2017 to summarising an American College of Cardiology conference at the request of some of the world’s top medical tweeters

ScotPublicHealth has attempted to bring together insights around public health and social media techniques, with the intention of learning, networking and broadcasting positive and evidence-based messages about health and wellbeing. Over the course of this work I have learnt and refined techniques in extracting and processing large quantities of information from Twitter to source top quality content.

As with any new technique, there is a lot of learning, curiousity and experimentation required. You’re not sure where such work will lead, but you follow your nose. This particular post, which brings together three “big data” analyses over three days, has emerged out of relationships developed on Twitter, and a bit of luck.

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Using a quick extract of “Air Pollution” tweets to source content for National Clean Air Day (15 June 2017)

My recent blog posts have looked at post hoc analyses of Twitter “big data” to describe conferences and awareness raising campaigns. This blog post looks at how “big data” can help identify high quality content to feature in a forthcoming campaign.

Air pollution, climate change and global warming are highly relevant to Public Health, with an up to date analysis provided in the Global Burden of Disease study in the Lancet. The #AirPollution hashtag is used in tweets throughout the year. I have extracted tweets that mention “air pollution” (from 12 and 13 June 2017) to identify potential content for “National Clean Air Day” on 15 June. The top 60 “air pollution” tweets (by number of retweets at 14:00 UK time on 13 June) are listed in a Wakelet summary. Searching for “air pollution” will identify tweets with the phrase itself or the hashtag. There is a wide range of content here, from Scientific American and Guardian news stories to other articles, infographics and tools, including posts and websites in French and one tweet in Japanese. The Guardian article was the most quoted “air pollution” story from this list. In order to demonstrate the range of people tweeting I have included each of the tweets in the top 60, but moving repeated stories to the end. The content (images, URLs etc) can be explored and used in new tweets specifically for the National Clean Air Day campaign.

air pollution guardian article
Source: Guardian website

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Guest editing WePublicHealth global public health Twitter feed (28 May to 4 June)

Between 28 May and 4 June 2017 I guest edited the Twitter feed for the second time. Read blog from guest editing this global Public Health blog the first time (January 2016).

This time round I used Twitter “big data” to source the best tweets and related materials from around the world on a series of Public Health topics, including physical activity, social determinants of health, antibiotic resistance, vaccination, smoking, mental health, and advocacy, introducing a new topic each day. I took the “big data” outputs and produced simple summaries on each topic. Find out more about the techniques I used in this blog on Immunization Week last month.

On 31 May I tweeted live from the Royal College of Physicians Edinburgh conference “Public Health in a Changing World” (hashtag , programme here).

Read a short summary of each day’s activities below. From grassroots advocacy to global awareness campaigns this provides a whirlwind tour of recent Public Health work across the world.

Graham Mackenzie (@gmacscotland on Twitter)

Consultant in Public Health

4 June 2017

Cynergy_Graham MacKenzie_509 (1)

(Photo taken from Inverleith Park, north Edinburgh, looking south over pond to Edinburgh Castle and Arthur’s Seat, evening of 2 June 2017)

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