Retweeting Risk Communication: The Role of Threat and Efficacy

Radon Risk Communication through News Stories: A Multi-Perspective Approach

Radon is, after tobacco, the most frequent cause of lung cancer. Communicating about its risks with a didactic perspective so that citizens become aware and take action to avoid radon remains a challenge. This research is framed in Spain, where 17% of the territory exceeds the maximum radon limits allowed by the WHO, and aims to study the role and impact of the media in radon risk communication. A mixed methodological design is applied, combining content analysis of news published in the last two decades by local media in the most affected areas with interviews with journalists and a survey of citizens to provide a multi-perspective approach. The results show that, although news coverage of radon is becoming more frequent, it is a topic that fails to position itself on the agenda for effective communication. The media are the most frequent source of information on radon, although they are not considered by the public the most trustworthy one. News stories about radon focus mainly on health and research to inform about the radon levels to which citizens are exposed and the risks associated with cancer. Collaborative strategies between the media, organizations, and public administration seem key to advancing the fight against radon.

Social Media Users' Engagement with Fear Appeal Elements in Government's Health Crisis Communication via State-Owned Media

Government health messaging is significant to the containment of public health crises. Such communication may benefit from using fear appeal, a message strategy for promoting health and preventing diseases. Yet little scholarly attention has been paid to how fear appeal is employed in government messaging to promote social media engagement through online actions including likes, shares, and comments. These actions play a meaningful role in addressing communication exigencies within the context of health crises. In this study, quantitative content analysis and corpus linguistics methods were employed to analyze fear appeal-related elements in COVID-19 messages sent by a state-owned media outlet on social media. The results show that when compared to messages without threat, messages conveying threat elicited significantly more comments, in which emotions and perceptions to threat and efficacy were exhibited, while messages containing both threat and efficacy generated more engagement in comparison to messages with threat alone. Moreover, while subdimensions under efficacy were positive predictors of engagement, those under threat were primarily found to have exerted negative effects. The findings provide insights into how fear appeal elements can be employed in government health crisis communication to engage the public.

Community engagement through social media: A promising low-cost strategy for rural recruitment?

PURPOSE

For the same reasons that rural telehealth has shown promise for enhancing the provision of care in underserved environments, social media recruitment may facilitate more inclusive research engagement in rural areas. However, little research has examined social media recruitment in the rural context, and few studies have evaluated the feasibility of using a free social media page to build a network of rural community members who may be interested in a research study. Here, we describe the rationale, process, and protocols of developing and implementing a social media approach to recruit rural residents to participate in an mHealth intervention.

METHODS

Informed by extensive formative research, we created a study Facebook page emphasizing community engagement in an mHealth behavioral intervention. We distributed the page to local networks and regularly posted recruitment and community messages. We collected data on the reach of the Facebook page, interaction with our messages, and initiations of our study intake survey.

FINDINGS

Over 21 weeks, our Facebook page gained 429 followers, and Facebook users interacted with our social media messages 3,080 times. Compared to messages that described desirable study features, messages that described community involvement resulted in higher levels of online interaction. Social media and other recruitment approaches resulted in 225 people initiating our in-take survey, 9 enrolling in our pilot study, and 26 placing their names on a waiting list.

CONCLUSIONS

A standalone social media page highlighting community involvement shows promise for recruiting in rural areas.

#4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial

BACKGROUND

Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas.

OBJECTIVE

This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah.

METHODS

We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign.

RESULTS

The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management.

CONCLUSIONS

Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50392.

Clearing the air: evaluating institutions' social media health messaging on wildfire and smoke risks in the US Pacific Northwest

BACKGROUND

Wildfire smoke contributes substantially to the global disease burden and is a major cause of air pollution in the US states of Oregon and Washington. Climate change is expected to bring more wildfires to this region. Social media is a popular platform for health promotion and a need exists for effective communication about smoke risks and mitigation measures to educate citizens and safeguard public health.

METHODS

Using a sample of 1,287 Tweets from 2022, we aimed to analyze temporal Tweeting patterns in relation to potential smoke exposure and evaluate and compare institutions' use of social media communication best practices which include (i) encouraging adoption of smoke-protective actions; (ii) leveraging numeric, verbal, and Air Quality Index risk information; and (iii) promoting community-building. Tweets were characterized using keyword searches and the Linguistic Inquiry and Word Count (LIWC) software. Descriptive and inferential statistics were carried out.

RESULTS

44% of Tweets in our sample were authored between January-August 2022, prior to peak wildfire smoke levels, whereas 54% of Tweets were authored during the two-month peak in smoke (September-October). Institutional accounts used Twitter (or X) to encourage the adoption of smoke-related protective actions (82% of Tweets), more than they used it to disseminate wildfire smoke risk information (25%) or promote community-building (47%). Only 10% of Tweets discussed populations vulnerable to wildfire smoke health effects, and 14% mentioned smoke mitigation measures. Tweets from Washington-based accounts used significantly more verbal and numeric risk information to discuss wildfire smoke than Oregon-based accounts (p = 0.042 and p = 0.003, respectively); however, Tweets from Oregon-based accounts on average contained a higher percentage of words associated with community-building language (p < 0.001).

CONCLUSIONS

This research provides practical recommendations for public health practitioners and researchers communicating wildfire smoke risks on social media. As exposures to wildfire smoke rise due to climate change, reducing the environmental disease burden requires health officials to leverage popular communication platforms, distribute necessary health-related messaging rapidly, and get the message right. Timely, evidence-based, and theory-driven messaging is critical for educating and empowering individuals to make informed decisions about protecting themselves from harmful exposures. Thus, proactive and sustained communications about wildfire smoke should be prioritized even during wildfire "off-seasons."

Exploring communication by public health leaders and organizations during the pandemic: a content analysis of COVID-related tweets

OBJECTIVES

Health communication is an essential competency in public health practice. The increasing use of social media and the connectivity between the general public and public health leaders present a unique opportunity to explore how digital communications tools were leveraged in the COVID-19 pandemic. This study explores Twitter-based communications from public health leaders and organizations across Canada and compares them with those from the World Health Organization (WHO). This research aimed to understand Twitter communications strategies to address the COVID-19 pandemic, other public health emergencies, and non-emergency public health issues.

METHODS

A content analysis of COVID-related Twitter content during the first wave of the pandemic (January 1-August 31, 2020) was performed. The Canadian Institute for Health Information (CIHI) Policy Intervention Scan was used as a framework to analyze messaging from public health leaders and the WHO.

RESULTS

Findings demonstrate that most tweets from public health leaders and organizations in Canada and the WHO focused on case management and public information. Gaps and areas of weakness identified include the lack of Twitter participation by some public health leaders and a narrow range of policy intervention topics, limiting the breadth and depth of public health messages.

CONCLUSION

Strengthening communications can serve to improve information sharing in future pandemics or public health crises. Further research should assess how public health leaders and organizations applied communication best practices on all social media platforms and across different policy interventions.

Public health agencies' use of social media for communication during pandemics: a scoping review of the literature

Public health agencies (PHAs) have increasingly incorporated social media into their communication mix during successive pandemics in the 21st century. However, the quality, timing, and accuracy of their health messages have varied significantly, resulting in mixed outcomes for communication, audience engagement, and pandemic management. This study aimed to identify factors influencing the effectiveness of pandemic-related health messages shared by PHAs on social media and to report their impact on public engagement as documented in the literature. A scoping literature review was conducted following a predefined protocol. An electronic search of 7 relevant databases and 5 grey literature repositories yielded 9,714 papers published between January 2003 and November 2022. Seventy-three papers were deemed eligible and selected for review. The results underscored the insufficiency of social media guidance policies for PHAs. Six themes were identified: message source, message topic, message style, message timing, content credibility and reliability, and message recipient profile. These themes encompassed 20 variables that could inform PHAs' social media public health communication during pandemics. Additionally, the findings revealed potential interconnectedness among the variables, and this study concluded by proposing a conceptual model that expands upon existing theoretical foundations for developing and evaluating pandemic-related health messaging.

Effects of Chinese provincial CDCs WeChat official account article features on user engagement during the COVID-19 pandemic

Background

WeChat has become a potent medium for disseminating public health information, especially during the coronavirus disease 2019 (COVID-19) pandemic. WeChat is important for public health organizations when considering users' information needs and preferences to further explore factors that affect user engagement.

Methods

We collected data from WeChat official accounts (WOAs) of the Chinese provincial Center for Disease Control and Prevention (CDC) to identify factors affecting and predicting the behavior of user engagement as measured by the level of reading and re-sharing during different phases of the COVID-19 pandemic between January 1, 2019, and December 31, 2020. We used multiple logistic regression analyses to identify features of articles with higher reading and re-sharing levels from 31 Chinese provincial CDCs. We developed a nomogram to predict the effect on user engagement.

Results

We collected a total of 26 302 articles. Release position, title type, article content, article type, communication skills, marketing elements, article length, and video length were key determinants of user engagement. Although the feature patterns also varied between different pandemic stages, the article content, release position, and article type were still the most prominent features driving user engagement. Regarding article content, the COVID-19 pandemic report and guidance for public protection were more likely to obtain high-level reading (normalization: odds ratio (OR) = 12.340, 95% confidence interval (CI) = 9.357-16.274) and re-sharing (normalization: OR = 7.254, 95% CI = 5.554-9.473) than other contents throughout the pandemic. When we compared release position with secondary push, users who used main push were more likely to exhibit high-level reading and re-sharing during any period, especially during normalization (OR = 6.169, 95% CI = 5.554-6.851; OR = 4.230, 95% CI = 3.833-4.669). For article type, a combination of text, links and pictures was associated with a higher rate of reading (normalization: OR = 4.262, 95% CI = 3.509-5.176) and re-sharing level (normalization: OR = 4.480, 95% CI = 3.635-5.522) compared to text only. Simultaneously, the prediction model showed good discriminatory power and calibration.

Conclusions

Discrepancies exist in article features between different pandemic stages. Public health agencies should make full use of official WOAs and consider the information needs and preferences of users in order to better carry out health education and health communication with the public when public health events occur.

Improving fire risk communication between authorities and micro-entrepreneurs: A mental models study of Ghanaian central market fires

This study conceptualizes how fire management authorities can empower nonexpert public to participate in fire risk communication processes and increase their own responsibilities for managing fire preventive, protective and recovery processes effectively. Drawing narratives from 10 disaster management experts working at government institutions and nine micro-entrepreneurs operating self-sustaining businesses in different merchandized lines in Ghana, we analyzed the data thematically and explored new insights on mental models to generate a two-way fire risk communication model. The findings suggest that fire management authorities planned fire disasters at the strategic level, collaborated with multiple stakeholders, disseminated information through many risk communication methods, and utilized their capabilities to manage fire at the various stages of fire risk communication, but the outcomes were poor. The micro-entrepreneurs sought to improve fire management outcomes through attitude change, law enforcement actions, strengthened security and better public trust building. The study has implications for policymakers, governments, and risk communication authorities of developing countries to strengthen their fire disaster policies to minimize commercial fire incidents and address the damaging effects of fire on people's livelihoods, businesses, properties, and environments. Our proposed two-way fire risk communication model is a new theoretical lens for experts and the nonexpert public to assess each other's beliefs about risk information and manage fire risk communication effectively at all stages.

Cyber violence caused by the disclosure of route information during the COVID-19 pandemic

Disclosure of patients' travel route information by government departments has been an effective and indispensable pandemic prevention and control measure during the COVID-19 pandemic. However, this measure may make patients susceptible to cyber violence (CV). We selected 13 real cases that occurred in China during the COVID-19 pandemic for analysis. We identified several characteristics that commonly appeared due to route information, such as rumors about and moral condemnation of patients, and determined that patients who are the first locally confirmed cases of a particular wave of the pandemic are more likely to be the victims of CV. We then analyzed and compared six real cases using data mining and network analysis approaches. We found that disclosing travel route information increases the risk of exposing patients to CV, especially those who violate infection prevention regulations. In terms of disseminating information, we found that mainstream media and influential we-media play an essential role. Based on the findings, we summarized the formation mechanism of route information disclosure-caused CV and proposed three practical suggestions-namely, promote the publicity of the media field with the help of mainstream media and influential we-media, optimize the route information collection and disclosure system, and ease public anxiety about the COVID-19 pandemic. To our knowledge, this study is one of the first to focus on CV on social media during the COVID-19 pandemic. We believe that our findings can help governments better carry out pandemic prevention and control measures on a global scale.

Use of equity-informed social media COVID-19 risk communication tools: a scoping review protocol

INTRODUCTION

Health agencies and community organisations play a crucial role in disseminating information to the public about COVID-19 risks and events, providing instructions on how to change behaviour to mitigate those risks, motivating compliance with health directives and addressing false information. Social media platforms are a critical tool in risk communication, providing a medium for rapid transmission of messages as well as providing the opportunity for engagement and immediate feedback. Access to health information, services and support are especially important for marginalised and underserved ('equity-deserving') populations who are disproportionately affected by COVID-19. This scoping review aims to review the breadth and depth of the academic and grey literature on equity-informed social media risk communication tools to provide guidance on promising practices and principles for reaching equity-deserving populations through social media.

METHODS AND ANALYSIS

Arksey and O'Malley's (2005) framework guided the identification of the research question; identification and selection of relevant studies from electronic databases and hand-searches of discipline-specific journals; extraction and charting of the data; and collating and reporting of findings. The results of the screening process will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis-Scoping Review guidelines.

FINDINGS

We will identify reported facilitators and barriers to the development of risk communications that target equity-deserving communities. We will also identify recommendations for equity-informed risk communication for COVID-19.

ETHICS AND DISSEMINATION

This study does not require ethics approval. We intend to disseminate the results through publication in an open-access peer-reviewed journal, conference presentations, lay summaries (eg, checklists) for health organisations and messages to be shared through social media.

Monitoring Misinformation on Twitter During Crisis Events: A Machine Learning Approach

Social media has been increasingly utilized to spread breaking news and risk communications during disasters of all magnitudes. Unfortunately, due to the unmoderated nature of social media platforms such as Twitter, rumors and misinformation are able to propagate widely. Given this, a surfeit of research has studied false rumor diffusion on Twitter, especially during natural disasters. Within this domain, studies have also focused on the misinformation control efforts from government organizations and other major agencies. A prodigious gap in research exists in studying the monitoring of misinformation on social media platforms in times of disasters and other crisis events. Such studies would offer organizations and agencies new tools and ideologies to monitor misinformation on platforms such as Twitter, and make informed decisions on whether or not to use their resources in order to debunk. In this work, we fill the research gap by developing a machine learning framework to predict the veracity of tweets that are spread during crisis events. The tweets are tracked based on the veracity of their content as either true, false, or neutral. We conduct four separate studies, and the results suggest that our framework is capable of tracking multiple cases of misinformation simultaneously, with F 1 $F_1$ scores exceeding 87%. In the case of tracking a single case of misinformation, our framework reaches an F 1 $F_1$ score of 83%. We collect and drive the algorithms with 15,952 misinformation-related tweets from the Boston Marathon bombing (2013), Manchester Arena bombing (2017), Hurricane Harvey (2017), Hurricane Irma (2017), and the Hawaii ballistic missile false alert (2018). This article provides novel insights on how to efficiently monitor misinformation that is spread during disasters.

Disaster Recovery Communication in the Digital Era: Social Media and the 2016 Southern Louisiana Flood

This study explores disaster recovery communication in the digital era. In particular, this study analyzes Twitter communication data corresponding to the 2016 Southern Louisiana flood recovery process and examines patterns and characteristics of long-term recovery communication. Based on network and sentiment analyses of the longitudinal Twitter data, the study identifies the dynamic changes in participants' numbers, dominant voices, and sentiments in social media communication during the long-term recovery process. From the additional content analysis of relevant news articles, in-depth contextual information is provided to support and supplement the findings. Findings show the weaning communication volume during the recovery phase, lacking local voices over the long-term recovery communication process, and prolonging negative sentiments over the recovery period. Based on the findings, the authors provide implications highlighting the need for investing in long-term recovery communication, better utilizing information from social media, and supporting local voices during disaster recovery.

Social Cohesion: Mitigating Societal Risk in Case Studies of Digital Media in Hurricanes Harvey, Irma, and Maria

Natural disasters affect thousands of communities every year, leaving behind human losses, billions of dollars in rebuilding efforts, and psychological affectation in survivors. How fast a community recovers from a disaster or even how well a community can mitigate risk from disasters depends on how resilient that community is. One main factor that influences communities' resilience is how a community comes together in times of need. Social cohesion is considered to be"the glue that holds society together, which can be better examined in a critical situation. There is no consensus on measuring social cohesion, but recent literature indicates that social media communications and communities play an essential role in today's disaster mitigation strategies.This research explores how to quantify social cohesion through social media outlets during disasters. The approach involves combining and implementing text processing techniques and graph network analysis to understand the relationships between nine different types of participants during hurricanes Harvey, Irma, and Maria. Visualizations are employed to illustrate these connections, their evolution before, during, and after disasters, and the degree of social cohesion throughout their timeline. The proposed measurement of social cohesion through social media networks presented in this work can provide future risk management and disaster mitigation policies. This social cohesion measure identifies the types of actors in a social network and how this network varies daily. Therefore, decisionmakers could use this measure to release strategic communication before, during, and after a disaster strikes, thus providing relevant information to people in need.

Platform Effects on Public Health Communication: A Comparative and National Study of Message Design and Audience Engagement Across Twitter and Facebook

BACKGROUND

Public health agencies widely adopt social media for health and risk communication. Moreover, different platforms have different affordances, which may impact the quality and nature of the messaging and how the public engages with the content. However, these platform effects are not often compared in studies of health and risk communication and not previously for the COVID-19 pandemic.

OBJECTIVE

This study measures the potential media effects of Twitter and Facebook on public health message design and engagement by comparing message elements and audience engagement in COVID-19-related posts by local, state, and federal public health agencies in the United States during the pandemic, to advance theories of public health messaging on social media and provide recommendations for tailored social media communication strategies.

METHODS

We retrieved all COVID-19-related posts from major US federal agencies related to health and infectious disease, all major state public health agencies, and selected local public health departments on Twitter and Facebook. A total of 100,785 posts related to COVID-19, from 179 different accounts of 96 agencies, were retrieved for the entire year of 2020. We adopted a framework of social media message elements to analyze the posts across Facebook and Twitter. For manual content analysis, we subsampled 1677 posts. We calculated the prevalence of various message elements across the platforms and assessed the statistical significance of differences. We also calculated and assessed the association between message elements with normalized measures of shares and likes for both Facebook and Twitter.

RESULTS

Distributions of message elements were largely similar across both sites. However, political figures (P<.001), experts (P=.01), and nonpolitical personalities (P=.01) were significantly more present on Facebook posts compared to Twitter. Infographics (P<.001), surveillance information (P<.001), and certain multimedia elements (eg, hyperlinks, P<.001) were more prevalent on Twitter. In general, Facebook posts received more (normalized) likes (0.19%) and (normalized) shares (0.22%) compared to Twitter likes (0.08%) and shares (0.05%). Elements with greater engagement on Facebook included expressives and collectives, whereas posts related to policy were more engaged with on Twitter. Science information (eg, scientific explanations) comprised 8.5% (73/851) of Facebook and 9.4% (78/826) of Twitter posts. Correctives of misinformation only appeared in 1.2% (11/851) of Facebook and 1.4% (12/826) of Twitter posts.

CONCLUSIONS

In general, we find a data and policy orientation for Twitter messages and users and a local and personal orientation for Facebook, although also many similarities across platforms. Message elements that impact engagement are similar across platforms but with some notable distinctions. This study provides novel evidence for differences in COVID-19 public health messaging across social media sites, advancing knowledge of public health communication on social media and recommendations for health and risk communication strategies on these online platforms.

The social amplification of risk framework: New perspectives

Several decades have elapsed since the introduction in 1988 of the social amplification of risk framework (SARF) by researchers from Clark University and Decision Research. SARF was offered as an umbrella under which social, psychological, and cultural theories of risk could be integrated and thereby supplement technical risk analyses. Some critics suggest that SARF cannot be tested thus, the framework is useful, at most, as a post hoc analysis of some kinds of risks. Others counter that predictability is not required for a framework to be useful and that SARF is an effective tool in organizing data related to public perceptions, values, and behaviors. It can also be used to design more effective risk communication and public engagement strategies. SARF also suggests how to conceptually view the dynamics of social media channels, despite the fact that SARF was developed before the explosion of global digital platforms. The papers in this special issue consider developments, refinements, critiques, contributions, extensions of the approach to new risk issues, as well as the findings and hypotheses that have grown out of what is now close to three decades of empirical research. This introductory paper provides background on SARF, presents a literature review since 2003, introduces the contributions to this issue, and highlights several areas for future research.

Public and Private Information Sharing under "New Normal" of COVID-19: Understanding the Roles of Habit and Outcome Expectation

Information sharing is critical in risk communication and management during the COVID-19 epidemic, and information sharing has been a part of individual prevention and particular lifestyles under the "New Normal" of COVID-19. Thus, the purpose of this study was to explore influencing factors and mechanisms in public and private information sharing intention among people under the regular risk situation. This study investigated an information sharing mechanism based on a cross-sectional design. We collected 780 valid responses through a sample database of an online questionnaire platform and utilized partial least squares structural equation modeling (PLS-SEM) to further analyze the data. To explore the difference caused by news frames, we divided respondents into two groups according to the news frame (action frame vs. reassurance frame) and proceeded with the multi-group analysis. The results showed that four types of outcome expectations (information seeking, emotion regulation, altruism and public engagement) and habit had impacts on public and private information sharing intention. Two paths influencing information sharing proposed in this study were supported. The results showed that outcome expectations were positively related to habit, which implies that the cognitive mechanism was positively relevant to the formation of habit. The results proved that habit played a mediating role between outcome expectations and information sharing. This research found that emotion regulation and public engagement outcome expectations only affected two types of information sharing intention mediated by habit. Regarding the role of the news frame, this study found no significant difference between the group exposed to action-framed news and the group exposed to reassurance-framed news. By exploring influencing factors and the mechanism of information sharing under the "New Normal", these findings contribute to understanding of information sharing and have implications on risk management. The proposed mechanism classifying public and private information sharing complements risk information flowing by considering online risk incubation.

Identifying features of source and message that influence the retweeting of health information on social media during the COVID-19 pandemic

Background

Social media has become an essential tool to implement risk communication, giving health information could gain more exposure by retweeting during the COVID-19 pandemic.

Methods

Content analysis was conducted to scrutinize the official (national and provincial) public health agencies’ Weibo posts (n = 4396) to identify features of information sources and message features (structure, style content). The Zero-Inflated Negative Binomial (ZINB) model was adopted to analyze the association between these features and the frequency of the retweeted messages.

Results

Results indicated that features of source and health information, such as structure, style, and content, were correlated to retweeting. The results of IRR further suggested that compared to provincial accounts, messages from national health authorities’ accounts gained more retweeting. Regarding the information features, messages with hashtags#, picture, video have been retweeted more often than messages without any of these features respectively, while messages with hyperlinks received fewer retweets than messages without hyperlinks. In terms of the information structure, messages with the sentiment (!) have been retweeted more frequently than messages without sentiment. Concerning content, messages containing severity, reassurance, efficacy, and action frame have been retweeted with higher frequency, while messages with uncertainty frames have been retweeted less often.

Conclusions

Health organizations and medical professionals should pay close attention to the features of health information sources, structures, style, and content to satisfy the public’s information needs and preferences to promote the public's health engagement. Designing suitable information systems and promoting health communication strategies during different pandemic stages may improve public awareness of the COVID-19, alleviate negative emotions, and promote preventive measures to curb the spread of the virus.

A content analysis of Canadian influencer crisis messages on Instagram and the public’s response during COVID-19

Successful mitigation of emerging infectious disease requires that the public adopt recommended behaviours, which is directly influenced by effective crisis communication. Social media has become an important communication channel during COVID-19 where official actors, influencers, and the public are co-creating crisis messages. Our research examined COVID-19-related crisis messages across Canadian influencer accounts within news media, politicians, public health and government, science communicators, and brand influencer and celebrities, posted on Instagram between December 2019 and March 2021 for Health Belief Model and Extended Parallel Processing Model constructs and the corresponding public comment sentiment and engagement. Thirty-three influencer accounts resulted in a total of 2,642 Instagram posts collected, along with 461,436 comments, which showed overall low use of constructs in both captions and images. Further, most posts used no combinations (n = 0 or 1 construct per post) of constructs in captions and images and very infrequently used captions that combined threat (severity and susceptibility) with cues to action and efficacy. Brand influencers and celebrities, politicians, and science communicators had above average post engagement while public health and government and news media had lower. Finally, most influencers saw the largest proportion of neutral sentiment comments. Crisis messages must be designed to include combinations of constructs that increase message acceptance and influence risk perception and efficacy to increase the adoption of recommended and mandated behaviours.

Evaluating the effectiveness of Internet-based communication for public health: a systematic review (Preprint)

Background

Communicating strategically is a key issue for health organizations. Over the past decade, health care communication via social media and websites has generated a great deal of studies examining different realities of communication strategies. However, when it comes to systematic reviews, there is fragmentary evidence on this type of communication.

Objective

The aim of this systematic review was to summarize the evidence on web institutional health communication for public health authorities to evaluate possible aim-specific key points based on these existing studies.

Methods

Guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, we conducted a comprehensive review across 2 electronic databases (PubMed and Web of Science) from January 1, 2011, to October 7, 2021, searching for studies investigating institutional health communication. In total, 2 independent researchers (AN and SS) reviewed the articles for inclusion, and the assessment of methodological quality was based on the Kmet appraisal checklist.

Results

A total of 78 articles were selected. Most studies (35/78, 45%) targeted health promotion and disease prevention, followed by crisis communication (24/78, 31%), general health (13/78, 17%), and misinformation correction and health promotion (6/78, 8%). Engagement and message framing were the most analyzed aspects. Few studies (14/78, 18%) focused on campaign effectiveness. Only 23% (18/78) of the studies had an experimental design. The Kmet evaluation was used to distinguish studies presenting a solid structure from lacking studies. In particular, considering the 0.75-point threshold, 36% (28/78) of the studies were excluded. Studies above this threshold were used to identify a series of aim-specific and medium-specific suggestions as the communication strategies used differed greatly.

Conclusions

Overall, the findings suggest that no single strategy works best in the case of web-based health care communication. The extreme variability of outcomes and the lack of a unitary measure for assessing the end points of a specific campaign or study lead us to reconsider the tools we use to evaluate the efficacy of web-based health communication.

The Spread of COVID-19 Crisis Communication by German Public Authorities and Experts on Twitter: Quantitative Content Analysis

BACKGROUND

The COVID-19 pandemic led to the necessity of immediate crisis communication by public health authorities. In Germany, as in many other countries, people choose social media, including Twitter, to obtain real-time information and understanding of the pandemic and its consequences. Next to authorities, experts such as virologists and science communicators were very prominent at the beginning of German Twitter COVID-19 crisis communication.

OBJECTIVE

The aim of this study was to detect similarities and differences between public authorities and individual experts in COVID-19 crisis communication on Twitter during the first year of the pandemic.

METHODS

Descriptive analysis and quantitative content analysis were carried out on 8251 original tweets posted from January 1, 2020, to January 15, 2021. COVID-19-related tweets of 21 authorities and 18 experts were categorized into structural, content, and style components. Negative binomial regressions were performed to evaluate tweet spread measured by the retweet and like counts of COVID-19-related tweets.

RESULTS

Descriptive statistics revealed that authorities and experts increasingly tweeted about COVID-19 over the period under study. Two experts and one authority were responsible for 70.26% (544,418/774,865) of all retweets, thus representing COVID-19 influencers. Altogether, COVID-19 tweets by experts reached a 7-fold higher rate of retweeting (t8,249=26.94, P<.001) and 13.9 times the like rate (t8,249=31.27, P<.001) compared with those of authorities. Tweets by authorities were much more designed than those by experts, with more structural and content components; for example, 91.99% (4997/5432) of tweets by authorities used hashtags in contrast to only 19.01% (536/2819) of experts' COVID-19 tweets. Multivariate analysis revealed that such structural elements reduce the spread of the tweets, and the incidence rate of retweets for authorities' tweets using hashtags was approximately 0.64 that of tweets without hashtags (Z=-6.92, P<.001). For experts, the effect of hashtags on retweets was insignificant (Z=1.56, P=.12).

CONCLUSIONS

Twitter data are a powerful information source and suitable for crisis communication in Germany. COVID-19 tweet activity mirrors the development of COVID-19 cases in Germany. Twitter users retweet and like communications regarding COVID-19 by experts more than those delivered by authorities. Tweets have higher coverage for both authorities and experts when they are plain and for authorities when they directly address people. For authorities, it appears that it was difficult to win recognition during COVID-19. For all stakeholders studied, the association between number of followers and number of retweets was highly significantly positive (authorities Z=28.74, P<.001; experts Z=25.99, P<.001). Updated standards might be required for successful crisis communication by authorities.

Six Cs of pandemic emergency management: A case study of Taiwan's initial response to the COVID-19 pandemic

A review of the disaster literature indicates that emergency responses to pandemics are often understudied; the current COVID-19 crisis provides an important opportunity to improve awareness and understanding about this and other contagious and disruptive diseases. With this in mind, this study examines Taiwan's response to COVID-19 because it was successful in spite of a high probability of contagion. The paper first explores the assertion that cognition, communication, collaboration, and control are vital for effective disaster response; it then indicates the need to consider two additional Cs: confidence (trust of government's competency) and coproduction (public participation in disaster transmission prevention). The paper also conducts a qualitative descriptive study of the Taiwan government's response timeline with examples of each of these concepts in action. To further illustrate the need for the two additional Cs, survey data illustrate how public confidence serves as a pivot between government's COVID-19 response and citizen coproduction in COVID-19 transmission prevention.

Has public health messaging during the COVID-19 pandemic reflected local risks to health?: A content analysis of tweeting practices across Canadian geographies

During the COVID-19 pandemic, public health agencies and decision-makers have used social media to disseminate information, encourage changes to behaviour and promote community supports and resources. Their communications have served to educate the public on risks and initiate the widespread adoption of public health measures to 'flatten the curve'. We conducted a content analysis of COVID-19 Tweets by Canadian public health accounts during the first 6 months of the pandemic to explore differences in Tweeting practices by geography and identify opportunities to improve risk communication. We found that Canadian public health accounts in particular geographic settings did not always apply best practices for health communication. Tweeting practices differed considerably between jurisdictions with varying burdens of COVID-19. Going forward, Tweets authored by public health accounts that promote behaviour change and community-building ought to be utilized whenever risks to health are high to reflect an increase in disease transmission requiring intervention. Our study highlights the need for public health communicators to deliver messaging that is relevant for the levels of risk that their audiences are encountering in a given geographic context.

Examining Tweet Content and Engagement of Canadian Public Health Agencies and Decision Makers During COVID-19: Mixed Methods Analysis

BACKGROUND

Effective communication during a health crisis can ease public concerns and promote the adoption of important risk-mitigating behaviors. Public health agencies and leaders have served as the primary communicators of information related to COVID-19, and a key part of their public outreach has taken place on social media platforms.

OBJECTIVE

This study examined the content and engagement of COVID-19 tweets authored by Canadian public health agencies and decision makers. We propose ways for public health accounts to adjust their tweeting practices during public health crises to improve risk communication and maximize engagement.

METHODS

We retrieved data from tweets by Canadian public health agencies and decision makers from January 1, 2020, to June 30, 2020. The Twitter accounts were categorized as belonging to either a public health agency, regional or local health department, provincial health authority, medical health officer, or minister of health. We analyzed trends in COVID-19 tweet engagement and conducted a content analysis on a stratified random sample of 485 tweets to examine the message functions and risk communication strategies used by each account type.

RESULTS

We analyzed 32,737 tweets authored by 118 Canadian public health Twitter accounts, of which 6982 tweets were related to COVID-19. Medical health officers authored the largest percentage of COVID-19-related tweets (n=1337, 35%) relative to their total number of tweets and averaged the highest number of retweets per COVID-19 tweet (112 retweets per tweet). Public health agencies had the highest frequency of daily tweets about COVID-19 throughout the study period. Compared to tweets containing media and user mentions, hashtags and URLs were used in tweets more frequently by all account types, appearing in 69% (n=4798 tweets) and 68% (n=4781 tweets) of COVID-19-related tweets, respectively. Tweets containing hashtags also received the highest average retweets (47 retweets per tweet). Our content analysis revealed that of the three tweet message functions analyzed (information, action, community), tweets providing information were the most commonly used across most account types, constituting 39% (n=181) of all tweets; however, tweets promoting actions from users received higher than average retweets (55 retweets per tweet). When examining tweets that received one or more retweet (n=359), the difference between mean retweets across the message functions was statistically significant (P<.001). The risk communication strategies that we examined were not widely used by any account type, appearing in only 262 out of 485 tweets. However, when these strategies were used, these tweets received more retweets compared to tweets that did not use any risk communication strategies (P<.001) (61 retweets versus 13 retweets on average).

CONCLUSIONS

Public health agencies and decision makers should examine what messaging best meets the needs of their Twitter audiences to maximize sharing of their communications. Public health accounts that do not currently employ risk communication strategies in their tweets may be missing an important opportunity to engage with users about the mitigation of health risks related to COVID-19.

Health information diffusion on Twitter: The content and design of WHO tweets matter

BACKGROUND

Micro-blogging services empower health institutions to quickly disseminate health information to many users. By analysing user data, infodemiology (i.e. improving public health using user contributed health related content) can be measured in terms of information diffusion.

OBJECTIVES

Tweets by the WHO were examined in order to identify tweet attributes that lead to a high information diffusion rate using Twitter data collected between November 2019 and January 2020.

METHODS

One thousand hundred and seventy-seven tweets were collected using Python's Tweepy library. Afterwards, k-means clustering and manual coding were used to classify tweets by theme, sentiment, length and count of emojis, pictures, videos and links. Resulting groups with different characteristics were analysed for significant differences using Mann-Whitney U- and Kruskal-Wallis H-tests.

RESULTS

The topic of the tweet, the included links, emojis and (one) picture as well as the tweet length significantly affected the tweets' diffusion, whereas sentiment and videos did not show any significant influence on the diffusion of tweets.

DISCUSSION

The findings of this study give insights on why specific health topics might generate less attention and do not showcase sufficient information diffusion.

CONCLUSION

The subject and appearance of a tweet influence its diffusion, making the design equally essential to the preparation of its content.

Cutting Through the Noise: Predictors of Successful Online Message Retransmission in the First 8 Months of the COVID-19 Pandemic

In this paper, we investigate how message construction, style, content, and the textual content of embedded images impacted message retransmission over the course of the first 8 months of the coronavirus disease 2019 (COVID-19) pandemic in the United States. We analyzed a census of public communications (n = 372,466) from 704 public health agencies, state and local emergency management agencies, and elected officials posted on Twitter between January 1 and August 31, 2020, measuring message retransmission via the number of retweets (ie, a message passed on by others), an important indicator of engagement and reach. To assess content, we extended a lexicon developed from the early months of the pandemic to identify key concepts within messages, employing it to analyze both the textual content of messages themselves as well as text included within embedded images (n = 233,877), which was extracted via optical character recognition. Finally, we modelled the message retransmission process using a negative binomial regression, which allowed us to quantify the extent to which particular message features amplify or suppress retransmission, net of controls related to timing and properties of the sending account. In addition to identifying other predictors of retransmission, we show that the impact of images is strongly driven by content, with textual information in messages and embedded images operating in similar ways. We offer potential recommendations for crafting and deploying social media messages that can “cut through the noise” of an infodemic.

#Ebola: Emergency Risk Messages on Social Media

Public health threats require effective communication. Evaluating effectiveness during a situation that requires emergency risk communication is difficult, however, because these events require an immediate response and collecting data may be secondary to more immediate needs. In this article, we draw on research analyzing the effectiveness of social media messages during times of imminent threat and research analyzing the emergency risk communication conceptual model in order to propose a method for evaluating emergency risk communication on social media. We demonstrate this method by evaluating 2,915 messages sent by local, state, and federal public health officials during the 2014 Ebola outbreak in the United States. The results provide empirical support for emergency risk communication and identify message strategies that have the potential to increase exposure to official communication on social media during future public health threats.

Exploring How Media Influence Preventive Behavior and Excessive Preventive Intention during the COVID-19 Pandemic in China

In the context of global fighting against the unexpected COVID-19 pandemic, how to promote the public implementation of preventive behavior is the top priority of pandemic prevention and control. This study aimed at probing how the media would affect the public’s preventive behavior and excessive preventive intention accordingly. Data were collected from 653 respondents in the Chinese mainland through online questionnaires and further analyzed by using partial least squares structural equation modeling (PLS-SEM). Taking risk perception, negative emotions, and subjective norms as mediators, this study explored the impact of mass media exposure and social networking services involvement on preventive behavior and excessive preventive intention. Based on differences in the severity of the pandemic, the samples were divided into the Wuhan group and other regions group for multi-group comparison. The results showed that mass media exposure had a significant positive impact on subjective norms; moreover, mass media exposure could significantly enhance preventive behavior through subjective norms, and social networking services involvement had a significant positive impact on negative emotions; meanwhile, social networking services involvement promoted excessive preventive intention through negative emotions.

How Adolescents Use Social Media to Cope with Feelings of Loneliness and Anxiety During COVID-19 Lockdown

Next to physical health problems and economic damage, the coronavirus disease 2019 (COVID-19) pandemic and associated lockdown measures taken by governments of many countries are expected to cause mental health problems. Especially for adolescents, who highly rely on social contacts with peers, the prolonged period of social isolation may have detrimental effects on their mental health. Based on the mood management theory, the current study examines if social media are beneficial for adolescents to cope with feelings of anxiety and loneliness during the quarantine. A survey study among 2,165 (Belgian) adolescents (13-19 years old) tested how feelings of anxiety and loneliness contributed to their happiness level, and whether different social media coping strategies (active, social relations, and humor) mediated these relations. Structural equation modeling revealed that feelings of loneliness had a higher negative impact on adolescents' happiness than feelings of anxiety. However, anxious participants indicated to use social media more often to actively seek for a manner to adapt to the current situation, and to a lesser extent as a way to keep in touch with friends and family. The indirect effect of anxiety on happiness through active coping was significantly positive. Participants who were feeling lonely were more inclined to use social media to cope with lacking social contact. However, this coping strategy was not significantly related to their happiness feelings. Humorous coping was positively related with feelings of happiness, but not influenced by loneliness or anxiety. To conclude, social media can be used as a constructive coping strategy for adolescents to deal with anxious feelings during the COVID-19 quarantine.

The First 60 Days: American Public Health Agencies' Social Media Strategies in the Emerging COVID-19 Pandemic

In this paper, we capture, identify, and describe the patterns of longitudinal risk communication from public health communicating agencies on Twitter during the first 60 days of the response to the novel coronavirus disease 2019 (COVID-19) pandemic. We collected 138,546 tweets from 696 targeted accounts from February 1 to March 31, 2020, employing term frequency-inverse document frequency to identify keyword hashtags that were distinctive on each day. Our team conducted inductive content analysis to identify emergent themes that characterize shifts in public health risk communication efforts. As a result, we found 7 distinct periods of communication in the first 60 days of the pandemic, each characterized by a differing emphasis on communicating information, individual and collection action, sustaining motivation, and setting social norms. We found that longitudinal risk communication in response to the COVID-19 pandemic shifted as secondary threats arose, while continuing to promote pro-social activities to reduce impact on vulnerable populations. Identifying patterns of risk communication longitudinally allows public health communicators to observe changes in topics and priorities. Observations from the first 60 days of the COVID-19 pandemic prefigures ongoing messaging needs for this event and for future disease outbreaks.

COVID-19: Retransmission of official communications in an emerging pandemic

As the most visible face of health expertise to the general public, health agencies have played a central role in alerting the public to the emerging COVID-19 threat, providing guidance for protective action, motivating compliance with health directives, and combating misinformation. Social media platforms such as Twitter have been a critical tool in this process, providing a communication channel that allows both rapid dissemination of messages to the public at large and individual-level engagement. Message dissemination and amplification is a necessary precursor to reaching audiences, both online and off, as well as inspiring action. Therefore, it is valuable for organizational risk communication to identify strategies and practices that may lead to increased message passing among online users. In this research, we examine message features shown in prior disasters to increase or decrease message retransmission under imminent threat conditions to develop models of official risk communicators' messages shared online from February 1, 2020-April 30, 2020. We develop a lexicon of keywords associated with risk communication about the pandemic response, then use automated coding to identify message content and message structural features. We conduct chi-square analyses and negative binomial regression modeling to identify the strategies used by official risk communicators that respectively increase and decrease message retransmission. Findings show systematic changes in message strategies over time and identify key features that affect message passing, both positively and negatively. These results have the potential to aid in message design strategies as the pandemic continues, or in similar future events.

Celebrity Cancer on Twitter: Mapping a Novel Opportunity for Cancer Prevention

Social media platforms have the potential to facilitate the dissemination of cancer prevention and control messages following celebrity cancer diagnoses. However, cancer communicators have yet to systematically leverage these naturally occurring interventions on social media as these events are difficult to identify as they are unfolding and little research has analyzed their effect on social media conversations. In this study, we add to the research by analyzing how a celebrity cancer announcement influenced Twitter conversations in terms of the volume of social media messages and the type of content. Over a 9-day period, during which actor Ben Stiller announced that he had been treated for prostate cancer, we collected 1.2 million Twitter messages about cancer. We conducted automated content analyses to identify how often common cancer sites (prostate, breast, colon, or lung) were discussed. Then, we used manual content analysis on a sample of messages to identify cancer continuum content (awareness, prevention, early detection, diagnosis, treatment, survivorship, and end of life). Chi-square analyses were implemented to evaluate changes in cancer site and cancer continuum content before and after the announcement. We found that messages related to prostate cancer increased significantly more than expected for 2 days following Stiller’s announcement. However, the number of cancer messages that described other cancer locations either did not increase or did not increase by the same magnitude. In terms of message content, results showed larger than expected increases in diagnosis messages. These results suggest opportunities to shape social media conversations following celebrity cancer announcements and increase prevention and early detection messages.