Use of Social Media in Health Care-Opportunities, Challenges, and Ethical Considerations: A Position Statement of the American Academy of Neurology

Development of a Medical Social Media Ethics Scale and Assessment of #IRad, #CardioTwitter, and #MedTwitter Posts: Mixed Methods Study

BACKGROUND

Social media posts by clinicians are not bound by the same rules as peer-reviewed publications, raising ethical concerns that have not been extensively characterized or quantified.

OBJECTIVE

We aim to develop a scale to assess ethical issues on medical social media (SoMe) and use it to determine the prevalence of these issues among posts with 3 different hashtags: #MedTwitter, #IRad, and #CardioTwitter.

METHODS

A scale was developed based on previous descriptions of professionalism and validated via semistructured cognitive interviewing with a sample of 11 clinicians and trainees, interrater agreement, and correlation of 100 posts. The final scale assessed social media posts in 6 domains. This was used to analyze 1500 Twitter posts, 500 each from the 3 hashtags. Analysis of posts was limited to original Twitter posts in English made by health care professionals in North America. The prevalence of potential issues was determined using descriptive statistics and compared across hashtags using the Fisher exact and χ2 tests with Yates correction.

RESULTS

The final scale was considered reflective of potential ethical issues of SoMe by participants. There was good interrater agreement (Cohen κ=0.620, P<.01) and moderate to strong positive interrater correlation (=0.602, P<.001). The 6 scale domains showed minimal to no interrelation (Cronbach α=0.206). Ethical concerns across all hashtags had a prevalence of 1.5% or less except the conflict of interest concerns on #IRad, which had a prevalence of 3.6% (n=18). Compared to #MedTwitter, posts with specialty-specific hashtags had more patient privacy and conflict of interest concerns.

CONCLUSIONS

The SoMe professionalism scale we developed reliably reflects potential ethical issues. Ethical issues on SoMe are rare but important and vary in prevalence across medical communities.

Education Research: The Development and Utilization of a Virtual Twitter Onboarding Curriculum for Neurologists, Trainees, and Students: A Prospective Study

Background and Objectives

Social media has increased in popularity among neurologists in the past few years without a parallel increase in training opportunities to learn how to use social media effectively. This study tests the feasibility of an asynchronous, virtual onboarding curriculum using Twitter as a tool for professional development for neurologists and neurology trainees.

Methods

Neurologists and neurology trainees were recruited virtually through email, Twitter, and a listserv of the American Academy of Neurology (Synapse). Participants were excluded if they had a professional Twitter account or lived outside the United States. Participants performed all study procedures virtually, including a baseline survey followed by three 30-minute modules: introduction to NeuroTwitter, peer learning, and academic scholarship on Twitter. A postmodule survey was completed to provide postprogram curriculum feedback. Newly created Twitter accounts were followed for 3 months to track Twitter engagement.

Results

Sixty-one participants were screened, and 50 were eligible to enroll. Forty-five (90%) participants completed a consent form and baseline survey. Twenty-seven participants completed all 3 modules, and 26 (52%) completed the postmodule survey. Participants indicated that there was a role for social media in neurology but had minimal to no training on how to use it effectively. Twitter knowledge postmodule completion increased by a median of 2 of 15 questions, with a range of -1 to +5. There were no technical barriers with a virtual-based curriculum, and participants were able to access the modules and surveys successfully. Ninety-six percent of participants would recommend the modules to colleagues. Thirty new Twitter accounts were created with an average of 33 followers, 59 following, 16 tweets, and 61 likes at 4 months.

Discussion

This study highlights the feasibility of virtual asynchronous content leading to an increase in Twitter knowledge among neurologists who completed our modules, though limited by a high dropout rate. Recruitment for virtual asynchronous modules was an effective approach to deliver informative and interactive content for neurologists. Further studies are needed to determine optimal content and length to promote long-term engagement with Twitter.

Social Media in Neuro-Ophthalmology: Paradigms, Opportunities, and Strategies

BACKGROUND

Social media (SoMe) is an integral part of life in the 21st century. Its potential for rapid dissemination and amplification of information offers opportunities for neuro-ophthalmologists to have an outsized voice to share expert-level knowledge with the public, other medical professionals, policymakers, and trainees. However, there are also potential pitfalls, because SoMe may spread incorrect or misleading information. Understanding and using SoMe enables neuro-ophthalmologists to influence and educate that would otherwise be limited by workforce shortages.

EVIDENCE ACQUISITION

A PubMed search for the terms "social media" AND "neuro-ophthalmology," "social media" AND "ophthalmology," and "social media" AND "neurology" was performed.

RESULTS

Seventy-two neurology articles, 70 ophthalmology articles, and 3 neuro-ophthalmology articles were analyzed. A large proportion of the articles were published in the last 3 years (2020, 2021, 2022). Most articles were analyses of SoMe content; other domains included engagement analysis such as Altmetric analysis, utilization survey, advisory opinion/commentary, literature review, and other. SoMe has been used in medicine to share and recruit for scientific research, medical education, advocacy, mentorship and medical professional networking, and branding, marketing, practice building, and influencing. The American Academy of Neurology, American Academy of Ophthalmology, and North American Neuro-Ophthalmology Society have developed guidelines on the use of SoMe.

CONCLUSIONS

Neuro-ophthalmologists may benefit greatly from harnessing SoMe for the purposes of academics, advocacy, networking, and marketing. Regularly creating appropriate professional SoMe content can enable the neuro-ophthalmologist to make a global impact.

The Use of Social Media by Clinical Nurse Specialists at a Tertiary Hospital: Mixed Methods Study

BACKGROUND

Recently, many health care professionals, who use social media to communicate with patients and colleagues, share information about medical research and promote public health campaigns.

OBJECTIVE

This study aimed to examine the motives, barriers, and implementation of social media use among clinical nurse specialists in Oman.

METHODS

A mixed methods study was conducted among 47 clinical nurse specialists at Sultan Qaboos University Hospital between November and December 2020. Qualitative data were collected using an open-ended questionnaire and analyzed using thematic analysis, and quantitative data were collected with a questionnaire and analyzed using SPSS (version 21.0; IBM Corp).

RESULTS

Of the 47 clinical nurse specialists surveyed, 43 (91.5%) responded. All respondents reported using social media applications, with WhatsApp being the most commonly used platform. Most respondents (n=18, 41.9%) spent 1-2 hours per day on social media. The main motives for using social media were increasing knowledge, communication, reaching patients easily, and reducing the number of hospital visits. The main barriers to social media use were privacy concerns, time constraints, and a lack of awareness of legal guidelines for social media use in the workplace. All participants requested clear rules and regulations regarding the use of social media among health care providers in the future.

CONCLUSIONS

Social media has the option to be a powerful institutional communication and health education tool for clinical nurse specialists in Oman. However, several obstacles must be addressed, including privacy concerns and the need for clear guidelines on social media use in the workplace. Our findings suggest that health care institutions and clinical nurse specialists must work together to overcome these impediments and leverage the benefits of social media for health care.Bottom of Form.

Protecting Privacy: Health Insurance Portability and Accountability Act of 1996, Twenty-First Century Cures Act, and Social Media

Advances in electronic health record technology, the ever-expanding use of social media, and cybersecurity sabotage threaten patient privacy and render physicians and health care organizations liable for violating federal and state laws. Violating a patient's privacy is both an ethical and legal breach with potentially serious legal and reputational consequences. Even an unintentional Health Insurance Portability and Accountability Act of 1996 (HIPAA) violation can result in financial penalties and reputational harm. Staying complaint with HIPAA requires vigilance on the part of both individuals with legitimate access to protected health information (PHI) and the organizations handling that PHI.

Use of Social Media in Stroke: A Systematic Review

Background

Stroke is a leading cause of death and disability globally. Over the last decade, digital health and related technology has emerged as a useful adjunct in the management of persons with stroke, particularly with the development of a large number of mobile phone applications dedicated to various aspects of stroke. However, whether social media can provide similar key support in stroke is an intriguing question. In this systematic review, we aimed to the scope and limits of social media platforms in care and research pertinent to persons with stroke.

Methods

PubMed database was searched using Medical Subject Headings terms and exploded keywords. The search retrieved 556 abstracts, which were screened by two reviewers. Of these, 14 studies met the review inclusion criteria. Given the small number of studies and heterogeneity of outcomes, quantitative analysis was not possible. The review was registered on PROSPERO (CRD42022324384).

Results

The social media platforms employed by the included studies comprised YouTube (n = 5), Twitter (n = 5), Facebook (n = 2), both Twitter and Facebook (n = 1), and WhatsApp (n = 1). Four assessed quality and accuracy of videos on YouTube available for stoke patients and caregivers. Three used social media to research link between role of gender and stroke descriptors on social media platforms, and one studied Twitter-derived racial/ethnic perceptual construction on the occurrence of cardiovascular disease. Three studies described use of social media by stroke survivors, in post-stroke care and engagement. 11 studies were assessed to be of "fair" quality and three were assessed to be of "poor" quality.

Conclusions

Limited preliminary data of low quality indicates that social media is used by persons with stroke and their caregivers, and may be harnessed as a tool of education and research. Future studies must address the current lack of high-quality evidence for the use of social media in stroke care.

Be in the Digital Room Where it Happens, Part I: Tweeting & Technology for Career Development

Social media has become a part of everyday life. It has changed the way we obtain and distribute information, connect, and interact with others. As the number of platforms and users grow, medical professionals have learned the value social media can have in education, research, advocacy, and clinical care initiatives. Platforms provide opportunities to network, build collaborations, and develop a reputation. This is part one of a two-part series. This article provides an overview on how social media can benefit professional career development for clinicians and researchers, as well as for advocacy to raise awareness against biases, disparities, and for patient benefit. We review challenges, limitations, and best practices for social media use by medical professionals with neurology-specific examples.