The use of social media among health care professionals within an online postgraduate diabetes diploma course

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1 The use of social media among health care professionals within an online postgraduate diabetes diploma course A Lipp PhD, Principal Lecturer, Care Sciences, University of South Wales, UK RE Davis PhD, Head of Care Sciences, University of South Wales, UK R Peter MD, Consultant Diabetologist, Morriston Hospital, Swansea, UK JS Davies MD, Consultant Endocrinologist, University Hospital of Wales, Cardiff, UK Correspondence to: JS Davies, MD, Consultant Endocrinologist, University Hospital of Wales Medicine, Heath Park, Cardiff CF14 4XN, UK; daviesjs@cf.ac.uk Received: 13 June 2013 Accepted in revised form: 10 September 2013 Abstract Social media is a rapidly growing arena through which members of the health care community can communicate between themselves as well as inform and educate patients. We assessed the impact of certain types of social media (YouTube and Twitter) among a group of health care professionals (HCPs) studying for a diploma in diabetes with the University of South Wales. As part of a module of the diabetes diploma, HCPs were tasked with using social media (Twitter and YouTube) to communicate information on diabetes and metrics were assessed on its impact. In respect of Twitter accounts, interactivity was assessed through number of tweets users posted, the number of followers that each account attracted together with the number of people that the user followed. For YouTube videos, we collected data on the length of video, the number of views each received as well as likes or dislikes. We also asked all students to complete a voluntary questionnaire on their subjective feelings regarding their experience with social media. Of 89 subjects, 27 developed YouTube videos and 62 set up Twitter accounts (in the event of a subject using both Twitter and YouTube, only their YouTube data are used). Average video length was 7 minutes 10 seconds, with videos viewed from times up to August Sixty-two Twitter accounts were established with an average of 77 tweets, average of 34 followers and an average of 49 following. Thirteen (15%) HCPs responded to a feedback questionnaire, four having selected YouTube and nine, Twitter. Eight students expressed apprehension before embarking on the task but all expressed a sense of achievement and confidence in use of social media upon completion. Fifty (81%) HCPs stopped using Twitter within six months of completing the module, although Twitter activity continued among 12 (19%) HCPs. This study reveals a successful uptake and communication of a professional message to a wider audience through Twitter and YouTube among social media-naïve HCPs studying for a postgraduate diploma in diabetes. Despite initial apprehension, HCPs felt confident in using social media to convey the message with continuing use of social media beyond the confines of the course. Copyright 2014 John Wiley & Sons. Practical Diabetes 2014; 31(1): Key words social media; diabetes; medical education; diabetes diploma Introduction Social media is a collective term for the various platforms and applications that allow user-generated content to be created and shared. It includes social networks, chatrooms and blogs that have transformed internet users from passive recipients of information into active participants in the generation of content. Increasingly, these channels are being used by people seeking medical advice, or looking for fellow patients with whom to share their experiences of a chronic disease such as diabetes. Social media platforms are used by medical professionals, students and trainees but often for personal rather than professional use. 1 In 2012, Facebook emerged as the most-used social media network with an estimated 750 million unique users, 50% of whom log in every day to interact with community pages, groups and posts from personal networks of friends. 2 Twitter is a similar platform, allowing users to share ideas expressed in no more than 140 characters: those who contribute or tweet attract followers who can pass the information on by re-tweeting it to their own followers. Twitter was established in 2006, rapidly gaining worldwide popularity: by 2102, it had over 500 million registered users, generating 340 million tweets a day, and handling over 1.6 billion search queries a day. Twitter has 14 PRACTICAL DIABETES VOL. 31 NO. 1 COPYRIGHT 2014 JOHN WILEY & SONS

2 become an attractive medium, used by celebrities and politicians alike to promote their activities or ideas, and is increasingly popular among health care professionals with some celebrity doctors attracting in excess of one million followers. Another popular channel is YouTube, which provides a platform for users to upload their own video footage and to view that created by others. Established in 2005, YouTube has more than 800 million unique users each month, viewing more than 4 billion hours of video per month. 3 A search using the simple term health returns about 2.3 million results, with close to of these relating to diabetes. It is also clear that social media channels are gaining in acceptance by health care professionals as useful communication tools: between colleagues, between teacher and student, and between doctor and patient. In the US, 26% of all hospitals now participate in social media and 60% of doctors recently surveyed believe that social media improves the quality of care delivered to patients. 4 Furthermore, present-day students have grown up with considerable knowledge of multi-media. The communication modes they use are faster, more spontaneous and independent of place and time. Integration of Web 2.0 (user generated content) and social media is a modern form of self-determined learning. It stimulates reflection and actively involves the students in the construction of their knowledge. 5 With evident awareness and interest across multiple disciplines, further studies are needed to define training requirements, and discover what, if any, uses for social media will be appropriate in clinical training. 6 Our challenge was to consider how social media can be incorporated into medical education and, more specifically, how we could use such channels to communicate a health message so important in the management of chronic disease. Methods We assessed the use of social media among a group of health care professionals studying for a postgraduate diploma in diabetes. Participants Year of study No. of students Discipline Nurse 14 (33%) 9 (20%) Diabetes specialist nurse 5 (12%) 3 (7%) Diabetes educator 4 (9%) 1 (2%) Pharmacist 2 (5%) Podiatrist 4 (9%) 2 (4%) Dietitian 4 (9%) 6 (13%) General practitioner 10 (23%) 20 (43%) Retinal screener 4 (9%) Biokineticist 1 (2%) Country of origin UK 16 (37%) 23 (50%) Overseas 27 (63%) 23 (50%) Chosen social medium Twitter 34 (79%) 28 (61%) YouTube 9 (21%) 18 (39%) Table 1. Characteristics of participants in the study were tasked with either creating a YouTube video about an aspect of diabetes or a Twitter account and tweet about diabetes as part of a module. These channels were selected as it was felt that they catered better for the delivery of an online health care message. YouTube is a social media channel allowing the registered user to display their own video. Twitter is a social media site that enables the user to set up an account through registration and then post short messages or tweets, within 140 characters, to an audience of followers. Objective data on activity were collected over two years of intakes until the end of August Health care professionals activity on Twitter was measured by assessing the number of tweets posted, the number of followers and numbers following for the Twitter accounts. With regard to the YouTube video, duration of video was measured, and the impact assessed by number of views and the number of likes or dislikes. Subjective views of the health care professionals were assessed through the use of an online questionnaire which asked the users about their perceptions of using social media before and after completing the assignment, how useful they found it as a means of communicating with patients and/ or colleagues, and whether or not they had continued to use social media in a professional capacity since the end of the course. At the start of this project we also drew the subjects attention to the responsible use of social media by health care professionals, including avoiding any patient identifiable data. 7,8 Results The characteristics of the group of health care professionals are illustrated in Table 1. In total, 89 subjects undertook social media activity through the two annual modules undertaken in 2011 and Of the 43 subjects in 2010, none had previously used social media in a professional capacity. Nine (21%) developed YouTube videos and 34 (79%) Twitter accounts. With regard to the former, average video length was 6 minutes 90 seconds. The 34 Twitter accounts produced an average of 57 tweets, engaging 38 followers and following 48 other accounts (Figure 1). In the intake of 2011, the number of students developing YouTube videos was higher than in 2010, at 18 (39%) but Twitter remained a more popular choice, with 28 (61%) students opting for this medium. The YouTube clips were viewed 40 times, on average, while average PRACTICAL DIABETES VOL. 31 NO. 1 COPYRIGHT 2014 JOHN WILEY & SONS 15

3 video length was 8 minutes 20 seconds. Those who opted for Twitter accounts posted an average of 101 tweets, attracted an average of 29 followers, and followed an average of 50 Twitter users (Figure 1). Of the 62 Twitter users, 50 (81%) health care professionals stopped using Twitter within six months of completing the module, although Twitter activity continued with 12 (19%) health care professionals, many of whom used it for both academic and social purposes. Among the topics covered in YouTube videos were: several different aspects of diabetes and macrovascular complications; a one-to-one discussion on hypertension and cardiovascular disease; a to camera piece on the links between diabetes and erectile dysfunction; and, from an overseas student, a thoughtprovoking video on the burden of diabetes in South Africa, contrasting the levels of care available in the private and public sectors. The most popular YouTube video was entitled Vascular assessment of the lower limb and clinical diagnostics which had been viewed 1274 times by August Of those who elected to create a Twitter account, the most active user had tweeted 257 times with 74 followers and following 86 other accounts. The least active Twitter user only tweeted six times but had secured 28 followers and was following 81 Twitter users. Data for 2010 and 2011 students are shown in Figure 1. Although there was a higher number of tweets posted by students in 2011 compared with students in 2010, the number of accounts that they followed, and the number of followers they attracted, were broadly similar. In total, 13 (15%) health care professionals responded to an online questionnaire, four having selected YouTube and nine, Twitter (Figure 2). Eight students reported apprehension before embarking on the task but all expressed a sense of achievement and confidence in use of social media upon completion. Participants agreed that the assignment had changed their perception of social media, and that they could visualise how it would be useful to them in their own practice, Number Figure 1. Use of Twitter by health care professionals studying for a postgraduate diploma in diabetes in 2010 (n=34) and 2011 (n=28) Yes No No answer No. of tweets No. following No. of followers Number Figure 2. Response to feedback questionnaire on use of social media (n=13) although one student expressed concern that using social media to communicate with patients could lead to urgent medical information not being acted upon within an appropriate timeframe. Discussion The exponential growth in internet use and, specifically, the rise in the use of social media including Twitter, Facebook, YouTube and similar channels that enable users to generate their own content and share with a vast audience have prompted many health care professionals to utilise this media for education 4 as well as patient communication. 9 As the intent of our postgraduate qualification is to enhance clinical expertise and Helped communication with patients Helped communication with colleagues Gained in confidence improve patient care, we elected to incorporate social media within a postgraduate diabetes diploma and endeavour to assess its success. Despite the growing popularity of social media as a way of communicating with patients as well the health care community at large, it was somewhat surprising that none of our health care professionals had any prior experience of using social media in a professional capacity. Our study focused on the use of Twitter and YouTube. Individuals may have been using Facebook or other social media channels in a personal capacity, but not for professional purposes. This is reflected by the fact that, at the start of the study, many of the users felt initial apprehension about developing a 16 PRACTICAL DIABETES VOL. 31 NO. 1 COPYRIGHT 2014 JOHN WILEY & SONS

4 professional social media presence. The social media module was designed to challenge them to explore how these channels could be used to communicate both with the public and their colleagues. Setting this assignment encouraged students to overcome any misgivings they may have had and to demonstrate that they could successfully adopt social media as an additional way of communicating with patients on a wider scale than by conventional means. Although blogs and tweets are often used to speed up and enrich communication, health care professionals may not initially consider them as tools to improve communication with patients 10 as demonstrated by the subjects in this study. While online communication can never replace the face-to-face consultation, social media can enhance between-visit care and help people with chronic diseases to self-manage their condition. 10 It can help patients learn more about their condition, increase their participation in their care, give them more confidence to discuss their care with their health care providers and help them learn to make behavioural changes. This is particularly important with regard to the care of the patient with diabetes as it is estimated that patients with chronic disease may spend as little as 8 hours per year in actual contact with a health professional. 11 Thus, social media may prove to be a useful tool in supporting the care of patients with chronic disease. 12 Much has also been made regarding the appropriate use of social media by health care professionals. It is particularly important to be aware of the legal and ethical considerations, including potential breaches of patient confidentiality and blurring of professional boundaries by agreeing to friend patients on Facebook. 13 As such, we supported the ethical use of social media, drawing subjects attention to guidelines relating to such issues and also monitoring use. It was reassuring that we encountered no breaches of guidance throughout the study period suggesting that users, when made aware, respect such professional codes. Key points Social media is a rapidly evolving area in terms of communicating a health care message to a wider audience of patients and professionals Although there was initial apprehension, health professionals from a diverse background were able to adopt and effectively utilise social media platforms such as Twitter and YouTube to deliver health care messages Health professionals should consider using social media to complement patient care There is ample evidence of the extent to which members of the public are seeking out medical information through all online channels including social media, but among health care professionals it is debateable as to whether the information that is available online is trustworthy or valid. 14 The provision of information and advice from people with professional expertise and relevant clinical experience, such as the members of our study group, should be encouraged and social media are the ideal channels for dissemination of such information. Social media applications also offer the additional benefit of providing health care professionals with potentially effective methods of keeping up to date, and sharing medical knowledge with their peers in order to improve the quality of patient care. 14 Subjective data revealed that, despite apprehension, social medianaïve health care professionals quickly learned how to use social media to deliver a health care message. However, of the health care professionals who decided to use Twitter only around 20% continue to use it as a professional resource beyond the confines of the module. One limitation of this study was the application of metrics that determine the impact of online activity. Besides the metrics that we collected there is little else to assess one s online impact. The website, Klout, has been established to endeavour to do this and has been proposed as a useful way of assessing online impact in medicine. 15 We did not use Klout, as it requires the individual s registration across the social media channels nor is it able to assess the quality of material being posted. With the latter in mind and with no previous experience of tweeting or creating video content, some of the content could have been improved with closer attention to production values; nonetheless, the attempts demonstrated the subjects ability to communicate useful and accurate information about diabetes. Similarly, it is encouraging that some students have continued to use these media channels beyond the course requirements, gaining skills and experience in disseminating their clinical knowledge to a wider audience. In addition, we recognise that it is difficult to draw firm conclusions regarding the views of subjects participating in this study when only a minority answered the questionnaire. Although creating a potential bias, the observations are still of interest and do support the observation of a minority trend regarding the long-term use of Twitter. Conclusion With the rising use of social and mobile media in health care, the opportunities for promoting health, improving care and communicating with peers should not be overlooked. Our study reveals that, despite initial apprehension, social media-naïve health care professionals were successful in conveying a professional message through Twitter and YouTube. Furthermore, social media use continues in a substantial number of subjects beyond the confines of the study, suggesting appreciation for how social media may be used in inter-health professional communication as well as the care of the patient with chronic disease. Declaration of interests There are no conflicts of interest declared. References References are available in Practical Diabetes online at diabetes.com. PRACTICAL DIABETES VOL. 31 NO. 1 COPYRIGHT 2014 JOHN WILEY & SONS 17

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