What the evidence shows about hospitals on social media
Healthcare organisations' use of social media has been measured: how many hospitals had adopted it and which kinds were likelier to, what consumers say it changes in their health decisions, what the largest hospitals and medical schools post, and which posts draw engagement.
Adoption across countries and hospital types
In general, hospitals in North America seemed further along than European ones in using the new channels. Around one in five American hospitals — 21% — used Facebook, Twitter or YouTube, with a similar figure in Canada. Of Germany's approximately 2,000 hospitals, almost 200 were on Facebook in 2011, about 10%. Data from 2010 suggested that hospitals in Sweden and Norway were very active on LinkedIn but significantly less so on channels such as Facebook, and LinkedIn usage was also high in hospitals in the Netherlands and the UK. A 2010 study found 40% of British NHS Primary Care Trusts using at least one social media channel.
Whether a hospital is able or willing to use social media depends on a range of factors. A 2011 study showed that US hospitals that were large, urban or part of a health system were statistically more likely to use social media, and also more likely to treat children or to be involved with graduate medical education.
A majority of US hospitals have at least some social media presence, and many universities and medical schools are leading voices on the platforms.
What consumers say social media changes
In a 2012 survey of 1,060 adults by PricewaterhouseCoopers' Health Research Institute, 40% said information gathered on social media would affect how they handled a chronic condition or their approach to diet and exercise, 42% used social media to find reviews of treatments and physicians, 45% said social media content would affect a decision to seek a second opinion, 25% had posted about their health experiences and 61% were likely to trust information posted by providers. In another study 57% of consumers said a social media presence would strongly influence their choice of provider and 81% read a robust presence as a sign of leading-edge technology.
Health-related social channels were gaining followers fast, and content sharing was rising. A Cleveland Clinic YouTube video on empathy in healthcare had more than 2.7 million views, the Centers for Disease Control and Prevention had more than 602,000 Facebook followers, and the National Institutes of Health listed dozens of social media properties on a dedicated web page. A 2012 Google/Compete study of consumers' online habits found that the number of people following YouTube to a hospital website rose 119% from 2011 to 2012, and that these people were more likely to book an appointment, find a doctor or provider location, or contact a hospital.
What the largest US hospitals and medical schools post
Hospitals and medical schools are new players in online health communication, having recently integrated social media into their communication strategies. A survey retrieved 257,250 posts from the top 10 US hospitals and 94,332 from the top 10 US medical schools on Facebook, Twitter and Instagram, from July 2009 to 15 September 2020, with their metadata, through the platforms' application programming interfaces. Both groups had steadily increased their activity over the decade. Collectively the hospitals had 10.7 million followers on the three platforms and the schools 3.4 million, and Twitter was the preferred platform for both, with about three times as many posts on average as Facebook or Instagram. Word clouds of the 2019 posts showed hospitals communicating mainly about patients and health, cancer, research and treatments, and schools about similar topics together with students and research. From January 2020 the content shifted visibly to the novel coronavirus, COVID-19 and the pandemic.
Topic modelling with the latent Dirichlet allocation visualisation tool found distinct and partly overlapping themes. Hospital posts covered hospital matters and doctors and nurses, with clusters on cancer, research, sports and injuries, stress, lifestyle, exercise and nutrition. School posts covered education, research, disease risk and school announcements. Both kinds of institution had clusters of positive messaging, such as congratulations, acknowledgements and social interaction.
What draws engagement and whom it misses
On Twitter, engagement in likes and retweets varied with the kind of post and the words in it. Surveying reactions to all posts over ten years and to selected posts over the seven days after publication, the study found that overall, retweets and replies drew the least engagement. Of 65 terms common in the posts, those related to COVID-19 — coronavirus, virus, infect, mask, vaccine — predicted more likes and more retweets. Terms related to research and education, such as disease, cause, expert, insight, professor and student, and the word community also predicted higher engagement. So institutional strategies centred on public health issues, the community, and research and education may engage audiences more effectively in a health-centred information environment.
Informing and engaging every segment of the public on health issues has proved hard for social media. Barriers to the reach of online media are the underrepresentation of minorities in posts, the low engagement of adolescents and young adults, and the technological barriers that keep older adults from using digital technology effectively. To engage their audiences fully, platforms may need a mix of literary techniques, visual elements and the highlighting of specific content. Photos, videos and interactive graphics appear to increase engagement. In an analysis of diabetes-related Facebook pages, for example, imagery was a strong predictor of liking a post; imagery, information on the consequences of diabetes and positive identity, including beliefs about the illness and its symptoms, led to more sharing, while negative affect, social support and crowdsourcing predicted more commenting.