#hcsmSA – Analysing a Tweet chat during World Antibiotic Awareness Week
A Twitter chat took place on the 15th of November 2018 at 20:30 SAST | 13:30 EST | 18:30 BST | 20:30 CAT to discuss achieving the Antimicrobial Resistance Strategic Goals for Africa. The chat session was moderated on behalf of the South African Antibiotic Stewardship Programme (SAASP) by the Twitter handle @hcsmSA and participants used the geographic hashtag #hcsmSA so that tweets disseminated during the session were centralised in one thread for a transcript which we recorded on Symplur.
Background of hcsm and healthcare Tweet chats
hcsm is an acronym which is recognised in over 30 countries globally as Healthcare Communications and Social Media and represents the ethical and technical use of social media platforms to share information, debate health policy, promote healthy behaviours, engage with citizens as well as educate and interact with patients, caregivers, students and colleagues. Social media forms part of the web 2.0 landscape because it enables user-generated content, usability (ease of use, even by non-experts), a participatory culture and interoperability (i.e: a website can work well with other products, systems and devices) . Twitter is categorised as a microblogging web 2.0 platform which has established much of its popularity around an open source policy , which means that content can reach a much wider, global audience as well as be more accessible and affordable to analyse .
Tweet chats take place on the Twitter platform and can help to facilitate engagement in two-way communications between public health entities and their audience . A geographic Twitter community like #hcsmSA ensures tweets using the relevant hashtag are grouped by region, instead of only relying on geolocation enabled by a user on their device which at times may not be reliable . A hashtag, represented by the pound or sharp symbol (#) in the IT world is referred to as metadata, or in layman terms “data about data” and when used correctly next to a keyword or phrase, can help to structure big data (i.e. large data sets) which is often fragmented on the web . In past years, hashtags have gained most of their popularity on Twitter, however Linkedin and Facebook have also recently adopted a hashtag system in response to this global trend of conversation indexing and data refinement. When important public health debates take place such as during World Antibiotic Awareness Week, a Twitter chat provides a meaningful opportunity to bring diverse stakeholders together using a common hashtag in an open source environment so the impact can reach global proportions. Alternative social platforms using hashtags in comparison to Twitter with restrictive privacy policies don’t provide the same capability which is why hcsm professionals refer to Twitter as the Gold Standard for health.
To implement the Twitter chat, a blog was written on the hcsmSA.org website (Blog) which explained what Antimicrobial Resistance was in relation to Antibiotic Resistance. We themed the chat “Taking Action to Achieve the Antimicrobial Resistance Strategic Goals in Africa.” During the 60-minutes, questions were tweeted out by the moderator which appeared at the top of the blog. For this session, we modelled those questions around the Five Strategic Pillars as set out by the World Health Organisation in their AMR Global Action Plan (Document). A sixth question was proposed by one of our special panel experts from the Africa CDC being “How do citizens play a role towards tackling Antimicrobial Resistance?” which we felt was important to include. Because of the magnitude of the topic of AMR, we invited a large panel of guests made up of diverse professionals from South Africa, as well as in other regions of Africa and Globally. We invited thirty-one guests in total and managed to secure twenty-four, however wary of their changing schedules during this busy period didn’t expect they attend the complete session, if at all.
Guests that were able to attend included Dr Diane Ashiru from the Antibiotic Guardian Pledge Campaign which had recently been implemented in South Africa, Professor Adrian Brink, a Clinical Microbiologist and co-chair of the South African Antibiotic Stewardship Programme (SAASP), Dr Jay Varma, Senior Advisor to the Africa CDC at the African Union, Dr Dena van den Bergh, co-founder of the Best Care Always Campaign and a Wellcome Trust AMR Pioneer, Michelle Matsangaise, a student at SMU pharmacy, Dr Anna-Leena Lohiniva, a Cultural Anthropologist working alongside the World Health Organisation (WHO), Dr Esmita Charani, Senior Lead Pharmacist within the faculty of Medicine at Imperial College London at the NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance, Gladys Dube who participated on behalf of the Zulu community in South Africa as well as Dr Sarah-Jane Loveday, Dr Cecilia Ferreyra, Dr Cassandra Kelly-Cirino and Dr Heidi Albert from Find Diagnostics (FindDX) which is an international nonprofit organisation that enables the development and delivery of diagnostic tests for diseases of poverty in South Africa, Dr Niniola Soleye, Managing Director of the Dr Ameyo Stella Adadevoh (DRASA) Health Trust, an NGO in Nigeria focused on outbreak preparedness and health system strengthening and Estelle Onyekachi Mbadiwe, a Pharmacist with an MSc in Health Policy, Planning & Financing who has worked both between the UK and Nigeria and a Founding Partner of Ducit Blue Solutions. A complete list of panel experts can be accessed on the chat blog.
The purpose of coordinating a broad mix of panel experts is to First; Populate the transcript with opinions that are well-informed about a topic from various perspectives so the collection of data during the conversation is quality-driven. Second; The higher the number of experts that participate, the more widely the conversation spreads across the web because as each of them answer a question their followers have access to that in their newsfeed and in some instances reshare (i.e. Retweet) to their own followers creating a ripple effect which is referred to in the Analytics realm as Impressions .
Third; We open the sessions to the public and when several experts set a precedent, it can aid towards driving a constructive conversation. It can also provide credibility to encourage citizen participation as they feel their voices have a platform to be heard by the right authorities. Fourth; Content disseminated widely on Twitter during a public health awareness campaign should reflect a meaningful proportion of accurate insights from professionals in the field.
The chat session started with 5-minutes of introductions, then each question was prompted every 8-10 minutes by the @hcsmSA handle where participants were instructed to start each answer with the relevant T (Topic / Question) and Number. Community etiquette and instructions were distributed beforehand both in the blog and in a Tweet by the moderator shortly before the session (Community Etiquette). In some cases, panel experts were briefed through a Skype or telephone call. Experts were also encouraged to prepare answers beforehand so they were able to disseminate as many as possible between questions whilst feeling less intimidated by time constraints. This way, we could ensure their answers were also well thought out before sharing anything that might damage their reputation under a moment of pressure. Sessions can move quickly for new time users.
A data analysis of #hcsmSA using Symplur was taken between 15 November 2018, 19:30 SAST – 15 November 2018, 22:30. Although the Tweet chat took place from 20:30 – 21:30 SAST, we allowed one hour both between the start and end times of the session to ensure data was complete. According to Symplur 952 tweets were captured during a 24-hour period on the transcript, however, that translated into 750 during the chat.
The top influencer during the Tweet chat by mention was @inspired2leadQH, top influencer by tweet was @MimmieMatsanga and by impressions @_FaceSA. Each of these influencer metrics is measured according to the amount of data they generate in terms of interaction (i.e. Tweet, Mention or Impressions). This means that an influencer doesn’t necessarily need to answer questions, they can simply retweet others and if they have a vast following, the number of impression data is impacted. Often participants who are lurking, (i.e. Following the chat without participating), contribute to data in this way. Symplur measured 1, 475 Million Impressions, 750 Tweets and 42 Participants.
A transcript of the Twitter chat was recorded on Symplur which we extracted for the period of 15 November 2018, 19:30 SAST – 15 November 2018, 22:30 (Transcript). From the 750 Tweets captured during this two-hour period, we only highlighted 22 below, however, researchers, innovators and other policymakers are encouraged to visit the complete transcript to access more comprehensive data that might impact their work. Tweets were captured from both the invited panel experts and members of the public that joined in when they saw the session was taking place.
Questions were prompted as below:
T1: How might we improve awareness and understanding of Antimicrobial / Antibiotic Resistance?
T1: Awareness campaigns are crucial for both patients and healthcare providers – #hcsmSA
T1: When using technology, visual aids like video with narrations are useful to breaking health literacy barriers – #hcsmSA
T1: Making #AMR a core component of One-health professional education, training, certification, continuing education and development – #hcsmSA
T1: Some simple awareness strategies include continuous use of both social and traditional media, combined with grassroots community outreach. Celebrating WAAW in communities is important but the messaging must be ONGOING – #hcsmSA #WAAW18
T1: It has to be started by healthcare professionals by explaining in clear terms what are antibiotics and in which conditions they have to be used and then they have to respect it themselves – #hcsmSA
T1: If every health professional took a few minutes to talk about #AMR to their patients it would be so powerful – #hcsmSA
T1: Ukukhuluma #emphakathini elulwimini lwabo lwasekhaya usebenzisa izibonelo zokuphila kwangempela – #hcsmSA
T2: How might we strengthen surveillance and research?
T2: Surveillance starts with diagnosis. Doctors don’t offer it, patients don’t demand it, governments don’t enable it. We need to push demand for accurate, point of care diagnosis for all suspected infectious illness – #WAAW18 #hcsmSA
T2: Translate primary care or hospital-specific data to local empiric guidelines Surveillance also includes consumption – Improve antibiotic consumption metrics at individual prescriber level – #hcsmSA
T2: @inspired2leadQH @e_charani Currently using an App game called ‘Superbugs’ to reinforce fundamentals of abx conservation, a little bit of healthy competition and a prize helps incentivise! – #hcsmSA
T2: National surveillance programmes need to feed into global/regional ones – CF – #hcsmSA
T2: Agreed it should be open source and all research must be transparent. It’s the only way to ensure the maximum use of good surveillance and vigilance – #hcsmSA
T3: How might we reduce the incidence of infection?
T3: Educate!! Proper hand hygiene, sexual health education is a big thing with STIs. Educate on good hygiene in especially amongst risk groups i.e pre-schools, old age homes. Emphasis on immune-compromised populations – #hcsmSA
T3: By ensuring community based carers are taking up their responsibility in terms of infection prevention and control in the community – #hcsmSA
T4: How might we optimise Antimicrobial use in human, environment and animal health?
T4: We need to address prescribers, dispenser and patients simultaneously as behaviors are linked – #hcsmSA
T4: Patients should have a full record of all the antibiotics they have taken – it might be a wake-up call for many – #hcsmSA
T5: How might we improve investment for vaccines, diagnostics and other interventions that help reduce Antimicrobial / Antibiotic Resistance?
T5: Partner with private sector for investment in diagnostics and strengthen R&D locally – #hcsmSA
T5: With a focus on African countries, it’s probably time for national governments to take ownership of AMR, investing in diagnostic labs & research. Public-private partnerships have been beneficial in tackling a number of health problems, it might be a way to go – #hcsmSA
T6: How can citizens participate in the fight against Antimicrobial / Antibiotic Resistance?
T6: Citizens need to be empowered to educate themselves and demand #diagnostics to ensure they receive correct treatment – HA – #hcsmSA
T6: Only taking antibiotics that are prescribed for them; not self-medicating – #hcsmSA
T6: Bazifundise bese ulandela izincomo kanye nokwelashwa kwezifo – #hcsmSA
In addition to the above, datasets were extracted from Twitonomy using the hashtag #hcsmSA as a lead up to the chat from 05 November 2018, 15:20 SAST to 15 November 2018 21:57 SAST courtesy of Dr Graham Mackenzie (@gmascotland) which demonstrated a Tweet map of participants based on geolocation (Tweet Map) as well as the top related hashtags on Twitter during this period which were #WAAW18 (Official World Antibiotic Awareness Week hashtag as published by the WHO) , #AMR (Antimicrobial Resistance), #AntibioticResistance, #WAAW2018 (Global trending hashtag for World Antibiotic Awareness Week 2018 self-elected by the public) and #hcsm (Healthcare Communications and Social Media Global Twitter Community) (Twitonomy Report). Dr Mackenzie was further able to contribute datasets from NodeXL over a 20-hour, 26-minute period from Thursday, 15 November 2018 at 03:21 UTC to Thursday, 15 November 2018 at 23:47 UTC. (Node XL Report)
NodeXL data Confirmed that the top users were:
Top related hashtags to #hcsmSA were:
From our experience which has included inviting, coaching and networking with a multitude of medical professionals across diverse disciplines including Oncology, Infectious Disease, Pathology, Academics, Animal, Public and Private Health, as well as with patients, NPO’s and some innovative startups both locally and globally over the past five years in preparation of the #hcsmSA Tweet chats, many remain hesitant of participating on public domains like Twitter for various reasons including “fear of the unknown”, meaning they are not sure how to participate and what they can or cannot say. Some are also not certain why a hashtag is used during these sessions and when they participate are not visible in the chat session to others, nor is their data captured. Providing brief training beforehand has been a means to overcome that. When comparing the marketing costs of traditional media such as printing and radio, Twitter provides a valuable opportunity to create mass public health campaigns with a small budget. Tweet chats also open up the opportunity to engage with citizens and gather real-time data whilst doing so. Further to this, the ability to orchestrate 24 experts to one place so they can discuss such an important issue in the past meant costly conferences and flying in global experts. For LMICs who are budget constraint, such as South Africa, these online tactics should be made a priority. In the area of Antimicrobial Resistance even more so as the diversity of experts required to tackle it using a One Health approach means finding solutions will become even more complex. To date, Symplur has registered 1253 healthcare Tweet chat hashtags globally  yet the concept still remains unfamiliar to many professionals. Given the right understanding of how these Twitter tools can benefit health and their ability to collaborate on a global scale, we hope to see their level of participation improve for World Antibiotic Awareness Week in 2019.
Until then, continue supporting conversations about Antibiotic Resistance and the South African Antibiotic Stewardship Programme by including the hashtag #ProtectAntibioticsZA in your tweets and remember to take the Antibiotic Guardian Pledge (#AntibioticGuardian).