67: Social Media and Learning Opportunities
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The use of social media has progressed considerably over the past decade, with approximately 3.484 billion people worldwide engaging in at least one application in 2019.1,2 The use of social media applications such as Facebook, YouTube, Instagram, Twitter and TikTok has become an integral part of people’s lives, with many users dedicating several hours of their day to these various platforms.1 According to the National Cancer Institute (NCI), social media usage in the United States increased from approximately 27% to 86% between 2009 and 2019, reflecting a 59% increase in a ten year period.2 This rise has been particularly prominent in the younger adult population, 90% of whom with internet access are social media users.3 YouTube is the most commonly utilised platform, with approximately 73% of U.S adults reporting use.4 This is closely followed by Facebook (69%), Instagram (37%), Pinterest (28%), LinkedIn (27%), Snapchat (24%) and Twitter (22%). Individual social media platforms, their characteristics and potential uses in pediatric urology are outlined in Table 1. With an increased uptake of social media by young adults, the potential exists to deliver high quality health information and interventions to a cohort that may be hard-to-reach with conventional health promotion and disease prevention measures.3
Table 1 Social media platforms, their characteristics and potential uses in pediatric urology**
|Social Media Platform||Characteristics||Potential uses in pediatric urology|
|Quick, frequent messages with a 140 character limit, ‘Tweets’ may contain photos, videos, links or text||Quick educational points on pediatric urology topics. Links to reliable sources of information|
|Sharing of text, images, videos or links to ‘followers’. No limit on characters.||Patient awareness campaigns, short educational videos|
|YouTube||Video-sharing platform (no limit on length)||Educational videos (academic and patient-friendly)|
|Photo and short video sharing application||Short educational videos or photographs|
|TikTok||Short videos (maximum 60 seconds)||Short educational videos|
Since its inception, users have become increasingly reliant on social media for health information.5 Given their unique relationship with social media, many young adults resort to social media applications as their primary source of healthcare information, an issue which has only been amplified by the recent COVID-19 pandemic.6 While social media has become a powerful tool for patients to obtain information about medical conditions, share their own experiences and even communicate with healthcare professionals, there lies a great potential for the spread of misinformation.7,8 These applications allow pseudo-experts and influencers, often lacking any expertise on the topic, to create content and spread false information that has the potential to reach millions of users worldwide.9 While this ability has the potential to be used to the advantage of the healthcare professional by delivering reliable, accessible information to the public, it unfortunately catalyses the dissemination of misinformation when in the wrong hands.10 Despite the risks social media poses to the public from a healthcare perspective, the potential benefits are undeniable.
Conventional methods of healthcare communication, via the use of pamphlets or newsletters for example, are rapidly becoming obsolete.7 The incorporation of social media by hospitals has been shown to significantly increase patient use of hospital services, as well as having a positive impact on its public perception.11 Healthcare professionals now have the ability to share information, promote good health behaviours and engage with the public via the use of social media applications, providing much-needed accessible healthcare information to vast amounts of users.12,13 The distribution of credible information via these applications has already proved to result in observable behavioural changes, with research demonstrating a positive effect on weight loss, smoking cessation and physical activity in exposed patients.12,14 Recognising that many healthcare professionals have incorporated social media applications into their methods of communication with patients, several government bodies have developed and published guidelines on how to utilise these platforms correctly, efficiently and safely.15
The field of urology is one of the pioneering specialties to harness the opportunities provided by social media for the education and global exchange of information pertaining to urological disorders.16 While urology residents worldwide are optimistic about the potential social media holds for education, an element of doubt exists surrounding its correct and appropriate usage within a healthcare setting.16,17,18 Several guidelines have been developed to shed light on this confusion, and provide healthcare professionals with clear and safe recommendations to engage with social media responsibly.19
In 2014, the British Society of Urology International (BJUI) proposed ten recommendations for healthcare professionals to engage responsibly in social media.19 These recommendations were as follows:
- Always consider that your content will exist forever and be available to everyone.
- If you are posting as a doctor, you should identify yourself.
- State that your views are your own if your institutions are identifiable.
- Your digital profile and behaviour online must align with the standards of your profession.
- Avoid impropriety—always disclose potential conflicts of interest.
- Maintain a professional boundary between you and your patient.
- Do not post content in anger and always be respectful.
- Protect patient privacy and confidentiality at all times.
- Alert colleagues if you feel they have posted content which may be deemed inappropriate for a doctor.
- Always be truthful and strive for accuracy.
The European Association of Urology (EAU) soon followed suit, publishing guidelines initially in 2014 and updating them in 2018.18 Similarly to BJUI, the EAU devised ten practical guidelines on the appropriate use of social media. These guidelines were as follows:
- Understand how other users behave online before interacting on social networks.
- Establish and maintain a professional digital identity that is in line with your professional practice and goals.
- Never undermine your patients’ privacy or confidentiality.
- Avoid providing medical advice and maintain limits between yourself and patients.
- Assume that anything and everything you post is permanent.
- Use instant messaging services with care.
- Exercise professionalism.
- Beware of social media policies set by employers.
- Beware of how advertisement and self-promotion will be perceive by others.
- Use disease-specific ontology hashtags for structured online communication.
Of note, the EAU Guidelines Office (GO) Dissemination Committee (DC) has recently published its strategy to improve the visibility and dissemination of EAU guidelines in order to successfully implement them worldwide.20 The DC has been able to adapt to and engage with a wide range of audience using Twitter, Facebook and more recently Instagram as a medium, thus maximising its reach. The EAU GO is also in the process of developing podcasts, which will involve panel members presenting guideline recommendations and encouraging debate in a question-answer format.21 This will undoubtedly be an invaluable tool for busy clinicians, who will soon be able to listen to new recommendations on the go.
Finally, the American Urological Association (AUA) published a document with seven ‘best practices’, designed to provide guidance and advice to effectively utilise social media within urology.22 The guidelines were as follows:
- Be professional
- Protect confidentiality
- Allow for interaction
- Be courteous
- Exercise discretion
- Support AUA’s identity
- Be thoughtful
While social media continues to be an exciting, novel area of digital communication for clinicians, risks do exist and it is imperative that we understand the boundaries of professionalism to avoid problems. Adhering to guidelines, such as those described above, will undoubtedly assist healthcare professionals posting content on these platforms and avert any risk of disciplinary action for misconduct.19
Twitter, a social networking platform with 330 million users launched in 2006, allows users to post messages up to 280 characters known as ‘tweets’.18 Its use in medicine involves research, online journal clubs, online support for patients and discussions about clinical care.23,24,25 The use of Twitter in the field of urology is well documented.18 Wilkinson et al analysed the use of the application at a variety of urological conferences to enhance the social media experience.26 They found that over the course of eight separate urology conferences in 2013, 12,363 tweets were sent generating a total of over 14 million impressions. Almost ten years on, these numbers have undoubtedly multiplied, exponentially increasing global reach and international engagement. Similarly, many urological academic journals have taken to Twitter to promote and highlight significant journal articles to readers.27,28 Cardona-Grau et al aimed to evaluate the reach and academic influence these journals have in the realm of social media, by developing the Twitter impact factor (TIF).27 This tool incorporates the number of followers, tweets and retweets an individual journal has, to provide a score that serves as an alternative to the conventional journal impact factor (JIF). Thangasamy et al described their twelve month experience from the International Urology Journal Club, the first international journal club to be carried out on Twitter.29 The club involved the monthly discussion of a recently published article, drawing in 189 unique users from nineteen countries across six continents. The authors concluded that the use of social media in this context was a viable and sustainable alternative, allowing urology trainees and specialists from multiple centres worldwide the opportunity to come together and discuss papers of interest.
Facebook, a social media site launched in 2007, has been utilised in medicine and specifically the field of urology for many reasons, including the establishment of physician group networks, recruitment for clinical trials and dissemination of information for patient awareness campaigns.18 Borgmann et al performed a feasibility study to assess the efficacy of a professional campaign on cryptorchidism using Facebook advertisements.30 With an investment of €7,500, the campaign generated 2,511,923 impressions, 7,369 homepage sessions and 1,086 brochure downloads, demonstrating that social media sites such as Facebook are an effective platform for campaigns such as the above. Despite the potential Facebook offers to the field of urology, the platform has also been used to expose potentially unprofessional personal behaviour to the public.30 Koo et al analysed the Facebook accounts of 281 US urology residency graduates for unprofessional content.30 72% of graduates had publicly identifiable profiles and 13% had profiles containing explicitly unprofessional behaviour, including intoxication, uncensored profanity, unlawful behaviour or displaying confidential patient information. It is evident that a greater awareness of our online identities is essential, to avoid implications for education and professionalism competencies.
YouTube is well established in the field of urology for patient and physician education via the creation and publication of videos.18 In 2017, Siegel et al measured the usage rate of various social media resources within the prostate cancer (PCa) community and found 536 videos accounting for 43,866,634 views, 52,655 likes and 12,393 comments.31 These videos were primarily educational and supportive in nature, but also included personal experiences of patients with the disease. Screening, prostate-specific antigen (PSA) testing and robotic-assisted prostatectomy were among the topics discussed. The authors demonstrated that the utilisation of social media within the PCa community is high and that YouTube in particular was engaged with more than its counterparts (Facebook, Twitter and Instagram). Borgmann et al used YouTube to quantify public and academic interest in urology, hypothesising that a discrepancy would exist between public and academic interest for various urologic diseases and treatments.32 Their results demonstrated a high public interest in premature ejaculation, testicular cancer and erectile dysfunction, whereas the topic with the highest academic interest was prostate cancer, confirming their hypothesis which undoubtedly has implications for future research strategies, conference planning and patient information projects. With the spread of misinformation on the rise, Loeb et al aimed to characterise the quality of educational bladder cancer posts on the video-sharing platform.33 The authors reviewed the first 150 videos on ‘bladder cancer’ and assessed each one for elements of misinformation, revealing moderate to high levels in 21% of videos assessed. Using the validated DISCERN instrument, 67% of videos were shown to contain moderate to poor quality of information, with a high commercial bias exhibited in 17%. This study demonstrated that while there are several educational videos on bladder cancer of good quality, much of the content surrounding this topic on YouTube is of poor quality and presents a risk of exposure to misinformation. Selvi et al suggested several methods of overcoming this risk, including the provision of thorough, high quality information to patients at the time of diagnosis, as well as the recommendation by healthcare professionals of YouTube channels run by international or national health organisations such as the European Association of Urology (EAU).34
Instagram, a photo and video sharing application launched in 2010, is no exception to the dissemination of misinformation.35 Xu et al searched for posts using the hashtag #prostatecancer in 2020, examining a combination of video and image posts and assessing their quality using validated tools.35 While the presence of educational content on prostate cancer on Instagram had previously been established, the quality of information being shared had yet to be characterised.31 The study demonstrated that 90% of content examined was of low to moderate quality (DISCERN rating <4) and 40% contained moderate to high levels of misinformation. This is the first study assessing the quality of content surrounding a urological disorder, and highlights the importance of proceeding with caution when searching social media platforms like Instagram for health information.
TikTok is a social media application that allows its 1.1 billion users to create short videos that have the potential to reach millions of users worldwide.36 Whilst the majority of these videos are solely entertainment based, the platform is being increasingly utilised as a way to search for or provide medical information.37 TikTok has been shown to have a farther and more diverse reach than its follower-based counterparts such as Instagram or Twitter, allowing for the vast dissemination of information to users of all age groups and backgrounds.38 With up to 96% of parents admitting to using social media for health education, it is imperative to assess the quality of content being published on these applications to ensure the safety of patients.39 O’Sullivan et al assessed the authenticity of information on various common paediatric conditions by comparing video content with guidelines provided by the EAU.10 Conditions assessed included nocturnal enuresis, vesicoureteral reflux, hypospadias and testicular torsion. The authors found factual EAU-backed information in only 22.2% of videos analysed, with several videos advising therapies that could prove harmful to the user. This study demonstrated the potential for TikTok to be utilised as a resource for health information, however further regulatory measures are necessary to prevent the spread of misinformation to patients.
- Many young adults resort to social media applications as their primary source of healthcare information.
- Healthcare professionals now have the ability to share information, promote good health behaviours and engage with the public via the use of social media applications, providing much-needed accessible healthcare information to vast amounts of users.
- The field of urology is one of the pioneering specialties to harness the opportunities provided by social media for the education and global exchange of information pertaining to urological disorders
- Various guidelines, such as those described by the BJUI and EAU, have been developed to help healthcare professionals engage with social media responsibly and present themselves professionally while doing so.
- The increased uptake of social media education by healthcare professionals within the field of urology, in combination with the introduction of regulatory measures to prevent misinformation, will allow for the production of evidence-based content to educate patients about their conditions and potential treatment options.
Social media use has exponentially increased over the last decade, with many healthcare professionals now utilising the platforms for research purposes, online journal clubs, discussions about patient care and for providing the public with accessible, high quality information about their conditions and management options.1,2,23 Various guidelines, such as those described by the BJUI and EAU, have been developed to help healthcare professionals engage with social media responsibly and present themselves professionally while doing so.18,19,22 The use of social media platforms is well described within the field of urology, however there is evidently work to be done to improve content and combat the spread of misinformation.10 The increased uptake of social media education by healthcare professionals within the field of urology, in combination with the introduction of regulatory measures to prevent misinformation, will allow for the production of evidence-based content to educate patients about their conditions and potential treatment options.
- Karim F, Oyewande A, Abdalla LF, Chaudhry Ehsanullah R, Khan S. Social Media Use and Its Connection to Mental Health: A Systematic Review. Cureus 2020; 2 (6): 8627. DOI: 10.7759/cureus.8627.
- Chou W-YS, Gaysynsky A, Trivedi N, Vanderpool RC. Using Social Media for Health: National Data from HINTS 2019. Journal of Health Communication 2021; 26 (3): 184–193. DOI: 10.1080/10810730.2021.1903627.
- Villanti AC, Johnson AL, Ilakkuvan V, Jacobs MA, Graham AL, Rath JM. Social Media Use and Access to Digital Technology in US Young Adults in. 2016; 9 (6): 196. DOI: 10.2196/jmir.7303.
- Centre PR. Share of U.S. adults using social media, including Facebook, is mostly unchanged since 2018. 2019.
- Suarez-Lledo V, Alvarez-Galvez J. Prevalence of Health Misinformation on Social Media: Systematic Review. Journal of Medical Internet Research 2021; 23 (1): e17187. DOI: 10.2196/17187.
- Yeung AWK, Tosevska A, Klager E, Eibensteiner F, Tsagkaris C, Parvanov ED, et al.. Medical and Health-Related Misinformation on Social Media: Bibliometric Study of the Scientific Literature (Preprint). J Med Internet Res 2022; 4 (1): 28152. DOI: 10.2196/preprints.28152.
- Househ M, Borycki E, Kushniruk A. Empowering patients through social media: The benefits and challenges. Health Informatics Journal 2014; 20 (1): 50–58. DOI: 10.1177/1460458213476969.
- Hagg E, Dahinten VS, Currie LM. The emerging use of social media for health-related purposes in low and middle-income countries: A scoping review. International Journal of Medical Informatics 2018; 115: 92–105. DOI: 10.1016/j.ijmedinf.2018.04.010.
- Racovita M. Lost in translation. EMBO Reports 2013; 14 (8): 675–678. DOI: 10.1038/embor.2013.90.
- O’Sullivan NJ, Nason G, Manecksha RP, O’Kelly F. The unintentional spread of misinformation on ‘TikTok’; A paediatric urological perspective. Journal of Pediatric Urology 2022; 18 (3): 371–375. DOI: 10.1016/j.jpurol.2022.03.001.
- Thielst CB. Social Media: Ubiquitous Community and Patient Engagement. Frontiers of Health Services Management 2011; 28 (2): 3–14. DOI: 10.1097/01974520-201110000-00002.
- George DR, Rovniak LS, Kraschnewski JL. Dangers and Opportunities for Social Media in Medicine. Clinical Obstetrics &Amp; Gynecology 2013; 56 (3): 453–462. DOI: 10.1097/grf.0b013e318297dc38.
- Bernhardt JM, Alber J, Gold RS. A Social Media Primer for Professionals. Health Promotion Practice 2014; 15 (2): 168–172. DOI: 10.1177/1524839913517235.
- Househ M. Social Media and Mobile Technologies for Healthcare. Advances in Healthcare Information Systems and Administration 2013; 183: 244–248. DOI: 10.4018/978-1-4666-6150-9.
- Hennessy CM, Smith CF, Greener S, Ferns G. Social media guidelines: a review for health professionals and faculty members. The Clinical Teacher 2019; 16 (5): 442–447. DOI: 10.1111/tct.13033.
- Taylor J, Loeb S. Guideline of guidelines: social media in urology. BJU International 2020; 125 (3): 379–382. DOI: 10.1111/bju.14931.
- Nolazco JI. The Importance of Faith and Religion: The Resident’s Perspective. PsycEXTRA Dataset 2018; 5 (3): 295. DOI: 10.1037/e552512009-001.
- Borgmann H, Cooperberg M, Murphy D, Loeb S, N’Dow J, Ribal MJ, et al.. Online Professionalism–2018 Update of European Association of Urology (\@Uroweb) Recommendations on the Appropriate Use of Social Media. European Urology 2018; 74 (5): 644–650. DOI: https://doi.org/10.1016/j.eururo.2018.08.022.
- Murphy DG, Loeb S, Basto MY. Faculty Opinions recommendation of Engaging responsibly with social media: the BJUI guidelines. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature 2014; 14 (1): –11. DOI: 10.3410/f.718541544.793499055.
- Pradere B, Esperto F, Oort IM van, Bhatt NR, Czarniecki SW, Gurp M van, et al.. Dissemination of the European Association of Urology Guidelines Through Social Media: Strategy, Results, and Future Developments. European Urology Focus 2021. DOI: 10.1016/j.euf.2021.10.010.
- Bhatt NR, Pradere B, Teoh JY, Cucchiara V, Czarniecki SW, Esperto F, et al.. Navigating the Next Wave of Social Media: Future Plans to Boost Dissemination of the European Association of Urology Guidelines. European Urology 2022; 81 (1): 3–4. DOI: 10.1016/j.eururo.2021.10.002.
- AUA. Social Media Best Practices. . DOI: 10.1016/b978-0-08-102409-6.00004-3.
- Roberts MJ, Perera M, Lawrentschuk N, Romanic D, Papa N, Bolton D. Globalization of Continuing Professional Development by Journal Clubs via Microblogging: A Systematic Review. Journal of Medical Internet Research 2015; 17 (4): e103. DOI: 10.2196/jmir.4194.
- Corrigendum to: The use of Twitter to facilitate sharing of clinical expertise in urology. Journal of the American Medical Informatics Association 2018; 25 (5): 617–617. DOI: 10.1093/jamia/ocx108.
- Attai DJ, Cowher MS, Al-Hamadani M, Schoger JM, Staley AC, Landercasper J. Twitter Social Media is an Effective Tool for Breast Cancer Patient Education and Support: Patient-Reported Outcomes by Survey. Journal of Medical Internet Research 2015; 17 (7): e188. DOI: 10.2196/jmir.4721.
- Wilkinson SE, Basto MY, Perovic G, Lawrentschuk N, Murphy DG. The social media revolution is changing the conference experience: analytics and trends from eight international meetings. BJU International 2015; 115 (5): 839–846. DOI: 10.1111/bju.12910.
- Cardona-Grau D, Sorokin I, Leinwand G, Welliver C. Introducing the Twitter Impact Factor: An Objective Measure of Urology’s Academic Impact on Twitter. European Urology Focus 2016; 2 (4): 412–417. DOI: 10.1016/j.euf.2016.03.006.
- Nason GJ, O’Kelly F, Kelly ME, Phelan N, Manecksha RP, Lawrentschuk N, et al.. The emerging use of Twitter by urological journals. BJU International 2015; 115 (3): 486–490. DOI: 10.1111/bju.12840.
- Thangasamy IA, Leveridge M, Davies BJ, Finelli A, Stork B, Woo HH. International Urology Journal Club via Twitter: 12-Month Experience. European Urology 2014; 66 (1): 112–117. DOI: 10.1016/j.eururo.2014.01.034.
- Koo K, Ficko Z, Gormley EA. Unprofessional content on Facebook accounts of US urology residency graduates. BJU International 2017; 119 (6): 955–960. DOI: 10.1111/bju.13846.
- Struck JP, Siegel F, Kramer MW, Tsaur I, Heidenreich A, Haferkamp A, et al.. Substantial utilization of Facebook, Twitter, YouTube, and Instagram in the prostate cancer community. World Journal of Urology 2018; 36 (8): 1241–1246. DOI: 10.1007/s00345-018-2254-2.
- Salem J, Borgmann H, Baunacke M, Boehm K, Groeben C, Schmid M, et al.. Mapping the landscape of urology: A new media based cross-sectional analysis of public versus academic interest. European Urology Supplements 2018; 16 (3): e1432–e1433. DOI: 10.1016/s1569-9056(17)30874-6.
- Loeb S, Reines K, Abu-Salha Y, French W, Steinberg GD, Walter D, et al.. Quality of bladder cancer information on YouTube. European Urology Open Science 2021; 19 (1): e2007. DOI: 10.1016/s2666-1683(20)33950-1.
- Selvi I, Baydilli N. An analysis of misleading YouTube videos on urological conditions: what to do about the danger of spreading misinformation of the YouTube videos? World Journal of Urology 2022; 40 (3): 885–886. DOI: 10.1007/s00345-021-03623-7.
- Xu AJ, Myrie A, Taylor JI, Matulewicz R, Gao T, Pérez-Rosas V, et al.. Instagram and prostate cancer: using validated instruments to assess the quality of information on social media. Prostate Cancer and Prostatic Diseases 2021: 1–3. DOI: 10.1038/s41391-021-00473-7.
- Teoh JY-C, Cacciamani GE, Gomez Rivas J. Social media and misinformation in urology: what can be done? BJU International 2021; 128 (4): 397–397. DOI: 10.1111/bju.15517.
- Zheng DX, Ning AY, Levoska MA, Xiang L, Wong C, Scott JF. Acne and social media: A cross-sectional study of content quality on TikTok. Pediatric Dermatology 2021; 38 (1): 336–338. DOI: 10.1111/pde.14471.
- Ostrovsky AM, Chen JR. TikTok and Its Role in COVID-19 Information Propagation. Journal of Adolescent Health 2020; 67 (5): 730. DOI: 10.1016/j.jadohealth.2020.07.039.
- O’Kelly F, Nason GJ, Manecksha RP, Cascio S, Quinn FJ, Leonard M, et al.. The effect of social media (#SoMe) on journal impact factor and parental awareness in paediatric urology. Journal of Pediatric Urology 2017; 13 (5): 513.e1–513.e7. DOI: 10.1016/j.jpurol.2017.03.027.
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