This week’s review of research addressing communication and COVID-19 focuses on social media, with many studies focusing specifically on Twitter. Here is what we know:

Public’s Views of Social Media

Social media is widely used by nearly all segments of society. Because of this, researchers argue that this communication tool could be used more effectively by public health departments across the country. In this study, researchers found that there was 150% increase in people following state public health departments since the start of the pandemic, most significantly in the Midwest and South. Even with this increase, public health department followings remain low suggesting a significant opportunity for public health departments to improve their social media engagement.

In another study of social media engagement of public health agencies, researchers found that the agencies’ network position and two-way communication strategies greatly influenced public engagement with their Twitter COVID-19 content. Based on their findings, the authors encourage public health agencies to coordinate social media communication efforts to strategically position themselves in networks to have the opportunity to augment public engagement outcomes.

One strategy to improve the public’s perception of COVID-19 public health recommendations is to have emergency health care providers share personal narratives on Twitter. In this study, researchers found that physicians’ personal messages about their COVID-19 experiences on Twitter were most effective at communicating the intended message and affecting people’s attitudes, and were most likely to be shared. The authors conclude that emergency physicians sharing personal narratives on Twitter are more effective at communicating health recommendations than federal officials communicating impersonal guidance.

Effects of Social Media

With an increase in social media use, especially during the COVID-19 pandemic, researchers have acknowledged the increased risk of addictive social media use. In this study, they found that COVID-19 stress was positively associated with tendencies consistent with addictive social media use. As more people experience COVID-19 stress, they may use social media more, which then puts them at higher risk of additional stress if exposed to overwhelming and inaccurate information. The authors suggest intervening with high-risk populations to reduce addictive social media use.

Another study of social media use also found increased negative outcomes including emotional contagion among Twitter users who retweeted content that is stressful and anxiety inducing. People who share others’ negative emotional expression via social media are likely to be negatively affected. However, the researchers also found that social media may have a positive effect by buffering emotional exhaustion and promoting individuals’ reappraisal of the stressful COVID-19 situation. Still, they determined that the negative effects may outweigh any possible positive ones.

Using Social Media Effectively

The authors of this commentary offer suggestions for applying evidence-based risk communication strategies to social media. Particularly, they discuss focusing on hazard (e.g., number of people exposed, infected, and ill) and outrage (e.g., response to risk mitigation) as it relates to COVID-19. They argue that social media offers an opportunity to communicate these factors quickly. When using social media, they suggest the following risk communication strategies to address hazard and outrage (and provide examples of communication messages in their article):

• Plan carefully
• Accept the public as partners
• Be transparent and honest (acknowledge uncertainty)
• Speak with compassion
• Evaluate and reassess strategies

In a study of the process of retweeting communication from public health agencies or government officials on Twitter, researchers determined that people were more likely to retweet hyperlinks and images about actions to take, official responses, and virus surveillance. They offer the following advice for public health communicators and government officials:

• Provide practical, useful content
• Use media critically
• Determine if an image is really needed
• Recognize not all hashtags are universal
• Time message during the weekend to maximize impact
• Don’t narrow your audience
• Cultivate your network

If used effectively, social media can have a tremendous effect on communicating with patients during the COVID-19 pandemic. In the February 2021 issues of Nursing Standard, the author of an article discusses the potential for reaching more people and supporting difficult-to-reach groups with necessary information. The following tips are included to increase reach (and the article also provides specific suggestions for moderating a closed Facebook group for patients):

• Create a brand
• Use a variety of platforms
• Post pictures, videos, and animations
• Use data to target your approach
• Make content inclusive

Misinformation on Social Media

Social media has become the breeding ground for misinformation during the COVID-19 pandemic. In this study of content and authors of misinformation on Twitter, researchers determined that even verified Twitter handles from organizations and celebrities create and spread misinformation. False claims actually propagate faster than only partially false claims. To tackle this infodemic, the authors argue that scientific oversight and better understanding of crisis management by practitioners is needed.

Another study suggests that to persuade people to correct COVID-19 misinformation, one must increase people’s perceptions of the severity of the influence of the misinformation to invoke guilt. Using the frameworks of presumed influence model and cognitive appraisal theory, the authors provide guidance on how to develop corrective messages to encourage others to counter misinformation as well.

One area with the greatest amount of misinformation online is related to the anti-vaccination movement. Researchers of this study found that anti-vaccination supporters are likely to share conspiracy theories, use emotional language, and are highly engaged in online discussions. They also determined that before his Twitter account was suspended, Donald Trump was the main driver of vaccine misinformation. They argue for policies to deter the circulation of vaccine misinformation and offer suggestions for building engaged online communities to disseminate factual information.

With even more misinformation and disinformation circulating since the release of coronavirus vaccines, the rates of vaccine hesitancy has increased. To combat these growing problems, the authors of this article argue that we must empower citizens to recognize these falsehoods to make more informed decisions, and the best way to do that is through eHealth literacy skills. By promoting this type of media literacy, which the authors argue is just as fundamental as reading and writing, the detrimental effects of erroneous information on vaccination decision-making could be mitigated.