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European Journal of Physiotherapy
ISSN: 2167-9169 (Print) 2167-9177 (Online) Journal homepage: https://www.tandfonline.com/loi/iejp20
Global communication practices of
physiotherapists on Twitter
Mark Merolli, Maria-Louisa Busuttil, Charlotte Wåhlin & Ann Green
To cite this article: Mark Merolli, Maria-Louisa Busuttil, Charlotte Wåhlin & Ann Green (2018): Global communication practices of physiotherapists on Twitter, European Journal of Physiotherapy, DOI: 10.1080/21679169.2018.1464061
To link to this article: https://doi.org/10.1080/21679169.2018.1464061
© 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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Published online: 26 Apr 2018.
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ORIGINAL ARTICLE
Global communication practices of physiotherapists on Twitter
Mark Merollia,b , Maria-Louisa Busuttilc, Charlotte Wåhlind,e and Ann Greenf
a
School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia;bHealth and Biomedical Informatics Centre, The University of Melbourne, Melbourne, Australia;cConsumer Affairs and Civil Liberties, Ministry for Social Dialogue, Valletta, Malta; d
Occupational and Environmental Medicine Centre, County Council of €Osterg€otland and Link€oping University, Link€oping, Sweden;eUnit of Intervention and Implementation Research, Karolinska Institutet, Institute for Environmental Medicine, Stockholm, Sweden;fFaculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom of Great Britain and Northern Ireland
ABSTRACT
Background: Social media have offered professional communities the opportunity to be digitally con-nected. The hashtag #GlobalPT was conceived and promoted from 2015 and has acted as a slogan for the globally connected physiotherapy community. This study explores the global reach and dominant communication themes that emerged during a set time frame that represented the single largest period of #GlobalPT activity.
Method: Using purposive sampling, 988 publically available tweets including the hashtag #GlobalPT were studied. Descriptive statistical analysis was conducted to quantify tweet data and qualitative, inductive phenomenological thematic content analysis to describe latent themes within the tweets. Results: #GlobalPT activity was noted across 24 countries (UK top represented) and four languages (929/988, 94.03% in English). Europe was the most active area (738/988, 74.70%), followed by Oceania (120/988, 12.15%). Thematic content analysis identified eight themes within the communication practi-ces of the physiotherapy community on Twitter. The three major themes were: sharing information (108/377, 28.65%), promotional activity (93/377, 24.67%) and positive feedback (69/377, 18.30%). Conclusion: The professional communication practices of physiotherapists on Twitter show a global spread of communication. The themes provide preliminary evidence for social media’s unique potential to assist the World Confederation for Physical Therapy strategic vision.
ARTICLE HISTORY
Received 1 February 2018 Revised 6 April 2018 Accepted 7 April 2018 Published online 26 April 2018
KEYWORDS
Physiotherapy; social media; twitter; professional networking; global; community
Introduction
Social media have come a long way in the last decade, with their application as tools for health increasingly noted in aca-demic literature [1–3]. The very principles underpinning these tools, such as: fostering active engagement, participation, collaboration and exchange of user-generated content, have re-engineered how individuals communicate and source information [4–6]. The social web has increased the speed, spread and availability of information and human capital. Hence, health professionals, consumers, patients, researchers, policy makers and various other stakeholders now have unprecedented access to information and support outside traditional channels and in real time [2,7]. Salient to this study, social media afford health professional communities of practice the opportunity to develop and mature [8–10]. Various professional bodies are realising the potential of social media, in particular platforms like Twitter. This is a medium well suited to disseminate information, globalise conferences and stimulate professional networking [11]. Examples of professional bodies in health realising the bene-fit of Twitter can be seen in the active online communities of urology and cardiology [6,12,13]. Published literature
cementing the development of allied health communities of practice using social media is still relatively immature. However, commentaries of physiotherapists’ professional use of social media are continuing to emerge [10,14].
The World Confederation for Physical Therapy (WCPT) gath-ers every 2 years for its international congress. Since 2015, the last two congress programmes have included a social media networking session. In 2015, members of the physiotherapy global community recognised the potential of social media to support its goals of supporting a digital network and more broadly the goals of WCPT [15]. Twitter was chosen as the pri-mary platform to drive communication beyond the congress based upon its reputation for fostering connections, network-ing and information dissemination at international level [11]. On 3 May 2015 during this networking session, the hashtag, #GlobalPT was conceived and since then, has acted as a signal for a globally connected physiotherapy community.
Since its inception, the GlobalPT hashtag has perpetuated, trended and become a badge of recognition amongst its users and serves as a useful case study. In conjunction with the inception of this online professional network, the WCPT also released its strategic plan towards 2021, presenting short- term, middle and long-term outcomes, which the
CONTACTMark Merolli mmerolli@swin.edu.au School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia Supplementary data for this article can be accessedhere.
ß 2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
confederation hopes to achieve in the physiotherapy arena [15]. In the strategic plan, the five outcomes include a physiotherapy community that; (1) is connected globally, (2) has significant influence on healthcare policy and health practice, (3) promotes value of physiotherapy, (4) shares its knowledge and (5) is well-suited to its overarching purpose. To outline that of particular focus over the short to medium-term actions, is outcome 1, ‘Global Community of Connected [Physiotherapists]’ [15]. A‘connected’ community is the opera-tive word, with networking through Twitter and #GlobalPT lending themselves directly to supporting this goal. Hence, examining the underpinnings of intra-professional network-ing through social media, such as Twitter through #GlobalPT may provide useful lessons for using social media in physio-therapy to create intra-professional networks.
An overarching goal of this research is that the global physiotherapy community better understands how social media can be used as a tool for discussion of professional issues, while also supporting the outcomes of the WCPT stra-tegic plan [15]. Hence, this case study aims to investigate the spread, influence and communication practices from one hashtag, #GlobalPT, during conferences and beyond that time. Primary objectives are to examine the relative success of Twitter in driving communication, while also exploring themes underlying this practice during a period that the WCPT strategic plan was developed.
Method
The study takes a qualitative approach to explore the con-tent of communication themes in an attempt to understand the contribution of social media, Twitter in this case, to this particular community of practice and the WCPT strategic plan. Also, to describe the community in terms of activity, country/region, language and membership category.
Study design
The setting for this exploration was publically accessible tweets that have included #GlobalPT in the body. Healthcare hashtag analysis platform ‘Symplur’ (http://www.symplur. com/) was used to examine Twitter activity using #GlobalPT.
The next phase of the study was sourcing tweet data for analysis. Various Twitter data mining plugins exist through software proprietors. Several were contacted to obtain cost estimates to retrospectively source the full #GlobalPT data set. It was affirmed that estimates for overall tweet volume for #GlobalPT were too low and dispersed (approximately 11,000 tweets). Hence, it would be costly and not be feasible to mine the full data set.
Therefore, using purposive sampling, the study team retrospectively explored what WCPT-related events had taken place over the hashtag’s lifetime to examine what periods could have provided sufficient Twitter activity to analyse. Over the hashtag’s lifetime, October, 2015 showed a wide sustained peak that corresponded to three major concurrent physiotherapy events that took place at that time. This con-currence has not occurred since: (1) the Australian
Physiotherapy Association (APA) national conference, (2) Physiotherapy (Chartered Society of Physiotherapy – CSP) UK conference, and (3) Release of the WCPT draft strategic plan/ preliminary consultation [15].
Thus, for study validity, October 2015 was chosen as a data set to analyse in this study. Using Symplur, freely accessible PDF transcripts of #GlobalPT tweets were obtained from that period. These were converted into de-identified comma-separated value (CSV) files by a software engineer at the University of Melbourne for analysis.
The data set was a total of 988 publically available tweets from the period of October 1st to 31st October 2015 that included the hashtag #GlobalPT. Retweets were removed to avoid coding duplication, leaving a total of 398 original tweets for analysis. Each tweet remained linked to its creator with a unique identifier rather than the individual’s Twitter handle to maintain privacy and avoid interpretation bias. Secondly, the refined data set was swept for relevance and accuracy. Tweets containing no content other than the hash-tag (2/398), as well as those with only a URL (19/398) were excluded from further coding. This left a final set of 377 tweets for thematic content analysis (TCA).
Data analysis
The study investigators independently explored the data set to develop the preliminary coding frame and at each phase, the reviewers acted independently. During Phase 1, data were coded with reference to the underlying communication theme latent within the tweet’s content (Figure 1). In Phase 2, the study’s chief investigator collated the preliminary list of themes. During Phase 2 (2b), themes were further refined grouping like similar themes together. A third review (2c) and conferral with the other members of the study team led to a final refinement of this list. In Phase 3, the investigators conferred and deliber-ated applying the refined coding schema to the tweets and to discuss any discrepancy in coding. In the final phase (Phase 4), the chief investigator reviewed the coding and finalised any discrepant coding (Supplementary Table S1).
Descriptive statistical analysis quantified aggregate data, as well as a detailed qualitative analysis to explore themes latent within the data set. Where geographic metadata was not available, location of the Tweeter was inferred from biograph-ical profile information and most recent tweets. Pertinent to this research was the examination of themes within the com-munication practices of this global physiotherapy community. To explore these themes, TCA was utilised, employing a grounded theory inductive phenomenological approach on the content of tweets to unveil any emergent themes.
Results
Descriptive statistics
For the full purposive data set of 988 tweets, n ¼ 294 individ-uals. Retweets accounted for 590/988 (59.72%) of activity. Only 174/988 (17.61%) of tweets originated from official accounts of physiotherapy Member Organisations (MOs), with most activity coming from an individual personal account
level (763/988, 77.23%). A modest amount of activity could be attributed to accounts belonging to the physiotherapy student community (51/988, 5.16%) suggesting students are also active within the global digital community.
Geographical spread of #global PT
Hashtag, #GlobalPT activity for October 2015 represented 24 countries, as well as a few multinational accounts (we refer to ‘multinational accounts’ as those representing entities that span more than one country) (Table 1). Four languages were identi-fied. English (929/988, 94.03%), followed by Spanish (33/988, 3.34%), Portuguese (19/988, 1.92%) and French (7/988, 0.71%).
The greatest activity was observed in the United Kingdom (579/988, 58.60%) and Australia (119/988, 12.04%). Breakdown according to geographic region was also tabu-lated. Regional mapping was performed according to the United Nations (UN) geographical compositions [16]. Based on geographic mapping for #GlobalPT, the following was observed: Europe (Denmark, France, Iceland, Ireland, Italy, Malta, the Netherlands, Spain, Sweden, UK) was the most active region (738/988, 74.70%), followed by Oceania (Australia, New Zealand) (120/988, 12.15%) (Figure 2).
Thematic content analysis
TCA of 377 tweets identified eight themes underpinning digital communication (Supplementary Table S1). Of these,
the three most frequent themes were: sharing information (108/377, 28.65%), promotional activity (93/377, 24.67%), and positive feedback (69/377, 18.30%) (Figure 3). Examples of tweets representative of each theme are provided, slightly paraphrased to maintain privacy.
Figure 1. Coding procedure.
Table 1. Geographic spread of #GlobalPT activity.
Nation Number of Tweets (%)
Australia 119/988 (12.04) Brazil 36/988 (3.64) Canada 5/988 (0.51) Denmark 1/988 (0.10) France 11/988 (1.11) Iceland 9/988 (0.91) India 1/988 (0.10) Ireland 36/988 (3.64) Italy 5/988 (0.51) Kenya 3/988 (0.30) Malta 16/988 (1.62) Netherlands 5/988 (0.51) Nigeria 1/988 (0.10) New Zealand 1/988 (0.10) Qatar 2/988 (0.20) Saudi Arabia 4/988 (0.40) Spain 42/988 (4.25) Sweden 34/988 (3.44) Thailand 2/988 (0.20) Turkey 4/988 (0.40) United Kingdom 579/988 (58.60) Uruguay 2/988 (0.20) USA 33/988 (3.34) Zimbabwe 1/988 (0.10)
Sharing information: Exchanges and research evidence
The ‘sharing information’ theme was the most prevalent activity amongst the global digital physiotherapy community and was observed in the top five most re-tweeted tweets. Of these, ‘sharing information’ accounted for three of the top five most retweeted #GlobalPT activity. Participants appeared to send out tweets when they felt that the information may be of value or interest to other members of the community. The theme centred on instances of participants giving others information about a variety of topics. For example, this may have been general information about conference material, clearing up queries, sharing statistics, quoting others, provi-sions about professional issues, or sharing research evidence (to name a few):
there is one [physiotherapist] to 360ppl. [resp. 69]
Also, often tweets appeared to draw attention to key mes-sages from WCPT leadership and other thought leaders in the profession:
#GlobalPT @xxxxxxx influencing global could impact locally. [resp. 24]
Promotion: Individuals, events, groups, opportunities and courses
Promotional themed tweets were also quite prevalent. As a theme category, promotion was one of the more encompass-ing themes. Early phases of the codencompass-ing process showed pro-motion coded under a variety of separate themes, eventually amalgamated into one overarching ‘promotion’ theme. Tweets of varying nature under the umbrella of promotion were abundant. Promotional activity ranged quite commonly from promoting professional development courses, such as:
have you registered yet xxxx?, register here. [resp. 1]
through to different resources, events, individuals, practice opportunities and special interest groups:
What could you do in Movember for Men’s Health? [resp. 219]
Positive feedback: Positivity and reinforcement
The positive feedback theme originally existed as two separ-ate themes of ‘positivity’ and ‘feedback’ (Supplementary Table S1). One key message that was apparent among the communication practices of PTs was the overwhelmingly positive message individuals were willing to share with each other. Examples include:
thanks for the inspirational sessions [resp. 60], xxxxxx what a star, hard work and dedication paid off. [resp. 228]
xxxxxx leading the way for students in WCPT. [resp. 202]
Participants were seen to praise others for inspirational materials or presentations, offer support for new ventures or endeavours and encourage individuals in their profes-sional pursuits.
Networking: People coming together and conversations
Perpetuation of the #GlobalPT movement was definitely seen in the growing number of conversations between individuals and groups. These ranged from more formal connections and arrangements to continue dialogue:
Me too! We’d like #GlobalPT community to join from abroad – one theme is joining in global PT. [resp. 77]
However, informal conversations and greetings often ensued, with the hashtag used in a relaxed and friendly tonality:
Good morning xxxx! Thanks for the message. [resp. 175]
Figure 2. GlobalPT activity by geographic region.
Figure 3. Themes identified in #GlobalPT activity. 4 M. MEROLLI ET AL.
Leadership: Taking charge and driving the profession
The leadership theme was a more niche identified theme. Tweets pertaining to leadership matters tended to relate more explicitly to the actions of the WCPT executive and/or a select number of individuals. Most tweets followed a similar structure. They tended to identify the individual at the centre of the message, and highlight their leadership qualities to the wider community. One example demonstrated this very well:
@xxxxxx emphasising the importance of engaging using #GlobalPT as a student, also early career professional. [resp. 114]
Similarly, quotations were often used to emphasise a key message from a leader in order to solidify their credentials in this space.
@xxxxxx indicates real leaders don’t create followers, they create leaders. [resp. 272]
Prompting discussion: Fostering active engagement
Prompting discussion largely centred on encouraging mem-bers of the global community to involve themselves in the wider physiotherapy community, not by passive engagement in #GlobalPT activity but to actively participate in influencing discussion. This theme was largely differentiated from the others in that the majority of interactions consisted of direct questions being posed or, crowd-sourcing of the #GlobalPT community to stimulate discussion. Certain tweets were good examples of this:
How can we use social media to target different groups? [resp. 183]
What does the future hold for the #GlobalPT community? [resp. 137]
Clinical practice: the hands-on side of physiotherapy
Clinical practice was evident in Twitter conversations, how-ever not in abundance. Key messages latent within the prac-tice theme largely focussed discussion on condition specific diagnostics and treatments. Low back pain (LBP) was the pri-mary focus of the limited clinical practice discussion.
Here’s some differential diagnosis ideas for LBP. [resp. 206]
Request information: Request for clarity
The least observed theme was requesting information. Unlike prompting discussion, which also had‘questions’ as its foun-dation,‘requesting information was seen more as an attempt by the individual to clarify a concept, or ask a direct question for pragmatic and logistical reasons.
can we assume discussions to be held in English? [resp. 33] need journal article by tomorrow.please help. [resp. 206]
Discussion
Principal findings
This study sheds light on digital communication practices of a physiotherapy community using an active example in #GlobalPT. Of the five strategic priorities set out by the WCPT, #GlobalPT most closely aligns to supporting outcome 1 (a global community of connected physiotherapists). Hence, the present study is not only grounded but has prac-tical implications in helping the WCPT achieve this priority [15]. The WCPT’s strategic plan will be revisited around 2021. Hence, the present study is timely and can partly serve as an objective measure for Outcome 1 in the short-term [15].
Descriptive findings
Several key lessons for the future perpetuation of digital health professional communities of practice can be postu-lated from the activity of #GlobalPT on Twitter:
i. Retweets dominate:
Retweets accounted for around 60% of observed activ-ity. This is not uncommon practice, as seen in other studies [17].
ii. People look to leaders:
The most re-tweeted content in this analysis were tweets of individuals in leadership positions with either the WCPT or MOs. This has lessons for driving profes-sional communities and the WCPT. Whereby, leaders play a vital role in the success of building digital com-munities [18].
iii. Digital networking is most active during major profes-sional events, like conferences.
As indicated, the analysis period corresponded to the APA and Physio (CSP) UK national conferences. Twitter activity at conferences has been the focus of previous research and suggests that at times of major events, professionals are likely to engage in information dissem-ination, and networking via social networks [6].
iv. Social media nurtures global networks of health profes-sionals:
Whether it be the immediacy of information spread, or asynchrony enabled through social media, this study observed tweet activity across every major geographical region based on the United Nations geographical com-positions [16] and is reported for similar health profes-sional communities. Similar widespread geographic use amongst health professionals has been reported, com-menting that Twitter for information dissemination, sci-ence communication sharing and networking [19–21].
Thematic content analysis
‘Sharing information’ was the most prevalent theme and tweets of a ‘promotional nature’ were also prevalent. While this can be useful, it is also advisable to be wary of Twitter and hashtags becoming a medium of over-zealous self-pro-motion [11,22] or, promotion of products, and events that
are not within the spirit of professional community building [23]. This raises further ethical queries for the use of social media, whereby promotional activity that is outside of the core values of the community can lead to mistrust and inter-fere with the goals of the community going forward [24,25].
There was less commentary for the theme of ‘clinical practice’. However, #GlobalPT has uniquely been a driver for professional issue conversation and may not be as readily identifiable or suitable for the perpetuation of clinical mat-ters. Recent commentary has indicated that social media as a medium will play an ever-increasing role in the future of clin-ical knowledge translation and intra-professional networking due to its ability to share and propagate research in engag-ing and digestible formats [26]. Now that social media has been accepted as a legitimate tool for health and clinical communication, its role in changing the way clinical know-ledge and research is transmitted in physiotherapy should not be underestimated and research is likely to continue to emerge in this area [26].
Study limitations
The analysed data set was only a small subset of all #GlobalPT communication, is limited to the hashtag and does not capture or represent all global physiotherapy com-munication. Thus, themes extracted are not fully representa-tive of the range of communication practices of the wider physiotherapy community and professional issues will have been communicated by physiotherapists on Twitter without the hashtag. Data came from a period of two major inter-national physiotherapy events (Australia and UK conference), and findings are skewed towards these regions.
This research is limited in its transferability across health professions. However, the authors believe that it is one of the few to examine intra-professional social media communi-cation practices in allied health. One study of Australian health professionals’ use of social media did include physio-therapists [27]. However, the focus was on use compared to non-use of social media, not communication practices.
It should also be noted that observational research into the social media usage behaviours of individuals is inherently biased towards a self-selecting population [28]. Findings are representative of a subset of the physiotherapy community who readily engage with social media for the purposes of professional networking and communication. In line with pre-vious research, the vast majority of allied health professionals still do not use social media for professional purposes. Based on the findings of the present study, the authors are optimis-tic that this paradigm may shift. It is duly acknowledged that findings for the communication practices and professional issues discussed by physiotherapists online are not necessar-ily a complete representation of professional issues across the profession.
Conclusions
Through Twitter, hashtags like #GlobalPT can support future development and perpetuation of global health professional
networks. If Twitter continues to be facilitated by global lead-ers and advocates within the profession, this research has potential and implications for helping to shape the leader-ship and engagement activities of the WCPT and its MOs going forward.
Acknowledgments
The authors duly acknowledge Tracy Bury and Emma Stokes of the WCPT for their expert consultation, and all Physiotherapist tweeting using #GlobalPT. We also graciously thank Bahadorezza Ofoghi of the Department of Computing and Information Systems, The University of Melbourne for his assistance with data extraction and expert consult-ation on analysis of Twitter data.
Disclosure statement
No potential conflict of interest was reported by the authors.
ORCID
Mark Merolli http://orcid.org/0000-0003-4273-1816 Charlotte Wåhlin http://orcid.org/0000-0002-4508-8304
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