Local Health Departments Tweeting About Ebola: Characteristics and Messaging

Context: The first imported US Ebola hemorrhagic fever case during the 2014 West Africa Ebola outbreak triggered an increase in online activity through various social media platforms, including Twitter. Objectives: The purpose of our study was to examine characteristics of local health departments (LHDs) tweeting about Ebola, in addition to how and when LHDs were communicating Ebola-related messages. Design: All tweets sent by 287 LHDs known to be using Twitter were collected from September 3 to November 2, 2014. Twitter data were merged with the 2013 National Association of County & City Health Officials Profile study to assess LHD characteristics associated with sending Ebola-related tweets. To examine the content of Ebola tweets, we reviewed all such tweets and developed a codebook including 4 major message categories: information giving, news update, event promotion, and preparedness. A time line tracking the trends in Ebola tweets was created by aligning daily tweets with major Ebola news events posted on the Centers for Disease Control and Prevention Ebola Web site. Results: Approximately 60% (n = 174) of all LHDs using Twitter sent a total of 1648 Ebola-related tweets during the study period. Sending more tweets in general (odds ratio: 2.42; 95% confidence interval, 1.00-5.84) and employing at least 1 public information specialist (odds ratio: 2.61; 95% confidence interval, 1.14-5.95) significantly increased the odds that an LHD tweeted about Ebola. Of all the Ebola tweets collected, 78.6% were information giving, 22.5% were on preparedness, 20.8% were news updates, and 10.3% were event promotion tweets. A temporal analysis of Ebola tweets indicated 5 distinct waves, each corresponding with major Ebola news events. Conclusions: Twitter has become a communication tool frequently used by many LHDs to respond to novel outbreaks, but messaging strategies vary widely across LHDs. We recommend that LHDs increase tweet frequency during public health emergencies in order to ensure timely dissemination of critical information.

[1]  C Raina MacIntyre,et al.  Heightened Vulnerability, Reduced Oversight, and Ethical Breaches on the Internet in the West African Ebola Epidemic , 2015, The American journal of bioethics : AJOB.

[2]  Jenine K Harris,et al.  Social media adoption in local health departments nationwide. , 2013, American journal of public health.

[3]  E. Fee,et al.  The unfulfilled promise of public health: déjà vu all over again. , 2002, Health affairs.

[4]  Tilly Gurman,et al.  Reaching the Global Community During Disasters: Findings From a Content Analysis of the Organizational Use of Twitter After the 2010 Haiti Earthquake , 2015, Journal of health communication.

[5]  Ed H. Chi,et al.  Want to be Retweeted? Large Scale Analytics on Factors Impacting Retweet in Twitter Network , 2010, 2010 IEEE Second International Conference on Social Computing.

[6]  Michael Marmot,et al.  The influence of income on health: views of an epidemiologist. , 2002, Health affairs.

[7]  Chris J. Vargo,et al.  Event versus Issue: Twitter Reflections of Major News, A Case Study , 2015 .

[8]  Rebecca A. Weldon.  An "Urban Legend" of Global Proportion: An Analysis of Nonfiction Accounts of the Ebola Virus , 2001, Journal of health communication.

[9]  M. McCombs.  Agenda setting function of mass media , 1977 .

[10]  Elia Gabarron,et al.  Ebola, Twitter, and misinformation: a dangerous combination? , 2014, BMJ : British Medical Journal.

[11]  D. Shaw,et al.  Agenda setting function of mass media , 1972 .

[12]  Jenine K. Harris,et al.  Are Public Health Organizations Tweeting to the Choir? Understanding Local Health Department Twitter Followership , 2014, Journal of medical Internet research.

[13]  Zion Tsz Ho Tse,et al.  Ebola and the social media , 2014, The Lancet.

[14]  Wayne Wanta,et al.  Agenda Setting and Issue Salience Online , 2002, Commun. Res..

[15]  Mowafa Said Househ,et al.  Communicating Ebola through social media and electronic news media outlets: A cross-sectional study , 2016, Health Informatics J..

[16]  Bechara Choucair,et al.  Tweeting for and Against Public Health Policy: Response to the Chicago Department of Public Health's Electronic Cigarette Twitter Campaign , 2014, Journal of medical Internet research.

[17]  Jenine K. Harris,et al.  Local Health Department Use of Twitter to Disseminate Diabetes Information, United States , 2013, Preventing chronic disease.

[18]  A. Rodríguez-Morales,et al.  What makes people talk about Ebola on social media? A retrospective analysis of Twitter use. , 2015, Travel medicine and infectious disease.

[19]  G. Eysenbach,et al.  Pandemics in the Age of Twitter: Content Analysis of Tweets during the 2009 H1N1 Outbreak , 2010, PloS one.

[20]  Irina Shklovski,et al.  Emergency Management, Twitter, and Social Media Evangelism , 2011, Int. J. Inf. Syst. Crisis Response Manag..

[21]  R. Ostfeld,et al.  Climate Change and Infectious Diseases: From Evidence to a Predictive Framework , 2013, Science.

[22]  John S. Williams,et al.  Critical Links: Population, Health, and the Environment , 2003 .

[23]  John Eldridge,et al.  The Social Amplification of Risk: Risk and relativity: BSE and the British media , 2003 .

[24]  Emilio Ferrara,et al.  Manipulation and Abuse on Social Media , 2015, ArXiv.